Abstract
It is unknown if probiotics exert pathogen-specific effects in children with diarrhea secondary to acute gastroenteritis. Analysis of patient-level data from two multi-center randomized, placebo controlled, trials conducted in pediatric emergency departments in Canada and the U.S.. Participants were 3-48 months with >3 diarrheal episodes in the preceding 24 hours, and were symptomatic for <72 hours and><7 days in the canadian and u.s. studies, respectively. participants received either placebo or probiotic preparation (canada-lactobacillus rhamnosus r0011 l. helveticus r0052; u.s.-l. rhamnosus gg). the primary outcome was post-intervention moderate-to-severe disease [i.e. ≥9 on the modified vesikari scale (mvs)]. pathogens were identified in specimens from 59.3% (928 1565) children. no pathogen groups were less likely to experience an mvs ≥9 based on treatment allocation (test for interaction="0.35)." no differences between groups were identified for adenovirus (arr: 1.42; 95%ci: 0.62, 3.23), norovirus (arr: 0.98; 95%ci: 0.56, 1.74), rotavirus (arr: 0.86; 95%ci: 0.43, 1.71) or bacteria (arr: 1.19; 95%ci: 0.41, 3.43). at pathogen-group and among individual pathogens there were no differences in diarrhea duration or the total number of diarrheal stools between treatment groups, regardless of intervention allocation or among probiotic sub-groups. among adenovirus-infected children, those administered the lactobacillus rhamnosus r0011 l. helveticus r0052 product experienced fewer diarrheal episodes (arr: 0.65; 95%ci: 0.47 to 0.90). neither probiotic product resulted in less severe disease compared to placebo across a range of the most common etiologic pathogens. clarifying the etiology of diarrhea among those without pathogens identified is warranted. it is unknown if probiotics exert pathogen-specific effects in children with diarrhea secondary to acute gastroenteritis. analysis of patient-level data from two multi-center randomized, placebo controlled, trials conducted in pediatric emergency departments in canada and the u.s.. participants were 3-48 months with>3 diarrheal episodes in the preceding 24 hours, and were symptomatic for <72 hours and><7 days in the canadian and u.s. studies, respectively. participants received either placebo or probiotic preparation (canada-lactobacillus rhamnosus r0011 l. helveticus r0052; u.s.-l. rhamnosus gg). the primary outcome was post-intervention moderate-to-severe disease [i.e. ≥9 on the modified vesikari scale (mvs)]. pathogens were identified in specimens from 59.3% (928 1565) children. no pathogen groups were less likely to experience an mvs ≥9 based on treatment allocation (test for interaction="0.35)." no differences between groups were identified for adenovirus (arr: 1.42; 95%ci: 0.62, 3.23), norovirus (arr: 0.98; 95%ci: 0.56, 1.74), rotavirus (arr: 0.86; 95%ci: 0.43, 1.71) or bacteria (arr: 1.19; 95%ci: 0.41, 3.43). at pathogen-group and among individual pathogens there were no differences in diarrhea duration or the total number of diarrheal stools between treatment groups, regardless of intervention allocation or among probiotic sub-groups. among adenovirus-infected children, those administered the lactobacillus rhamnosus r0011 l. helveticus r0052 product experienced fewer diarrheal episodes (arr: 0.65; 95%ci: 0.47 to 0.90). neither probiotic product resulted in less severe disease compared to placebo across a range of the most common etiologic pathogens. clarifying the etiology of diarrhea among those without pathogens identified is warranted.>
