title: Use of probiotics for management of acute gastroenteritis: a position paper by the ESPGHAN Working Group for Probiotics and Prebiotics.
abstract: The use of probiotics has been suggested in the treatment of acute gastroenteritis (AGE) in addition to early rehydration and avoidance of dietary restrictions. This document provides recommendations for the use of probiotics for the treatment of AGE in previously healthy infants and children based on a systematic review of previously completed systematic reviews and of randomized controlled trials (RCTs) published subsequently to these reviews. The recommendations were formulated only if at least 2 RCTs that used a given probiotic (with strain specification) were available. The GRADE system developed by the Grading of Recommendations, Assessment, Development, and Evaluations Working Group, was used to grade the strength of evidence and grades of recommendations used in these guidelines. It offers 4 categories of the quality of the evidence (high, moderate, low, and very low) and 2 categories of the strength of recommendation (strong or weak). The use of the following probiotics (in alphabetical order) may be considered in the management of children with AGE in addition to rehydration therapy: Lactobacillus rhamnosus GG (low quality of evidence, strong recommendation) and Saccharomyces boulardii (low quality of evidence, strong recommendation). Less compelling evidence is available for Lactobacillus reuteri DSM 17938 (very low quality of evidence, weak recommendation) and heat-inactivated Lactobacillus acidophilus LB (very low quality of evidence, weak recommendation). The latter, although traditionally discussed with other probiotics, does not fit with the definition of probiotics. Other strains or combinations of strains have been tested, but evidence of their efficacy is weak or preliminary.
authors.affiliation: *Medical University of Warsaw, Department of Paediatrics, Warsaw, Poland †Department of Translational Medicine, Section of Pediatrics, University of Naples Federico II, Naples, Italy ‡Department of Paediatrics, Children's Hospital Zagreb, University of Zagreb School um of Medicine, Zagreb, Croatia §Department of Pediatrics, University Hospital Policlinico, University of Bari, Italy ||Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Israel ¶Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium #Pediatric Gastroenterology and Nutrition Unit, Soroka Medical Center, Ben-Gurion University, Beer-Sheva, Israel.
authors.forename: Hania
authors.initials: H
authors.lastname: Szajewska
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guarino
authors.forename: Iva
authors.initials: I
authors.lastname: Hojsak
authors.forename: Flavia
authors.initials: F
authors.lastname: Indrio
authors.forename: Sanja
authors.initials: S
authors.lastname: Kolacek
authors.forename: Raanan
authors.initials: R
authors.lastname: Shamir
authors.forename: Yvan
authors.initials: Y
authors.lastname: Vandenplas
authors.forename: Zvi
authors.initials: Z
authors.lastname: Weizman
mesh_terms: D000208:Acute Disease; D001407:Bacillus; D001644:Bifidobacterium; D019317:Evidence-Based Medicine; D005759:Gastroenteritis / Q000628:therapy*; D006801:Humans; D007778:Lactobacillus; D019936:Probiotics / Q000627:therapeutic use*; D012440:Saccharomyces