Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations Effect of probiotic Lactobacillus strains in young children hospitalized with acute diarrhea The effect of early nutritional supplementation with a mixture of probiotic, prebiotic, fiber and micronutrients in infants with acute diarrhea in Indonesia. Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis Role of probiotic in preventing acute diarrhoea in children: a community-based, randomized, double-blind placebo-controlled field trial in an urban slum. Effect of probiotic Lactobacillus strains on acute diarrhea in a cohort of nonhospitalized children attending day-care centers Prebiotic and Probiotic Fortified Milk in Prevention of Morbidities among Children: Community-Based, Randomized, Double-Blind, Controlled Trial Evaluation of a Diet Containing Probiotics and Zinc for the Treatment of Mild Diarrheal Illness in Children Younger Than One Year of Age Probiotics and prebiotics in gastrointestinal disorders Probiotics to improve outcomes of colic in the community: Protocol for the Baby Biotics randomised controlled trial A Randomized Formula Controlled Trial of Bifidobacterium lactis and Streptococcus thermophilus for Prevention of Antibiotic-Associated Diarrhea in Infants Probiotics in the treatment of acute rotavirus diarrhoea. A randomized, double-blind, controlled trial using two different probiotic preparations in Bolivian children Limitations of Probiotic Therapy in Acute, Severe Dehydrating Diarrhea The probiotic Escherichia coli strain Nissle 1917 (EcN) stops acute diarrhoea in infants and toddlers The prophylactic use of probiotics in the prevention of radiation therapy-induced diarrhea. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics Effect of a Probiotic Infant Formula on Infections in Child Care Centers: Comparison of Two Probiotic Agents
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 Background . Oral bacteriotherapy promotes recovery from acute childhood diarrhea , but few strains have been shown to have therapeutic potentials . We examined the effect of two newly identified probiotic Lactobacillus strains in acute childhood diarrhea .  Methods . Sixty-nine children were r and omized during hospitalization for acute diarrhea to receive a mixture of Lactobacillus rhamnosus 19070 - 2 and Lactobacillus reuteri DSM 12246 , 1010 colony-forming units of each strain or placebo twice daily for 5 days . Before selection of these stains their potential probiotic characteristics were demonstrated in vitro and in healthy volunteers . Results . In patients receiving probiotics , the diarrheal phase was reduced by 20 % . The duration of diarrhea was 82 h in the treatment group vs. 101 h in the control group ( not significant , P = 0.07 ) . However , 3 of 30 patients from the treatment group vs. 13 of 39 from the control group still had loose stools at the end of the study period ( P = 0.03 ) . In patients with diarrhea for < 60 h before start of treatment ( early intervention ) , a clear effect of the probiotics was demonstrated ( 80 h in the treatment group vs. 130 h in the control group , P = 0.003 ) . After early intervention , the length of hospitalization was reduced by 48 % ( 3.5 vs. 1.7 days , P = 0.03 ) . At the end of the intervention , rotavirus antigen was found in 12 % of patients from the treatment group vs. 46 % from the control group ( P = 0.02 ) . Conclusions . The two probiotics , L. rhamnosus 19070 - 2 and L. reuteri DSM 12246 , ameliorated acute  diarrhea in hospitalized children and reduced the period of rotavirus excretion . Oral bacteriotherapy was associated with a reduced length of hospital stay . The beneficial effects were most prominent in children treated early in the diarrheal phase A r and omized double blind clinical trial was conducted to assess the efficacy of a special infant formula containing Lactobacillus rhamnosus LMG P-22799 ( probiotic : 5 x 10(8 ) CFU/100mL ) , inulin ( prebiotic : 0.15 g/100mL ) , dietary fiber ( soy polysaccharides : 0.2 g/100mL ) and increased amounts of zinc+iron ( + 0.4 and + 0.6 mg/100mL , respectively ) as active ingredients for the early dietary management of 58 Indonesian well-nourished male infants aged 3 - 12 months suffering from acute diarrhea with moderate dehydration . After adequate oral rehydration , the patients were r and omly assigned