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Acute Infectious Diarrhea
Andrea Lo Vecchio1, Vittoria Buccigrossi1, Maria Cristina Fedele2
1Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy.
Insights
Probiotics are effective for treating acute infectious diarrhea (AID) in children, with specific strains and doses recommended by guidelines. Their preventative role is mainly for at-risk populations, particularly in hospital settings.
Area of Science:
- Pediatrics
- Microbiology
- Gastroenterology
Background:
- Acute infectious diarrhea (AID) is a significant global health issue in children.
- Probiotics offer a promising intervention for AID due to their multifaceted actions on the gut.
- Strain-specific efficacy and appropriate usage are crucial for successful probiotic intervention.
Purpose of the Study:
- To summarize the mechanisms of action of probiotics in pediatric AID.
- To review evidence supporting probiotic use in the prevention and treatment of infant AID.
- To highlight the strongest indications for probiotic therapy in children.
Main Methods:
- Review of scientific literature on probiotic mechanisms and clinical efficacy in AID.
- Analysis of evidence for both treatment and prevention of AID in infants and children.
- Focus on strain selection, dosage, and specific indications.
Main Results:
- Probiotic therapy for AID is strongly supported by guidelines, with proven efficacy and safety for selected strains and doses.
- Probiotics are most convincingly effective in treating AID, representing a primary medical indication.
- Evidence supports probiotic use in preventing hospital-acquired diarrhea but is less conclusive for healthy populations or community settings.
Conclusions:
- Probiotic use in children with AID is well-supported, especially for treatment with specific strains early after symptom onset.
- Prevention of AID with probiotics is most relevant for at-risk populations, not the general healthy child population.
- Further research is needed to establish efficacy in understudied populations and settings.
Abstract:
Acute infectious diarrhea (AID) is one of the most common diseases in pediatric age with relevant burden both in high- and in low-income countries.Thanks to their direct action on enterocyte functions and indirect actions on mucosal and systemic immune system and intestinal microenvironment, probiotics are an ideal intervention to manage AID in childhood. However, their efficacy is strictly related to strains and indications, and practitioners should take this information into account in clinical practice.This chapter summarizes the main mechanisms of action of probiotics in AID, with a focus on proof of efficacy supporting their use in prevention and treatment of infant AID.The use of selected strains in appropriate doses is strongly recommended by guidelines of AID, based on large and consistent proofs of efficacy and safety. At present, therapy with probiotics of AID is arguably the strongest indication for probiotics in medicine. Future research should investigate probiotic efficacy in at-risk populations and settings where the evidence is missing.Their role in prevention of AID is however questionable in healthy population, whereas it should be considered in at-risk population. Evidence for prevention of diarrhea in day-care centers and communities is lacking, but consistent evidence supports efficacy in prevention of hospital acquired diarrhea.Overall, AID is the most convincing area for probiotic use in children, and effective strains should be used early after onset of symptoms.
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