title: Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations A trial in the Karelian Republic of oral rehydration and Lactobacillus GG for treatment of acute diarrhoea Probiotics in the treatment of acute rotavirus diarrhoea. A randomized, double-blind, controlled trial using two different probiotic preparations in Bolivian children Oral bacterial therapy reduces the duration of symptoms and of viral excretion in children with mild diarrhea. Lactobacillus paracasei Strain ST11 Has No Effect on Rotavirus but Ameliorates the Outcome of Nonrotavirus Diarrhea in Children From Bangladesh Viable versus inactivated lactobacillus strain GG in acute rotavirus diarrhoea. The effect of fermented yogurt on the prevention of diarrhea in a healthy adult population. Lactobacillus GG in the Prevention of Nosocomial Gastrointestinal and Respiratory Tract Infections Efficacy of Lactobacillus GG in prevention of nosocomial diarrhea in infants. Clinical evaluation of the addition of lyophilized, heat-killed Lactobacillus acidophilus LB to oral rehydration therapy in the treatment of acute diarrhea in children. Bacteriotherapy with Lactobacillus reuteri in rotavirus gastroenteritis. Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. Effect of probiotic Lactobacillus strains on acute diarrhea in a cohort of nonhospitalized children attending day-care centers Limitations of Probiotic Therapy in Acute, Severe Dehydrating Diarrhea Effect of probiotic Lactobacillus strains in children with atopic dermatitis. A human Lactobacillus strain (Lactobacillus casei sp strain GG) promotes recovery from acute diarrhea in children. Randomised controlled clinical trial of Lactobacillus sporogenes (Bacillus coagulans), used as probiotic in clinical practice, on acute watery diarrhoea in children. Use of VSL♯3 in the Treatment of Rotavirus Diarrhea in Children: Preliminary Results Lactobacillus GG promotes recovery from acute nonbloody diarrhea in Pakistan. Efficacy of Lactobacillus GG in Aboriginal Children With Acute Diarrhoeal Disease: A Randomised Clinical Trial Nitazoxanide vs. probiotics for the treatment of acute rotavirus diarrhea in children: a randomized, single-blind, controlled trial in Bolivian children. Lactobacillus GG in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centers: a randomized, double-blind, placebo-controlled trial. Randomized double blinded controlled trial to evaluate the efficacy and safety of Bifilac in patients with acute viral diarrhea
abstract: Objective To compare the efficacy of five probiotic preparations recommended to parents in the treatment of acute diarrhoea in children . Design R and omised controlled clinical trial in collaboration with family paediatricians over 12 months . Setting Primary care . Participants Children aged 3 - 36 months visiting a family paediatrician for acute diarrhoea . Intervention Children 's parents were r and omly assigned to receive written instructions to purchase a specific probiotic product : oral rehydration solution ( control group ) ; Lactobacillus rhamnosus strain GG ; Saccharomyces boulardii ; Bacillus clausii ; mix of L delbrueckii var bulgaricus , Streptococcus thermophilus , L acidophilus , and Bifidobacterium bifidum ; or Enterococcus faecium SF68 . Main outcome measures Primary outcomes were duration of diarrhoea and daily number and consistency of stools . Secondary outcomes were duration of vomiting and fever and rate of admission to hospital . Safety and tolerance were also recorded . Results 571 children were allocated to intervention .  Median duration of diarrhoea was significantly shorter ( P<0.001 ) in children who received L rhamnosus strain GG ( 78.5 hours ) and the mix of four bacterial strains ( 70.0 hours ) than in children who received oral rehydration solution alone ( 115.0 hours ) . One day after the first probiotic administration , the daily number of stools was significantly lower ( P<0.001 ) in children who received L rhamnosus strain GG and in those who received the probiotic mix than in the other groups . The remaining preparations did not affect primary outcomes . Secondary outcomes were similar in all groups . Conclusions Not all commercially available probiotic preparations are effective in children with acute diarrhoea . Paediatricians should choose bacterial preparations based on effectiveness data . Trial registration number Current Controlled Trials IS RCT N56067537 In a controlled trial in Petrozavodsk , Karelia , the effects of oral rehydration and Lactobacillus strain GG ( LGG ) on  recovery  from  acute diarrhoea ( 27 % rotavirus , 21 % bacterial aetiology ) were studied in 123 children aged between 1 and 36 months of age . On admission to hospital , the patients were first r and omized to receive either isotonic oral rehydration solution ( ORS ) with osmolality 311mosmol/l and sodium 90mmol/l ( WHO‐ORS ) , or a hypotonic ORS with osmolality 224mosmol/l and sodium 60mmol/l ( Light‐ORS ) , and thereafter