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Meta-analysis: Lactobacillus GG for treating acute gastroenteritis in children--updated analysis of randomised
H Szajewska1, A Skórka, M Ruszczyński
1Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland. hania@ipgate.pl
Insights
Lactobacillus GG (LGG) significantly shortens diarrhea duration in children with acute gastroenteritis (AGE). Higher doses (≥10¹⁰ CFU/day) and European treatment settings showed greater effectiveness, though results should be viewed cautiously.
Area of Science:
- Pediatrics
- Microbiology
- Gastroenterology
Background:
- Probiotic efficacy requires individual assessment.
- Lactobacillus GG (LGG) has previously demonstrated effectiveness in treating acute gastroenteritis (AGE) in pediatric populations.
Purpose of the Study:
- To conduct an updated meta-analysis evaluating the efficacy of Lactobacillus GG (LGG) in treating acute gastroenteritis (AGE) in children.
- This study aims to refine previous findings from a 2007 meta-analysis.
Main Methods:
- A systematic literature search was performed across Cochrane Library, MEDLINE, and EMBASE databases.
- The search covered randomized controlled trials (RCTs) and meta-analyses published up to May 2013.
- Fifteen RCTs involving 2963 participants met the inclusion criteria for this updated meta-analysis.
Main Results:
- LGG significantly reduced diarrhea duration by an average of 1.05 days compared to placebo or no treatment (n=2444).
- Higher daily doses of LGG (≥10¹⁰ CFU) demonstrated greater efficacy (MD -1.11 days) than lower doses (MD -0.9 days).
- Effectiveness was more pronounced in European settings (MD -1.27 days) compared to non-European settings (MD -0.87 days).
Conclusions:
- Lactobacillus GG is effective in reducing the duration of diarrhea in children with AGE.
- Optimal benefit may be observed in pediatric patients receiving high daily doses (≥10¹⁰ CFU/day) within European geographical regions.
- Methodological limitations in the included trials necessitate cautious interpretation of the evidence.
Background:
The efficacy of each probiotic should be evaluated separately. Previously, we have shown that Lactobacillus GG (LGG) is effective in treating acute gastroenteritis (AGE) in children.
Aim:
To update our 2007 meta-analysis on the effectiveness of LGG in treating AGE in children.
Methods:
The Cochrane Library, MEDLINE and EMBASE databases were searched from August 2006 (end date of last search) to May 2013, with no language restrictions, for randomised controlled trials (RCTs) and meta-analyses.
Results:
Fifteen RCTs (2963 participants) met the inclusion criteria in this updated meta-analysis. Combined data from 11 RCTs (n = 2444) showed that LGG significantly reduced the duration of diarrhoea compared with placebo or no treatment (mean difference, MD -1.05 days, 95% CI -1.7 to -0.4). LGG was more effective when used at a daily dose ≥10¹⁰ CFU (eight RCTs, n = 1488, MD -1.11 days, 95% CI -1.91 to -0.31) than when used at a daily dose <10¹⁰ CFU (three RCTs, n = 956, MD -0.9 day, 95% CI -2.5 to 0.69). LGG was effective in children treated in Europe (five RCTs, n = 744, MD -1.27 days, 95% CI -2.04 to -0.49); in the non-European setting, the difference between the LGG group and the control group was of a borderline statistical significance (six RCTs, n = 1700, MD -0.87, 95% CI -1.81 to 0.08).
Conclusions:
Lactobacillus GG reduces the duration of diarrhoea. A subset of patients that is more likely to benefit includes subjects treated with a high daily dose of LGG (≥10¹⁰ CFU/day) who are either in-patients or out-patients from geographical Europe. Given the methodological limitations of many of the included trials, the evidence should be viewed with caution.
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