title: Systematic review of probiotics for the treatment of community-acquired acute diarrhea in children.
abstract: BACKGROUND
  Oral rehydration salts (ORS), zinc, and continued feeding are the recommended treatments for community-acquired acute diarrhea among young children. However, probiotics are becoming increasingly popular treatments for diarrhea in some countries. We sought to estimate the effect of probiotics on diarrhea morbidity and mortality in children < 5 years of age.
  
  
  METHODS
  We conducted a systematic review of randomized controlled trials to estimate the effect of probiotic microorganisms for the treatment of community-acquired acute diarrhea in children. Data were abstracted into a standardized table and study quality was assessed using the Child Health Epidemiology Reference Group (CHERG) adaption of the GRADE technique. We measured the relative effect of probiotic treatment in addition to recommended rehydration on hospitalizations, duration and severity. We then calculated the average percent difference for all continuous outcomes and performed a meta-analysis for discrete outcomes.
  
  
  RESULTS
  We identified 8 studies for inclusion in the final database. No studies reported diarrhea mortality and overall the evidence was low to moderate quality. Probiotics reduced diarrhea duration by 14.0% (95% CI: 3.8-24.2%) and stool frequency on the second day of treatment by 13.1% (95% CI: 0.8 - 25.3%). There was no effect on the risk of diarrhea hospitalizations.
  
  
  CONCLUSIONS
  Probiotics may be efficacious in reducing diarrhea duration and stool frequency during a diarrhea episode. However, only few studies have been conducted in low-income countries and none used zinc (the current recommendation) thus additional research is needed to understand the effect of probiotics as adjunct therapy for diarrhea among children in developing countries.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Applegate
authors.forename: Christa L
authors.initials: CL
authors.lastname: Fischer Walker
authors.forename: Ramya
authors.initials: R
authors.lastname: Ambikapathi
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
mesh_terms: D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality; D003906:Developing Countries; D003967:Diarrhea / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D011203:Poverty; D019936:Probiotics / Q000627:therapeutic use*; D015532:Rehydration Solutions / Q000627:therapeutic use; D014131:Trace Elements / Q000627:therapeutic use; D015032:Zinc / Q000627:therapeutic use
chemical_list: D015532:Rehydration Solutions; D014131:Trace Elements; D015032:Zinc