r and omized to receive either 5 × 109 colony forming units of LGG or a matching placebo . The two ORS performed equally for acute rehydration , and oral rehydration with either ORS was associated with a shorter duration of diarrhoea than intravenous rehydration ( p= 0.036 ) . Patients receiving LGG had a significantly shorter duration of watery diarrhoea [ mean ( SD ) 2.7 ( 2.2 ) days ] than those receiving the placebo [ 3.7 ( 2.8 ) days , p= 0.03 ] . LGG significantly shortened the duration of rotavirus diarrhoea but not diarrhoea with confirmed bacterial aetiology Background Evidence suggests that probiotics reduce  rotavirus diarrhoea duration . Although there are several probiotic strains potentially useful , daily practice is often limited by the type and number of products locally available . In general , information about combined products is scarce . In this study we compare the effect of two probiotic products in the treatment of diarrhoea in children less than 2 years of age . Methods A R and omized double-blind controlled clinical trial in children hospitalized for acute rotavirus diarrhoea , in the Paediatric Centre Albina Patino , Cochabamba , Bolivia . Participants were children aged 1 - 23 months , who were r and omly assigned to receive one of three treatments : Oral rehydration therapy plus placebo ; Oral rehydration solution plus Saccharomyces boulardii ; or Oral rehydration solution plus a compound containing Lactobacillus acidophilus , Lactobacillus rhamnosus , Bifidobacterium longum and Saccharomyces boulardii . Sample size was 20 per group and the outcomes were duration of diarrhoea , of fever , of vomiting and of hospitalization . Results 64 cases finished the protocol . On admission , patients ' characteristics were similar . Median duration of diarrhoea ( p = 0.04 ) in children who received the single species product ( 58 hours ) was shorter than in controls ( 84.5 hrs ) . Comparing children that received the single probiotic product and controls showed shorter duration of fever ( 18 vs 67 hrs ) ( p = 0.0042 ) and the mixed probiotic of vomiting ( 0 vs 42.5 hrs ) ( p = 0.041 ) . There was no effect on duration of hospitalization ( p = 0.31 ) . When experimental groups were merged , statistical significance of changes increased ( total duration of diarrhoea , fever and vomiting P = 0.025 , P = 0.025 and P = 0.014 , respectively ) . Conclusions Both products decreased the duration of diarrhoea compared to oral rehydration solution alone . This decrease was significant only for the single species product which also decreased the duration of fever . With the multiple species product there was no vomiting subsequent to the initiation of treatment . The quantity of probiotic bacteria needed for optimum treatment of gastroenteritis remains to be determined , particularly when multiple species are included in the product . Trial Registration Clinical Trials ( NCT ) : BACKGROUND Oral administration of live Lactobacillus casei strain GG is associated with the reduction of duration of diarrhea in children admitted to the hospital because of diarrhea . The purpose s of this work were to investigate the clinical efficacy of oral administration of Lactobacillus in children with mild diarrhea who were observed as out patients , and to see whether Lactobacillus GG can reduce the duration of rotavirus excretion . METHODS Duration of diarrhea was recorded in 100 children seen by family pediatricians and r and omly assigned to receive oral rehydration or oral rehydration followed by the administration of lyophilized Lactobacillus casei , strain GG .  Rotavirus was looked for in the stools of all children and in those in whom results were positive , stools were examined again 6 days after the onset of diarrhea . RESULTS In 61 children results were positive for rotavirus and in 39 results were negative . Duration of diarrhea was reduced from 6 to 3 days in children receiving Lactobacillus GG , with a similar pattern in rotavirus-positive and -negative children . Six days after the onset of diarrhea , stools in only 4 out of 31 children that received Lactobacillus GG were positive for rotavirus compared with positive findings in 25 out of 30 control subjects . CONCLUSIONS Oral administration of Lactobacillus GG is effective in rotavirus-positive and rotavirus-negative ambulatory children with diarrhea . Furthermore , it reduces the duration of rotavirus excretion Background . Previous studies have shown that selected strains of lactobacilli that are administered orally result in a modest reduction of diarrhea duration . However , duration alone is not considered optimal for therapeutic evaluation of any agent in diarrhea . Objective . To examine the effect of a new probiotic , Lactobacillus paracasei strain ST11 ( ST11 ) , in acute childhood diarrhea by using evaluation criteria recommended by the World Health Organization . Methods . In a r and omized , double-blind , placebo-controlled