Association Between Diarrhea Duration and Severity and Probiotic Efficacy in Children With Acute Gastroenteritis. (5th July 2021)

• Record Type: Journal Article
• Authors: Schnadower, David; O'Connell, Karen J.; VanBuren, John M.; Vance, Cheryl; Tarr, Phillip I.; Schuh, Suzanne; Hurley, Katrina; Rogers, Alexander J.; Poonai, Naveen; Roskind, Cindy G.; Bhatt, Seema R.; Gouin, Serge; Mahajan, Prashant; Olsen, Cody S.; Powell, Elizabeth C.; Farion, Ken; Sapien, Robert E.; Chun, Thomas H.; Freedman, Stephen B.
• Is Part Of: American journal of gastroenterology. Volume 116:Number 7(2021)
• Page Start: 1523
• Page End: 1532
• Publication Date: 2021-07-05
• Subjects: Stomach -- Diseases -- Periodicals; Intestines -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Gastrointestinal Diseases -- Periodicals; Electronic journals; Periodicals; 616.33
• DOI: 10.14309/ajg.0000000000001295
• Languages: English
• ISSNs: 0002-9270

Abstract

Abstract : INTRODUCTION: It is unclear whether the alleged efficacy of probiotics in childhood acute gastroenteritis depends on the duration and severity of symptoms before treatment. METHODS: Preplanned secondary analysis of 2 randomized placebo-controlled trials in children 3–48 months of age was conducted in 16 emergency departments in North America evaluating the efficacy of 2 probiotic products ( Lactobacillus rhamnosus GG and a combination probiotic: L. rhamnosus and L. helveticus ). Participants were categorized in severity groups according to the duration (<24, 24–<72, and ≥72 hours) and the frequency of diarrhea episodes in the 24 hours (≤3, 4–5, and ≥6) before presentation. We used regression models to assess the interaction between pretreatment diarrhea severity groups and treatment arm (probiotic or placebo) in the presence of moderate-to-severe gastroenteritis (Modified Vesikari Scale score ≥9). Secondary outcomes included diarrhea frequency and duration, unscheduled healthcare provider visits, and hospitalization. RESULTS: A total of 1, 770 children were included, and 882 (50%) received a probiotic. The development of moderate-to-severe gastroenteritis symptoms after the initiation of treatment did not differ between groups (probiotic—18.4% [162/882] vs placebo—18.3% [162/888]; risk ratio 1.00; 95% confidence interval 0.87, 1.16; P = 0.95). There was no evidence of interaction between baseline severity and treatment ( P = 0.61) for the primary or any of the secondary outcomes: diarrhea duration ( P = 0.88), maximum diarrheal episodes in a 24-hour period ( P = 0.87), unscheduled healthcare visits ( P = 0.21), and hospitalization ( P = 0.87). DISCUSSION: In children 3–48 months with acute gastroenteritis, the lack of effect of probiotics is not explained by the duration of symptoms or frequency of diarrheal episodes before presentation.