to receive either a low lactose infant formula supplemented with added precooked rice ( 1.5 g/100mL ) with the above active ingredients ( study group ) or a low lactose infant formula with added precooked rice without the above active ingredient supplement ( control group ) . No antibiotic , anti-secretory drug or antiemetic was given at all . Both study and control groups showed similar outcomes for weight gain and stool weight . The duration of diarrhea was significantly shorter in the study group than in the control group ( 1.63 versus 2.45 days ; p<0.05 ; for the study and control group respectively ) . No treatment failure or other side effects were observed during the course of the study . The present study supports the evidence for the efficacy of a special anti-diarrhea infant formula containing probiotic , prebiotic , fiber and iron+zinc after oral rehydration by shortening the duration of infantile diarrhea in developing countries . However , from the results of our study we can not discern the individual contribution of the active ingredients and also not whether they may act independent from each other or in a synergistic way Background Gastroenteritis accounts for approximately 1.7 million visits to the emergency department ( ED ) by children in the United States every year . Data to determine whether the use of probiotics improves outcomes in these children are lacking . Methods We conducted a r and omized , double‐blind trial involving 886 children 3 to 48 months of age with gastroenteritis who presented to six pediatric EDs in Canada . Participants received a 5‐day course of a combination probiotic product containing Lactobacillus rhamnosus R0011 and L. helveticus R0052 , at a dose of 4.0 × 109 colony‐forming units twice daily or placebo . The primary outcome was moderate‐to‐severe gastroenteritis , which was defined according to a post‐enrollment modified Vesikari scale symptom score of 9 or higher ( scores range from 0 to 20 , with higher scores indicating more severe disease ) . Secondary outcomes included the duration of diarrhea and vomiting , the percentage of children who had unscheduled physician visits , and the presence or absence of adverse events . Results Moderate‐to‐severe gastroenteritis within 14 days after enrollment occurred in 108 of 414 participants ( 26.1 % ) who were assigned to probiotics and 102 of 413 participants ( 24.7 % ) who were assigned to placebo ( odds ratio , 1.06 ; 95 % confidence interval [ CI ] , 0.77 to 1.46 ; P=0.72 ) . After adjustment for trial site , age , detection of rotavirus in stool , and frequency of diarrhea and vomiting before enrollment , trial‐group assignment did not predict moderate‐to‐severe gastroenteritis ( odds ratio , 1.06 ; 95 % CI , 0.76 to 1.49 ; P=0.74 ) . There were no significant differences between the probiotic group and the placebo group in the median duration of diarrhea ( 52.5 hours [ interquartile range , 18.3 to 95.8 ] and 55.5 hours [ interquartile range , 20.2 to 102.3 ] , respectively ; P=0.31 ) or vomiting ( 17.7 hours [ interquartile range , 0 to 58.6 ] and 18.7 hours [ interquartile range , 0 to 51.6 ] , P=0.18 ) , the percentages of participants with unscheduled visits to a health care provider ( 30.2 % and 26.6 % ; odds ratio , 1.19 ; 95 % CI , 0.87 to 1.62 ; P=0.27 ) , and the percentage of participants who reported an adverse event ( 34.8 % and 38.7 % ; odds ratio , 0.83 ; 95 % CI , 0.62 to 1.11 ; P=0.21 ) . Conclusions In children who presented to the emergency department with gastroenteritis , twice‐daily administration of a combined L. rhamnosus – L. helveticus probiotic did not prevent the development of moderate‐to‐severe gastroenteritis within 14 days after enrollment . ( Funded by the Canadian Institutes of Health Research and others ; PROGUT Clinical Trials.gov number , NCT01853124 . Acute diarrhoea remains a major public health challenge in developing countries . We examined the role of a probiotic in the prevention of acute diarrhoea to discover if there was an effect directed towards a specific aetiology . A double-blind , r and omized , controlled field trial involving 3758 children aged 1 - 5 years was conducted in an urban slum community in Kolkata , India . Participants were given either a probiotic drink containing Lactobacillus casei strain Shirota or a nutrient drink daily for 