clinical trial , 230 male infants and young children , 4 to 24 months of age , presenting with diarrhea of < 2 days ' duration were admitted to the metabolic research ward of the International Centre for Diarrheal Disease Research , Bangladesh , and fed 1010 colony-forming units of lyophilized ST11 or placebo daily for 5 days . Stool output and frequency , oral rehydration solution intake , and excretion of rotavirus were monitored daily . Results . No effect of ST11 treatment on severe rotavirus diarrhea was observed . However , the probiotic treatment did significantly reduce cumulative stool output ( 225 ± 218 vs 381 ± 240 mL/kg ) , stool frequency ( 27.9 ± 17 vs 42.5 ± 26 ) , and oral rehydration solution intake ( 180 ± 207 vs 331 ± 236 mL/kg ) in children with less-severe nonrotavirus diarrhea compared with those receiving placebo treatment . A significantly higher proportion of nonrotavirus children receiving ST11 had their diarrhea resolve within 6 days of therapy ( ST11 versus placebo : 76 % vs 49 % ) . Conclusions . ST11 has a clinical ly significant benefit in the management of children with nonrotavirus-induced diarrhea , but it is ineffective in those with rotavirus diarrhea The effect of viable or heat inactivated human Lactobacillus casei strain GG on rotavirus immune responses in patients with rotavirus diarrhoea was assessed . Rotavirus serum IgA enzyme immunoassay antibody responses were higher in infants treated with viable L casei strain GG than in those treated with inactivated L casei strain GG . There was a significant difference at convalescence with rotavirus specific IgA secreting cells found in 10/12 infants receiving viable but only 2/13 infants receiving inactivated L casei strain GG . The results indicate that viable L casei strain GG stimulate rotavirus specific IgA antibody responses , theoretically significant in the prevention of reinfections BACKGROUND Probiotic dairy products are increasingly gaining popularity . Although the role of probiotic bacteria in the prevention and treatment of pediatric and antibiotic associated diarrhea is fairly well established , their role in the prevention of adult infectious diarrhea has not been well investigated . METHODS Five hundred forty-one , young male military recruits were enrolled and r and omly assigned to receive a yogurt containing Lactobacillus casei ( n = 275 ) or a nonprobiotic yogurt ( n = 266 ) . The incidence and duration of diarrhea were documented and stool sample s examined for bacteria and parasites . RESULTS Five hundred and two participants were eligible for final analysis , 254 receiving probiotic yogurt and 248 in the control group . Seventy-one participants ( 14.14 % ) experienced diarrhea during the study period . The incidence of diarrhea in the probiotic group and the control group was 12.2 % and 16.1 % , respectively ( P = .207 ) . The mean duration of diarrhea was 3 + /- 1.95 days in the probiotic group and 2.6 + /- 1.08 days in the control group ( P = .276 ) . CONCLUSION Our study demonstrated a nonsignificant trend for reduction of the incidence of diarrhea among healthy young adults consuming yogurt containing Lactobacillus casei . Further study is needed to evaluate the role of probiotics in adults OBJECTIVE : The incidence of nosocomial infections , predominantly gastrointestinal and respiratory , in children in developed countries is high , ranging from 5 % to 44 % . There is no effective strategy for preventing these infections . The objective of our study was to investigate the role of Lactobacillus GG ( LGG ) in preventing nosocomial gastrointestinal and respiratory tract infections at a pediatric hospital . METHODS : We conducted a r and omized , double-blind , placebo-controlled trial of 742 hospitalized children . They were r and omly allocated to receive for their hospitalization LGG at a dose of 109 colony-forming units in 100 mL of a fermented milk product ( LGG group , n = 376 ) or placebo that was the same postpasteurized fermented milk product without LGG ( placebo group , n = 366 ) . RESULTS : In the LGG group , compared with the placebo group , we found a significantly reduced risk for gastrointestinal infections ( relative risk [ RR ] : 0.40 [ 95 % confidence interval ( CI ) : 0.25–0.70 ] ; number needed to treat : 15 [ 95 % CI : 9–34 ) ] , respiratory tract infections ( RR : 0.38 [ 95 % CI : 0.18–0.85 ] ; number needed to treat : 30 [ 95 % CI : 16–159 ] ) , vomiting episodes ( RR : 0.5 [ 95 % CI : 0.3–0.9 ] ) , diarrheal episodes ( RR : 0.24 [ 95 % CI : 0.10–0.50 ] ) , episodes of gastrointestinal infections that lasted > 2 days ( RR : 0.40 [ 95 % CI : 0.25–0.70 ] ) , and episodes of respiratory tract infections that lasted > 3 days ( RR : 0.4 [ 95 % CI : 0.2–0.9 ] ) . Groups did not differ in hospitalization duration ( P = .1 ) . CONCLUSIONS : LGG administration can be recommended as a valid measure for decreasing the risk for nosocomial gastrointestinal and respiratory