Limitations of probiotic therapy in acute, severe dehydrating diarrhea.
BACKGROUND
Recent studies have shown that probiotics, most commonly, may be useful in treating acute gastroenteritis. However, beneficial effects appear to be limited to a modest decrease in the duration of diarrhea. No studies have evaluated this therapy in moderate to severe dehydrating diarrhea in a metabolic facility.


METHODS
Male children less than 2 years of age were admitted to a metabolic unit of the Department of Pediatrics at the Federal University of Bahia, Brazil, with moderate dehydration and were randomized in a double-blind, placebo-controlled fashion. Oral rehydration solution (ORS) was administered per protocol and either placebo or was given in combination with the ORS. Output of urine, stool, and vomitus was recorded along with stool weight, nude body weight, and standard laboratory assessments for hydration.


RESULTS
There was no significant reduction in diarrhea duration and stool output in the group. However, Kaplan-Meier survival analysis demonstrated that, even in moderate to severe diarrhea, resolution of the illness occurred so rapidly, that statistically significant benefits of probiotic therapy could not be demonstrated.


CONCLUSIONS
Our data implies that colonization must occur before benefits of probiotics can be realized. Probiotics are, therefore, likely to be of limited benefit in treating diarrheal illnesses of short duration such as viral enteritis. The beneficial effects of probiotics may be limited to prophylactic usage in high-risk populations.
Costa-Ribeiro
Hugo
H
Department of Pediatrics, School of Medicine, Federal University of Bahia Salvador, Bahia, Brazil.
Ribeiro
Tereza Cristina M
TC
Mattos
Angela P
AP
Valois
Sandra S
SS
Neri
Daniela A
DA
Almeida
Patricia
P
Cerqueira
Celina M
CM
Ramos
Eduardo
E
Young
Rosemary J
RJ
Vanderhoof
Jon A
JA
D000208:Acute Disease; D001938:Brazil; D003681:Dehydration / Q000209:etiology*; D003968:Diarrhea, Infantile / Q000382:microbiology / Q000628:therapy*; D004311:Double-Blind Method; D005440:Fluid Therapy; D006801:Humans; D007223:Infant; D007778:Lactobacillus; D008297:Male; D019936:Probiotics / Q000627:therapeutic use*; D016019:Survival Analysis; D013997:Time Factors