12 weeks . They were followed up for another 12 weeks . The primary outcome of this study was the occurrence of first episodes of diarrhoea . We assessed this during 12 weeks of intake of study agent and also for 12 weeks of follow-up . There were 608 subjects with diarrhoea in the probiotic group and 674 subjects in the nutrient group during the study period of 24 weeks . The level of protective efficacy for the probiotic was 14 % ( 95 % confidence interval 4 - 23 , P<0·01 in adjusted model ) . The reduced occurrence of acute diarrhoea in the probiotic group compared to nutrient group was not associated with any specific aetiology . No adverse event was observed in children of either probiotic or nutrient groups . The study suggests that daily intake of a probiotic drink can play a role in prevention of acute diarrhoea in young children in a community setting of a developing country 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 review s suggest common infectious diseases continue to be a major cause of death among preschool children in developing countries . Identification of feasible strategies to combat this disease burden is an important public health need . We evaluated the efficacy of adding prebiotic oligosaccharide and probiotic Bifidobacterium lactis HN019 to milk , in preventing diarrhea , respiratory infections and severe illnesses , in children aged 1–4 years as part of a four group study design , running two studies simultaneously . Methods and Findings In a community based double-masked , r and omized controlled trial , children 1–3 years of age , willing to participate , were r and omly allocated to receive either control milk ( Co ; n = 312 ) or the same milk fortified with 2.4 g/day of prebiotic oligosaccharide and 1.9 × 107 colony forming unit (c.f.u)/day of probiotic Bifidobacterium lactis HN019 ( PP ; n = 312 ) . Children were followed up for 1 year providing data for 1–4 years . Biweekly household surveillance was conducted to gather information on compliance and morbidity . Both study groups were comparable at baseline ; compliance to intervention was similar . Overall , there was no effect of prebiotic and probiotic on diarrhea ( 6 % reduction , 95 % Confidence Interval [ CI ] : −1 to 12 % ; p = 0.08 ) . Incidence of dysentery episodes was reduced by 21 % ( 95 % CI : 0 to 38 % ; p = 0.05 ) . Incidence of pneumonia was reduced by 24 % ( 95 % CI : 0 to 42 % ; p = 0.05 ) and severe acute lower respiratory infection ( ALRI ) by 35 % ( 95 % CI : 0 to 58 % ; p = 0.05 ) . Compared to children in Co group , children in PP group had 16 % ( 95 % CI : 5 to 26 % , p = 0.004 ) and 5 % ( 95 % CI : 0 to 10 % ; p = 0.05 ) reduction in days with severe illness and high fever respectively . Conclusions / Significance Milk can be a good medium for delivery of prebiotic and probiotic and result ed in significant reduction of dysentery , respiratory morbidity and febrile illness . Overall , impact of diarrhea was not significant . These findings need confirmation in other setting s. Trial Registration Clinical Trials.gov Objectives : Supplementation of probiotics and supplementation of zinc during acute gastroenteritis in children have been shown to exert positive effects on diarrhea duration and severity . Our aim was to evaluate a new diet enriched with zinc and probiotic bacteria in the treatment of acute gastroenteritis in young children . Methods : In a double blind prospect i ve study , 65 children aged 6–12 months were r and omized to receive 6 × 109 colony forming units of Streptococcus thermophilus , Bifidobacterium lactis , Lactobacillus acidophilus ( 2 × 109 of each strain ) , 10 mg of zinc/day , and 0.3 grams of fructo-oligosaccharides in the supplemented group ( n = 33 ) or placebo ( n = 32 ) , given in a soy protein based rice cereal . For each child , age , sex , weight , degree of dehydration , the presence of fever or vomiting , stool frequency and consistency were recorded daily until diarrhea resolution . Results : Diarrhea resolution occurred after 1.43 ± 0.71 days in the supplemented group vs. 1.96 ± 1.24 in the control group ( p = 0.017 ) . In the subset of children who presented with vomiting , time to vomiting resolution was 0.27 ± 0.59 vs. 0.81 ± 0.91 days in the supplemented and control groups , respectively ( p = 0.06 ) . On day 3 , there was only 1 