tract infections in pediatric facilities OBJECTIVE Nosocomial diarrhea is a major problem in pediatric hospitals worldwide . We evaluated the efficacy of orally administered Lactobacillus GG ( LGG ) in the prevention of this disease in young children . STUDY DESIGN Eighty-one children aged 1 to 36 months who were hospitalized for reasons other than diarrhea were enrolled in a double-blind trial and r and omly assigned at admission to receive LGG ( n = 45 ) at a dose of 6 x 10(9 ) colony-forming units or a comparable placebo ( n = 36 ) twice daily orally for the duration of their hospital stay . RESULTS LGG reduced the risk of nosocomial diarrhea ( > or =3 loose or watery stools/24 h ) in comparison with placebo ( 6.7 % vs 33.3 % ; relative risk : 0.2 ; [ 95 % CI : 0.06 - 0.6 ] ; number needed to treat : 4 [ 95 % CI : 2 - 10 ] ) . The prevalence of rotavirus infection was similar in LGG and placebo groups ( 20 % vs 27.8 % , respectively ; relative risk : 0.72 ; 95 % CI : 0.33 - 1.56 ) . However , the use of LGG compared with placebo significantly reduced the risk of rotavirus gastroenteritis ( 1/45 [ 2.2 % ] vs 6/36 [ 16.7 % ] , respectively ; relative risk : 0.13 ; 95 % CI : 0.02 - 0.79 ; number needed to treat : 7 ; 95 % CI : 3 - 40 ) . CONCLUSIONS Prophylactic use of LGG significantly reduced the risk of nosocomial diarrhea in infants , particularly nosocomial rotavirus gastroenteritis BACKGROUND Addition of a medication to the World Health Organization protocol for treatment of acute diarrhea in children is controversial . In this trial , the clinical efficacy of a medication ( Lactéol Fort sachets ; Laboratoire du Lactéol du Docteur Boucard , Houdan France ) containing lyophilized heat-killed Lactobacillus acidophilus LB was assessed as an adjunct to oral rehydration therapy . METHODS Children aged 3 to 24 months with acute diarrhea and mild or moderate dehydration were enrolled in the study . Children received oral rehydration therapy for the first 4 hours . After this first rehydration phase , undiluted milk formula or breast milk was fed alternately with oral rehydration solution . Children were fed rice gruel as tolerated . They received either one sachet containing 10 billion of lyophilized heat-killed L. acidophilus LB or placebo at admission and at 12-hour intervals for five doses . RESULTS Seventy-three children ( 37 L. acidophilus LB , 36 placebo ) were enrolled , of whom 40 ( 17 L. acidophilus LB , 23 placebo ) received an antibiotic before inclusion . Rotavirus was identified in approximately 50 % of the children in each group . After 24 hours of treatment , the number of rotavirus-positive children with watery stools was significantly lower ( p = 0.012 ) in the L. acidophilus LB group . Mean duration of diarrhea was decreased ( p = 0.034 ) with L. acidophilus LB ( 43.4 hours ) versus placebo ( 57.0 hours ) . This decreased duration was particularly marked in children with no antibiotic therapy before inclusion ( 31.1 hours ) : 42.9 hours for the L. acidophilus LB group versus 74.0 hours for the placebo group ( p = 0.016 ) . CONCLUSIONS Addition of L. acidophilus LB to oral rehydration therapy was effective in the treatment of children with acute diarrhea by decreasing the duration of diarrhea BACKGROUND Certain lactic acid bacteria may accelerate recovery from acute diarrhea .  Lactobacillus reuteri is a commonly occurring Lactobacillus species with therapeutic potential in diarrhea . DESIGN Prospect i ve , r and omized , placebo-controlled trial in two hospitals . METHODS Children between 6 and 36 months of age admitted for rotavirus-associated diarrhea were r and omized into three groups to receive either 10(10 ) or 10(7 ) colony-forming units ( cfu ) of L. reuteri or a matching placebo once a day for up to 5 days . RESULTS The main effect of L. reuteri was on the duration of watery diarrhea . The mean ( + /-SD ) duration of watery diarrhea after initiation of treatment was 2.5 ( 1.5 ) days in the placebo group ( n = 25 ) vs. 1.9 ( 0.9 ) days in the small dosage ( n = 20 ) and 1.5 ( 1.1 ) days in the large dosage ( n = 21 ) L. reuteri recipients ( P = 0.01 ) . By the second day of treatment watery diarrhea persisted in 80 % of the placebo , 70 % of the small dosage and 48 % of the large dosage L. reuteri recipients ( P = 0.04 , large dosage vs. placebo ) . Stool cultures for lactobacilli confirmed that administration of L. reuteri result ed in good colonization of the GI tract . The mean ( + /-SD ) of total Lactobacillus count 2 days after treatment initiation was 2.8 ( 1.6 ) log 10 cfu/g in the placebo group , 4.5 ( 2.0 ) log 10 cfu/g in the small dosage L. reuteri group and 6.1 ( 1.2 ) log 10 cfu/g in the large dosage L. reuteri group ( P = 0.0004 ) . CONCLUSIONS L. reuteri effectively colonized the gastrointestinal tract after administration and significantly shortened the duration of watery diarrhea associated with rotavirus . There was a correlation between the dosage