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Published on: January 27, 2019
Pathogen-Specific Effects of Probiotics in Children With Acute Gastroenteritis Seeking Emergency Care: A Randomized
Stephen B Freedman1, Yaron Finkelstein2, Xiao Li Pang3,4
1Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Insights
Probiotics did not show pathogen-specific benefits for children with acute gastroenteritis. This study found no evidence that probiotics reduce disease severity across common pathogens in pediatric diarrhea.
Area of Science:
- Pediatric Gastroenterology
- Microbiome Research
- Clinical Trials
Background:
- The efficacy of probiotics in treating pediatric acute gastroenteritis is not fully understood, particularly regarding pathogen-specific effects.
- Investigating whether probiotics offer targeted benefits against specific infectious agents causing diarrhea in children is crucial for optimizing treatment strategies.
Purpose of the Study:
- To determine if specific probiotic strains provide pathogen-specific benefits in children suffering from diarrhea due to acute gastroenteritis.
- To analyze patient-level data from randomized controlled trials to assess the impact of probiotics on disease severity based on identified pathogens.
Main Methods:
- A pooled analysis of two multicenter, randomized, placebo-controlled trials involving children aged 3-48 months with acute diarrhea.
- Participants received either a probiotic preparation (Lactobacillus rhamnosus R0011/Lactobacillus helveticus R0052 or L. rhamnosus GG) or a placebo.
- The primary outcome measured was the incidence of moderate-to-severe disease, assessed using the Modified Vesikari Scale (MVS) score.
Main Results:
- Pathogens were identified in 59.3% of the participants. No significant pathogen-specific differences in moderate-to-severe disease (MVS score ≥9) were observed between probiotic and placebo groups.
- No differences in diarrhea duration or stool frequency were found between treatment groups, irrespective of pathogen or probiotic subgroup.
- A potential benefit was noted in children with adenovirus infection who received L. rhamnosus R0011/L. helveticus R0052, experiencing fewer diarrheal episodes.
Conclusions:
- The study concludes that neither probiotic product demonstrated pathogen-specific efficacy in reducing disease severity in children with acute gastroenteritis compared to placebo.
- The overall evidence does not support the use of probiotics for pathogen-specific benefits in this pediatric population.
- Further research may be needed to explore potential niche benefits, such as the observed effect in adenovirus infections.
Background:
It is unknown if probiotics exert pathogen-specific effects in children with diarrhea secondary to acute gastroenteritis.
Methods:
Analysis of patient-level data from 2 multicenter randomized, placebo controlled trials conducted in pediatric emergency departments in Canada and the United States. 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 US studies, respectively. Participants received either placebo or a probiotic preparation (Canada-Lactobacillus rhamnosus R0011/Lactobacillus helveticus R0052; US-L. rhamnosus GG). The primary outcome was post-intervention moderate-to-severe disease (ie, ≥9 on the Modified Vesikari Scale [MVS] score).
Results:
Pathogens were identified in specimens from 59.3% of children (928/1565). No pathogen groups were less likely to experience an MVS score ≥9 based on treatment allocation (test for interaction = 0.35). No differences between groups were identified for adenovirus (adjusted relative risk [aRR]: 1.42; 95% confidence interval [CI]: .62, 3.23), norovirus (aRR: 0.98; 95% CI: .56, 1.74), rotavirus (aRR: 0.86; 95% CI: .43, 1.71) or bacteria (aRR: 1.19; 95% CI: .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 L. rhamnosus R0011/L. helveticus R0052 product experienced fewer diarrheal episodes (aRR: 0.65; 95% CI: .47, .90).
Conclusions:
Neither probiotic product resulted in less severe disease compared to placebo across a range of the most common etiologic pathogens. The preponderance of evidence does not support the notion that there are pathogen specific benefits associated with probiotic use in children with acute gastroenteritis.
Clinical Trials Registration:
NCT01773967 and NCT01853124.
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