Potential, Benefits and Proper Use of Probiotics in the Treatment of Acute Gastroenteritis in Children
Clinical studies and experiences from clinical practice have shown the benefits of administering probiotics in the treatment of acute gastroenteritis in children. Pediatrician Dr. Natália Szitányi summarizes the possibilities and rationale for their use in this indication.
Etiopathogenesis of Acute Gastroenteritis in Children
Acute gastroenteritis is one of the most common reasons for a visit to the office of a general practitioner for children and adolescents. The most common cause of acute gastroenteritis in children is viruses (rotaviruses, adenoviruses, noroviruses), but in about 15% of cases in infants and toddlers, bacterial strains (enteropathogenic E. coli, salmonella, campylobacter, and others) are key pathogens, and in older children the proportion of bacteria among the causes of diarrhea is even higher. Often the infectious agent is not identified. Microbiological testing is particularly appropriate for children with dysenteric symptoms, high fever, chronic illness, known immune disorders, or a history of travel to high-risk countries.
Therapeutic Approach
The treatment approach for acute gastroenteritis is primarily dependent on the severity of the condition, particularly considering the degree of dehydration, weight loss, and rehydration possibilities. The basis of therapy is usually oral rehydration solution and refeeding. Diosmectite may be used, and in hospitalized children, antidiarrheal medications can also be considered.
The Role of Probiotics in Treatment
It is suitable to use probiotics as an adjunct to rehydration therapy in children with acute gastroenteritis. They are more effective in viral gastroenteritis, less so in bacterial. Greater effect is achieved if probiotics are administered early and in sufficient doses. The efficacy of specific strains (Lactobacillus rhamnosus GG, Saccharomyces boulardii, Lactobacillus reuteri DSM 17938) in the treatment of acute gastroenteritis has been confirmed by randomized double-blind and placebo-controlled studies.
Findings from Clinical Studies
The treatment of acute diarrhea is one of the most thoroughly researched indications for the use of probiotics. In a systematic review that formed the basis for the recommendations of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), 46 randomized clinical studies with various probiotic strains (most commonly Lactobacillus rhamnosus GG, Lactobacillus reuteri DSM 17938, Saccharomyces boulardii, or Enterococcus SF68 producing lactic acid) were evaluated; 2-8 bacterial strains were tested in 17 studies. The administration of probiotics reduced the duration of diarrhea by an average of 1 day, with L. reuteri DSM 17938 reducing it by 32 hours. Some studies also demonstrated a reduction in the length of hospitalization.
Conclusion
It is important to note that the efficacy and safety of one probiotic does not automatically imply the same effect for all probiotics, and results from individual studies cannot be generalized to all probiotics. It is recommended to administer probiotics whose efficacy has been confirmed in clinical studies. When choosing a probiotic, other factors such as the correct therapeutic dose and product stability should also be considered. The standard duration of probiotic administration is between 5 and 7 days.
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Source: Szitányi N. Treatment of Acute Gastroenteritis in Children. In: Probiotics and their Practical Use in General Practice. OSPDL CLS JEP.
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