of L. reuteri and the clinical effect BACKGROUND The probiotic Lactobacillus GG is effective in promoting a more rapid recovery of acute , watery diarrhea in children with rotavirus enteritis . Very limited information is available , however , on the potential role of such agents in non-rotaviral diarrheal episodes . Furthermore , no evidence is available concerning the efficacy of Lactobacillus GG administered in the oral rehydration solution during oral rehydration therapy . A multicenter trial was conducted to evaluate the efficacy of Lactobacillus GG administered in the oral rehydration solution to patients with acute-onset diarrhea of all causes . METHODS Children 1 month to 3 years of age with acute-onset diarrhea were enrolled in a double-blind , placebo-controlled investigation . Patients were r and omly allocated to group A , receiving oral rehydration solution plus placebo , or group B , receiving the same preparation but with a live preparation of Lactobacillus GG ( at least 10(10 ) CFU/250 ml ) . After rehydration in the first 4 to 6 hours , patients were offered their usual feedings plus free access to the same solution until diarrhea stopped . RESULTS One hundred forty children were enrolled in group A , and 147 in group B. There were no differences at admission between the groups in age , sex , previous types of feeding , previous duration of diarrhea , use of antibiotics , weight , height , weight-height percentile , prevalence of fever , overall status , degree of dehydration , and percentage of in- versus out patients . Duration of diarrhea after enrollment was 71.9 + /- 35.8 hours in group A versus 58.3 + /- 27.6 hours in group B ( mean + /- SD ; P = 0.03 ) . In rotavirus-positive children , diarrhea lasted 76.6 + /- 41.6 hours in group A versus 56.2 + /- 16.9 hours in groups B ( P < 0.008 ) . Diarrhea lasted longer than 7 days in 10.7 % of group A versus 2.7 % of group B patients ( P < 0.01 ) . Hospital stays were significantly shorter in group B than in group A. CONCLUSIONS Administering oral rehydration solution containing Lactobacillus GG to children with acute diarrhea is safe and results in shorter duration of diarrhea , less chance of a protracted course , and faster discharge from the hospital Background . Certain strains of lactobacilli have been shown to promote recovery from rotavirus enteritis in hospitalized children . Few studies have examined the effect of probiotics in nonhospitalized children with mild diarrhea . Methods . We studied in a r and omized placebo-controlled trial the effect of lyophilized Lactobacillus rhamnosus 19070 - 2 and Lactobacillus reuteri DSM 12246 , 1010 colony-forming units of each strain twice daily for 5 days , on acute diarrhea in children in a cohort of children recruited from local day-care centers . The duration of diarrhea and assessment of stool consistency were recorded by the parents . Results . In patients treated with the selected Lactobacillus strains , the mean duration of diarrhea after intervention was reduced ( 76 h in patients treated with probiotics vs. 116 h in the placebo group;P = 0.05 ) . In patients with diarrhea for < 60 h before start of treatment ( early intervention ) , a more pronounced effect of probiotics was found . The time to recovery after early treatment was 79 h vs. 139 h in the placebo group ( P = 0.02 ) ; 1 of 17 patients treated early vs. 6 of 13 in the control group still had loose stools 120 h after start of treatment ( P = 0.03 ) . Conclusions . In children from day-care centers with mild gastroenteritis , the combination of L. rhamnosus 19070 - 2 and L. reuteri DSM 12246 was effective in reducing the duration of diarrhea Background Recent studies have shown that probiotics , most commonly Lactobacillus GG , may be useful in treating acute gastroenteritis . However , beneficial effects appear to be limited to a modest decrease in the duration of diarrhea . No studies have evaluated this therapy in moderate to severe dehydrating diarrhea in a metabolic facility . Methods Male children less than 2 years of age were admitted to a metabolic unit of the Department of Pediatrics at the Federal University of Bahia , Brazil , with moderate dehydration and were r and omized in a double-blind , placebo-controlled fashion . Oral rehydration solution ( ORS ) was administered per protocol and either placebo or Lactobacillus GG was given in combination with the ORS .  