Meta-analysis: Lactobacillus reuteri strain DSM 17938 (and the original strain ATCC 55730) for treating acute gastroenteritis in children.
Lactobacillus reuteri ATCC 55730 has been shown to provide a moderate clinical effect in the treatment of acute gastroenteritis (AGE) in children. However, as the L. reuteri ATCC 55730 strain was found to carry potentially transferable resistance traits for tetracycline and lincomycin, it was replaced by a new strain, L. reuteri DSM 17938, without unwanted plasmid-borne antibiotic resistance. Bioequivalence of the two strains has been suggested. We aimed to systematically evaluate data on the effectiveness of L. reuteri DSM 17938 and the original strain, L. reuteri ATCC 55730, in the treatment of AGE in children. The Cochrane Library, MEDLINE, and EMBASE databases, reference lists, and abstract books of major scientific meetings were searched in August 2013, with no language restrictions, for relevant randomised controlled trials (RCTs). Two RCTs (n=196) that evaluated L. reuteri DSM 17938 and three RCTs (n=156) that evaluated L. reuteri ATCC 55730, which involved hospitalised children aged 3 to 60 months, met the inclusion criteria. Compared with placebo or no treatment, DSM 17938 significantly reduced the duration of diarrhoea (mean difference -32 h, 95% confidence interval (CI): -41 to -24) and increased the chance of cure on day 3 (relative risk: 3.5, 95% CI: 1.2 to 10.8, random effects model). Similar results were obtained with the original strain, L. reuteri ATCC 55730. In conclusion, in hospitalised children, use of both strains of L. reuteri reduced the duration of diarrhoea, and more children were cured within 3 days. Data from outpatients and countryspecific cost-effectiveness analyses are needed. Given the limited data and the methodological limitations of the included trials, the evidence should be viewed with caution.
Department of Paediatrics, The Medical University of Warsaw, Dzialdowska 1, 01-184 Warsaw, Poland.
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Szajewska
Department of Paediatrics, The Medical University of Warsaw, Dzialdowska 1, 01-184 Warsaw, Poland.
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Urbańska
Department of Paediatrics, The Medical University of Warsaw, Dzialdowska 1, 01-184 Warsaw, Poland.
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Chmielewska
Pediatric Gastroenterology and Nutrition Unit, Soroka Medical Center, Ben-Gurion University, P.O. Box 151, Beer-Sheva, Israel.
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Weizman
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, P.O. Box 559, Petach Tikvah 49202, Israel.
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Shamir
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002675:Child, Preschool; D003967:Diarrhea / Q000188:drug therapy / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D005243:Feces / Q000382:microbiology; D005759:Gastroenteritis / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007223:Infant; D052200:Limosilactobacillus reuteri / Q000145:classification* / Q000187:drug effects* / Q000378:metabolism; D008034:Lincomycin / Q000494:pharmacology; D019936:Probiotics / Q000627:therapeutic use*; D013752:Tetracycline / Q000494:pharmacology
D000900:Anti-Bacterial Agents; D008034:Lincomycin; D013752:Tetracycline
L. reuteri; RCT; diarrhoea; infants; microbiota; probiotics; systematic review