child with watery stools in the supplemented group versus 10 children in the control group ( p = 0.02 ) . Conclusions : In our series , the feeding of a cereal containing Streptococcus thermophilus , Bifidobacterium lactis , Lactobacillus acidophilus and zinc , reduced the severity and duration of acute gastroenteritis in young children . However , whether this combination is better than either the addition of probiotics or zinc alone is yet to be determined Purpose of review This review summarizes the clinical efficacy of probiotics and prebiotics in gastrointestinal disorders and examines the mechanisms of action related to their therapeutic effect . Recent findings The demonstration that immune and epithelial cells can discriminate between different microbial species has extended the known mechanism(s ) of action of probiotics beyond simple barrier and antimicrobial effects . It has also confirmed that probiotic bacteria modulate mucosal and systemic immune activity and epithelial function . The progressive unraveling of these mechanisms of action has led to new credence for the use of probiotics and prebiotics in clinical medicine . Level I evidence now exists for the therapeutic use of probiotics in infectious diarrhea in children , recurrent Clostridium difficile – induced infections and postoperative pouchitis . Level II evidence is emerging for the use of probiotics in other gastrointestinal infections , prevention of postoperative bacterial translocation , irritable bowel syndrome , and in both ulcerative colitis and Crohn disease . Nevertheless , one consistent feature has emerged over the past year : Not all probiotic bacteria have similar therapeutic effects . Future clinical trials will need to incorporate this fact into trial planning and design . Summary The use of probiotics and prebiotics as therapeutic agents for gastrointestinal disorders is rapidly moving into the “ mainstream . ” Mechanisms of action explain the therapeutic effects and r and omized ; controlled trials provide the necessary evidence for their incorporation into the therapeutic armamentarium Background Infant colic , characterised by excessive crying/fussing for no apparent cause , affects up to 20 % of infants under three months of age and is a great burden to families , health professionals and the health system . One promising approach to improving its management is the use of oral probiotics . The Baby Biotics trial aims to determine whether the probiotic Lactobacillus reuteri DSM 17938 is effective in reducing crying in infants less than three months old ( < 13.0 weeks ) with infant colic when compared to placebo . Methods / Design Design : Double-blind , placebo-controlled r and omised trial in Melbourne , Australia . Participants : 160 breast and formula fed infants less than three months old who present either to clinical or community services and meet Wessel ’s criteria of crying and /or fussing . Intervention : Oral once-daily Lactobacillus reuteri ( 1x108 cfu ) versus placebo for one month . Primary outcome : Infant crying/fussing time per 24 hours at one month . Secondary outcomes : i ) number of episodes of infant crying/fussing per 24 hours and ii ) infant sleep duration per 24 hours ( at 7 , 14 , 21 , 28 days and 6 months ) ; iii ) maternal mental health scores , iv ) family functioning scores , v ) parent quality adjusted life years scores , and vi ) intervention cost-effectiveness ( at one and six months ) ; and vii ) infant faecal microbiota diversity , viii ) infant faecal calprotectin levels and ix ) Eschericia coli load ( at one month only ) . Analysis : Primary and secondary outcomes for the intervention versus control groups will be compared with t tests and non-parametric tests for continuous data and chi squared tests for dichotomous data . Regression models will be used to adjust for potential confounding factors . Intention-to-treat analysis will be applied . Discussion An effective , practical and acceptable intervention for infant colic would represent a major clinical advance . Because our trial includes breast and formula-fed babies , our results should generalise to most babies with colic . If cost-effective , the intervention ’s simplicity is such that it could be widely taken up as a new st and ard of care in the primary and secondary care sectors . Trial Registration