Output of urine , stool , and vomitus was recorded along with stool weight , nude body weight , and st and ard laboratory assessment s for hydration . Results There was no significant reduction in diarrhea duration and stool output in the Lactobacillus GG group . However , Kaplan-Meier survival analysis demonstrated that , even in moderate to severe diarrhea , resolution of the illness occurred so rapidly , that statistically significant benefits of probiotic therapy could not be demonstrated . Conclusion Our data implies that colonization must occur before benefits of probiotics can be realized . Probiotics are , therefore , likely to be of limited benefit in treating diarrheal illnesses of short duration such as viral enteritis . The beneficial effects of probiotics may be limited to prophylactic usage in high-risk population BACKGROUND Recent studies suggest that oral bacteriotherapy with probiotics might be useful in the management of atopic dermatitis ( AD ) . OBJECTIVE The purpose of this investigation was to evaluate the clinical and anti-inflammatory effect of probiotic supplementation in children with AD . METHODS In a double-blind , placebo-controlled , crossover study , 2 probiotic Lactobacillus strains ( lyophilized Lactobacillus rhamnosus 19070 - 2 and Lactobacillus reuteri DSM 122460 ) were given in combination for 6 weeks to 1- to 13-year-old children with AD . The patients ' evaluations were registered after each intervention ( ie , better , unchanged , or worse ) . The clinical severity of the eczema was evaluated by using the scoring atopic dermatitis ( SCORAD ) score . As inflammatory markers , eosinophil cationic protein in serum and cytokine production by P BMC s were measured . RESULTS After active treatment , 56 % of the patients experienced improvement of the eczema , whereas only 15 % believed their symptoms had improved after placebo ( P = .001 ) . The total SCORAD index , however , did not change significantly . The extent of the eczema decreased during active treatment from a mean of 18.2 % to 13.7 % ( P = .02 ) . The treatment response was more pronounced in allergic patients ( at least one positive skin prick test response and elevated IgE levels ) , and in this group the SCORAD score decreased ( P = .02 compared with nonallergic patients ) . During active treatment , serum eosinophil cationic protein levels decreased ( P = .03 ) . No significant changes in the production of the cytokines IL-2 , IL-4 , IL-10 , or IFN-gamma were found . CONCLUSIONS A combination of L rhamnosus 19070 - 2 and L reuteri DSM 122460 was beneficial in the management of AD . The effect was more pronounced in patients with a positive skin prick test response and increased IgE levels To determine the effect of a human Lactobacillus strain  ( Lactobacillus casei sp strain GG , Gefilac ) on  recovery from acute diarrhea ( 82 % rotavirus ) , 71 well-nourished children between 4 and 45 months of age were studied . After oral rehydration , the patients r and omly received either Lactobacillus GG-fermented milk product , 125 g ( 10(10 - 11 ) colony-forming units ) twice daily ( group 1 ) ; Lactobacillus GG freeze-dried powder , one dose ( 10(10 - 11 ) colony-forming units ) twice daily ( group 2 ) ; or a placebo , a pasteurized yogurt ( group 3 ) 125 g twice daily ; each diet was given for 5 days , in addition to normal full diet otherwise free of fermented dairy products . The mean ( SD ) duration of diarrhea after commencing the therapy was significantly shorter in group 1 ( 1.4 [ 0.8 ] days ) and in group 2 ( 1.4 [ 0.8 ] days ) than in group 3 ( 2.4 [ 1.1 ] days ) ; F = 8.70 , P less than 0.001 . After rehydration , each dietary group maintained a positive weight trend . The urinary lactulose-mannitol recovery ratios ( means [ 95 % confidence intervals ] ) on admission were 0.09 ( 0.03 , 0.24 ) in group 1 , 0.12 ( 0.07 , 0.22 ) in group 2 , and 0.08 ( 0.04 , 0.18 ) in group 3 ; no significant alterations in intestinal permeability were observed at retesting after 2 days of realimentation . The result indicates that early nutritional repletion after rehydration causes no mucosal disruption and is beneficial for recovery from diarrhea . It is further suggested that Lactobacillus GG in the form of fermented milk or freeze-dried powder is effective in shortening the course of acute diarrhea OBJECTIVE To assess the clinical efficacy of Lactobacillus sporogenes ( Bacillus coagulans ) , as probiotic preparation , against  dehydrating diarrhoea in children .  METHODS Double-blind , r and omised , placebo-controlled , hospital-based clinical trial with children aged 6 - 24 months who had diarrhoea with some dehydration . Children received tablets of L. sporogenes ( B. coagulans ) or placebo ( control group ) and oral rehydration salt solution for correction of initial dehydration as well as maintenance therapy . Duration , frequency , volume of diarrhoea and intake of ORS of two groups were compared as outcome variables . RESULTS One hundred and forty-eight children participated , of whom 78 ( Study group ) received L. sporogenes ( B. coagulans ) and 70 received placebo ( Control group ) . Differences in recovery rate ( P=0.2 ) , duration ( P=0.5 ) , frequency ( P=0.05 ) , volume ( P=0.1 ) of diarrhoea , intake of ORS ( P=0.2 ) and other fluids ( P=0.1 ) were not significant between both groups . Neither did a subgroup analysis of children who had rotavirus as sole enteropathogens show any significant differences in duration ( P=0.5 ) , frequency ( P=0.6 ) , volume ( P=0.8 ) of diarrhoea , intake of ORS ( P=0.8 ) and other fluids ( P=0.8 ) among both groups . CONCLUSION L. sporogenes ( B. coagulans ) , as an adjunct to ORS , had no therapeutic impact on management of acute dehydrating diarrhoea of diverse etiology including rotavirus associated diarrhoea in children We conducted a double-blind r and omized placebo-controlled study to evaluate efficacy and tolerability of VSL♯3 ( CD Pharma India ) in the treatment of acute rotavirus diarrhea in children . The patients were r and omly assigned to receive 4 days of oral treatment with VSL♯3 probiotic mixture or placebo in addition to usual care for diarrhea . Results : Out of 230 rotavirus-positive acute diarrhea children , 224 children completed the study , ( 113 in the drug group and 111 in the placebo group ) . At recruitment on Day 1 , there were no significant differences between the 2 groups in terms of frequency of vomiting , mean loose stool frequency , stool consistency , and mean frequency of oral rehydration salts ( ORS ) and intravenous fluids administered . On Day 2 , a lower mean stool frequency and improved stool consistency was noted in the drug group , which achieved statistical significance . This was also reflected in the lower volume of ORS administration in the drug group . Even on Day 3 , mean loose stool frequency and frequency of ORS use and frequency of intravenous fluid use was significantly lower in the drug group . The differences in the frequency of loose stools persisted till 8 hours of Day 4 . After this , as the placebo group also showed spontaneous improvement the difference between the 2 groups in terms of the overall stools frequency became comparable . However , the overall ORS requirement continued to be significantly lower in the drug group even on Day 4 . The overall recovery rates were significantly better in the drug group compared with placebo . No side effects were noted with the use of the probiotic mixture . Use of probiotic mixture VSL♯3 in acute rotavirus diarrhea result ed in earlier recovery and reduced frequency of ORS administration reflecting decreased stool volume losses during diarrhea A prospect i ve , placebo-controlled , triple blind clinical trial was carried out in Pakistan to determine the effect of Lactobacillus GG on the course of  acute diarrhea in hospitalized children . Forty children ( mean age , 13 months ) were enrolled and after rehydration received either oral Lactobacillus GG ( n = 21 ) or placebo ( n = 19 ) twice daily for 2 days , in addition to the usual diet . The clinical course of diarrhea was followed during the treatment period . Features on admission into the study groups were similar and were characterized by severe diarrhea , malnutrition and inappropriate management before presentation . Response was evident on Day 2 when the frequency of both vomiting and diarrhea was less in the Lactobacillus group . In those who had presented with acute nonbloody diarrhea ( n = 32 ) , the percentage of children with persistent watery diarrhea at 48 hours was significantly less in the Lactobacillus group : 31 % vs. 75 % ( P < 0.01 ) . No significant difference was observed by 48 hours in those presenting with bloody diarrhea . The relevance of this finding to the management of diarrhea in the tropics is discussed Objective : The effectiveness of probiotic therapy for acute rotavirus infectious diarrhoea in an indigenous setting with bacterial/parasitic diarrhoea is unclear . In the present study , we assessed the efficacy of probiotics in Australian Aboriginal children in the Northern Territory admitted to hospital with diarrhoeal disease . Patients and Methods : A r and omised double-blind placebo-controlled study was conducted in Aboriginal children ( ages 4 months–2 years ) , admitted to hospital with acute diarrhoeal disease ( > 3 loose stools per day ) . Children received either oral Lactobacillus GG ( 5 × 109 colony-forming units 3 times per day for 3 days ; n = 33 ) or placebo ( n = 31 ) . Small intestinal functional capacity was assessed by the noninvasive 13C-sucrose breath test on days 1 and 4 . Results : Both groups showed mean improvement in the sucrose breath test after 4 days ; however , there was no difference ( mean , 95 % confidence interval ) between probiotic ( 2.9 [ cumulative percentage of dose recovered at 90 minutes ] ; 1.7–4.2 ) and placebo ( 3.7 ; 2.3–5.2 ) groups . Probiotics did not change the duration of diarrhoea , total diarrhoea stools , or diarrhoea score compared with placebo . There was a significant ( P < 0.05 ) difference in diarrhoea frequency on day 2 between probiotics ( 3.3 [ loose stools ] ; 2.5–4.3 ) and placebo ( 4.7 ; 3.8–5.7 ) groups . Conclusions : Lactobacillus GG did not appear to enhance short-term recovery following acute diarrhoeal illness in this setting BACKGROUND In previous studies , nitazoxanide has demonstrated a cytoprotective effect against rotavirus , reducing the duration of diarrhea in comparison to placebo . We design ed a r and omized , single-blind , controlled trial in order to assess the effectiveness of nitazoxanide and probiotics in comparison with a control group . METHODS Seventy-five children aged from 28 days to 24 months , with rotavirus diarrhea , were r and omly assigned to receive either oral nitazoxanide ( 15 mg/kg/day ) twice a day for three days , a combination of oral probiotics , 1 g twice a day for five days , or only oral or systemic rehydration solutions . The duration of diarrhea and of hospitalization were the primary outcome measures , and daily stool frequency , vomiting , and fever were some of the secondary outcome measures analyzed . RESULTS The median duration of hospitalization was significantly shorter ( p = 0.017 ) in patients who received nitazoxanide ( 81 h ) and probiotics ( 72 h ) compared to patients who received oral rehydration solution alone ( 108 h ) . Similarly , the median duration of diarrhea was significantly reduced ( p = 0.009 ) in children who received nitazoxanide ( 54 h ) and probiotics ( 48 h ) compared to the control group ( 79 h ) . CONCLUSIONS Treatment with nitazoxanide and probiotics is effective in the management of children with acute rotavirus diarrhea . Small differences in favor of nitazoxanide were found in comparison with probiotics . Nitazoxanide is an important treatment option for rotavirus diarrhea BACKGROUND & AIMS The aim of our study was to investigate the role of Lactobacillus GG ( LGG ) in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centers . METHODS We conducted a r and omized , double-blind , placebo-controlled trial in 281 children who attend day care centers . They were r and omly allocated to receive LGG at a dose of 10(9 ) colony-forming units in 100ml of a fermented milk product ( LGG group , n=139 ) or placebo that was the same post-pasteurized fermented milk product without LGG ( placebo group , n=142 ) during the 3-month intervention period . RESULTS Compared to the placebo group , children in the LGG group had a significantly reduced risk of upper respiratory tract infections ( RR 0.66 , 95 % CI 0.52 to 0.82 , NNT 5 , 95 % CI 4 to 10 ) , a reduced risk of respiratory tract infections lasting longer than 3 days ( RR 0.57 , 95 % CI 0.41 to 0.78 , NNT 5 , 95 % CI 4 to 11 ) , and a significantly lower number of days with respiratory symptoms ( p<0.001 ) . There was no risk reduction in regard to lower respiratory tract infections ( RR 0.82 , 95 % CI 0.24 to 2.76 ) . Compared with the placebo group , children in the LGG group had no significant reduction in the risk of gastrointestinal infections ( RR 0.63 , 95 % CI 0.38 to 1.06 ) , vomiting episodes ( RR 0.60 , 95 % CI 0.29 to 1.24 ) , and diarrheal episodes ( RR 0.63 , 95 % CI 0.35 to 1.11 ) as well as no reduction in the number of days with gastrointestinal symptoms ( p=0.063 ) . CONCLUSION LGG administration can be recommended as a valid measure for decreasing the risk of upper respiratory tract infections in children attending day care centers Objective To evaluate the efficacy and safety of Bifilacℳ on reducing the episodes ( frequency ) and duration of diarrhea induced by rotaviral infection and to evaluate the efficacy of Bifilacℳ to ameliorate the associated symptoms like dehydration and duration of rotaviral shedding in faeces . Methods 80 children aged between 3 months and 3 years were enrolled and divided into 2 groups , one group received st and ard therapy + placebo , the other group received st and ard therapy + probiotic ( Bifilac ) r and omly . Children assessed for frequency and duration of diarrhea . Degree of dehydration , duration and volume of oral rehydration salt [ ORS ] therapy , duration and volume of Intra venous fluids and duration of rotaviral shedding . Results When compared to the placebo , Bifilac showed clinical as well as statistically significant reduction in Number of episodes ( frequency ) of diarrhea in a day , mean duration of diarrhea ( in days ) degree of dehydration , duration and volume of oral rehydration salt [ ORS ] therapy , duration and volume of intravenous fluid [ IVF ] therapy , duration of rotaviral shedding ( P<0.01 ) . Conclusion The synbiotic , bifilac , appears to be a safe and very effective adjuvant in the management of acute rotaviral diarrhea
target: The pooled estimate of efficacy of lactobacillus rhamnosus GG and other probiotics significantly reduced the duration of diarrhea .
  In conclusion , probiotics exert positive effect in reducing the duration of acute rotavirus diarrhea  compared with control
background: BACKGROUND Probiotic therapies with different strains demonstrated some beneficial effects , although some studies did not show any significant effects .
  This study assessed systematic ally the current knowledge on the effect of probiotic bacteria on duration of  acute rotavirus diarrhea in children compared with control .