Current Controlled Trials IS RCT Goals : This clinical trial was carried out to determine whether oral treatment with a commercial probiotic formula containing Bifidobacterium lactis and Streptococcus thermophilus would reduce the frequency of  antibiotic-associated diarrhea ( AAD ) in infants . Study : In this double-bind formula controlled study , 80 infants , 6 to 36 months of age , were r and omly assigned to receive a commercial formula containing 107 viable cells of B. lactis and 106viable cells of S. thermophilus at the initiation of antibiotics for a duration of 15 days . The infants were assessed daily for formula intake , stool frequency , and stool consistency for a total duration of 30 days . Seventy-seven infants received  nonsupplemented formula for the entire duration . Results : There was a significant difference in the incidence of AAD in the children receiving probiotic-supplemented formula ( 16 % ) than nonsupplemented formula ( 31 % ) . Conclusions : The present study shows that prevention against AAD in infants was obtained by oral treatment with daily dose of B. lactis and S. thermophilus 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 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 In most cases , acute diarrhoea will become self-limiting during the first few days after onset . For young children , however , health risks may develop when the disease lasts longer than 3 days . The purpose of the present trial was to determine whether the stool frequency of infants and toddlers suffering from acute diarrhoea could be normalised more quickly by administering the probiotic Escherichia coli Nissle 1917 ( EcN ) solution than by administering a placebo . The safety of EcN were also assessed . A total of 113 children ( aged 2–47 months ) with acute diarrhoea ( > three watery or loose stools in 24 h ) were r and omised to either a group receiving the probiotic EcN suspension ( n = 55 ) or a group receiving the placebo suspension ( n = 58 ) in a confirmative , double-blind clinical trial . Depending on the age of patients , 1–3 ml per day of verum suspension ( 108 viable EcN cells per millilitre ) or placebo were administered orally . The causes of the diarrhoea were viral rather than bacterial , but they were mainly unspecific infections . The median onset of treatment response ( reduction of daily stool frequency to ≤ three watery or loose stools over at least 2 consecutive days ) occurred more rapidly in the children receiving the EcN solution ( 2.5 days ) than in those receiving the placebo ( 4.8 days ) , a significant difference ( 2.3 days ; p = 0.0007 ) . The number of patients showing a response was clearly higher ( p < 0.0001 ) in the EcN group ( 52/55 ; 94.5 % ) than in the placebo group ( 39/58 ; 67.2 % ) . EcN was found to be safe and well-tolerated , and it showed a significant superiority compared to the placebo in the treatment of acute diarrhoea in infants and toddlers Cancer treatment regimens that include radiation therapy ( RT ) to the abdominal region for cervical , ovarian , prostate , sigmoid , or colorectal cancer potentially disturb the colonization resistance of the indigenous gut flora , causing RT-induced diarrhea , enteritis , and colitis in more than 80 % of patients with cancer . One approach for the prevention of RT-induced diarrhea is the use of probiotics . R and omized clinical trials have demonstrated efficacy of probiotic preparations VSL # 3 and Lactobacillus casei DN-114 001 in decreasing the incidence and grade of RT-induced diarrhea . Oncology nurses and advanced practice clinicians are in a position to interpret research findings related to RT-induced diarrhea , enteritis , and colitis and to apply evidence -based practice principles in patients with cancer receiving RT to promote positive outcomes Background Prevalence of  allergic diseases in infants , whose parents and siblings do not have allergy , is approximately 10 % and reaches 20–30 % in those with an allergic first-degree relative . Intestinal microbiota may modulate immunologic and inflammatory systemic responses and , thus , influence development of sensitization and allergy . Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention . Objective The World Allergy Organization ( WAO ) convened a guideline panel to develop evidence -based recommendations about the use of probiotics in the prevention of allergy . Methods We identified the most relevant clinical questions and performed a systematic review of r and omized controlled trials of probiotics for the prevention of allergy . We followed the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach to develop recommendations . We search ed for and review ed the evidence about health effects , patient values and preferences , and re source use ( up to November 2014 ) . We followed the GRADE evidence -to-decision framework to develop recommendations . Results Currently available evidence does not indicate that probiotic supplementation  reduces the risk of developing allergy in children . However , considering all critical outcomes in this context , the WAO guideline panel determined that there is a likely net benefit from using probiotics result ing primarily from prevention of eczema . The WAO guideline panel suggests : a ) using probiotics in pregnant women at high risk for having an allergic child ; b ) using probiotics in women who breastfeed infants at high risk of developing allergy ; and c ) using probiotics in infants at high risk of developing allergy . All recommendations are conditional and supported by very low quality evidence . Conclusions WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents , clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding , and whether to give them to infants Objective . To investigate the effect of 2 different species of probiotics in preventing infections in infants attending child care centers . Methods . A double-blind , placebo-controlled , r and omized trial was conducted from December 1 , 2000 , to September 30 , 2002 , at 14 child care centers in the Beer-Sheva area of Israel in healthy term infants 4 to 10 months old . Infants were assigned r and omly to formula supplemented with Bifidobacterium lactis ( BB-12 ) , Lactobacillus reuteri ( American Type Culture Collection 55730 ) , or no probiotics . Duration of feeding , including follow-up , for each participant was 12 weeks . All infants were fed only the assigned formula and were not breastfed due to parental decision before recruitment to the study . Probiotic or prebiotic food products or supplements were not allowed . Main outcome measures were number of days and number of episodes with fever ( > 38 ° C ) and number of days and number of episodes with diarrhea or respiratory illness . Results . Participants ( n = 201 ) were similar regarding gestational age , birth weight , gender , and previous breastfeeding . The controls ( n = 60 ) , compared with those fed B lactis ( n = 73 ) or L reuteri ( n = 68 ) , had significantly more febrile episodes ( mean [ 95 % confidence interval ] : 0.41 [ 0.28–0.54 ] vs 0.27 [ 0.17–0.37 ] vs 0.11 [ 0.04–0.18 ] , respectively ) . The controls also had more diarrhea episodes ( 0.31 [ 0.22–0.40 ] vs 0.13 [ 0.05–0.21 ] vs 0.02 [ 0.01–0.05 ] , respectively ) and episodes of longer duration ( 0.59 [ 0.34–0.84 ] vs 0.37 [ 0.08–0.66 ] vs 0.15 [ 0.12–0.18 ] days , respectively ) . The L reuteri group , compared with BB-12 or controls , had a significant decrease of number of days with fever , clinic visits , child care absences , and antibiotic prescriptions . Rate and duration of respiratory illnesses did not differ significantly between groups . Conclusions . Child care infants fed a formula supplemented with L reuteri or B lactis had fewer and shorter episodes of diarrhea , with no effect on respiratory illnesses . These effects were more prominent with L reuteri , which was also the only supplement to improve additional morbidity parameters
Only Lactobacillus GG showed a consistent effect .
There is evidence of a clinical ly significant benefit of probiotics in the treatment of  acute infectious diarrhea in infants and children , particularly in rotaviral gastroenteritis .
Lactobacillus GG showed the most consistent effect , although other probiotic strains may also be effective .
Clinical and statistical heterogeneity of the prophylactic interventions preclude drawing firm conclusions about the efficacy of probiotics in preventing acute gastroenteritis
BACKGROUND This review was design ed to assess the evidence from r and omized controlled trials on effects of probiotics in the treatment and prevention of acute infectious diarrhea in infants and children .