Lactobacillus reuteri Supplementation for 3 Months Reduces the Number and Duration of Diarrhea Episodes in Children Attending Child Care

EBM Focus - Volume 9, Issue 15

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Reference: Pediatrics 2014 Apr;133(4):e904 (level 1 [likely reliable] evidence)

Children attending child care have an increased risk of acute diarrhea compared to children in home care (J Pediatr 1997 Sep;131(3):476). Probiotic supplementation has been evaluated for prevention of acute diarrhea in children, but the setting and choice of live bacterial supplement has varied widely. A recent randomized trial evaluated Lactobacillus reuteri DSM 17938 in 332 healthy children aged 6-36 months attending child care in Mexico.

Children were randomized to Lactobacillus reuteri DSM 17938 1 x 108 colony-forming units vs. placebo for 3 months and followed to 6 months. All children were born at term and were at least 2.5 kg at birth. Children with chronic disease, failure to thrive, allergy or atopic disease, or exposure to probiotics, prebiotics, or antibiotics in previous 4 weeks were excluded. Both interventions were administered once daily as 5 drops of oil formulation from dropper bottle directly in the mouth during the first feed at home. Antibiotic use was allowed for febrile episodes that persisted for > 72 hours.

The mean number of diarrhea episodes (passage of ≥ 3 watery stools within 24 hours) per child over the first 3 months was 0.2 with L. reuteri vs. 0.4 with placebo (p = 0.02). The mean duration of diarrhea episodes per child at 3 months was 0.32 days with L. reuteri vs. 0.96 days with placebo (p = 0.03). L. reuteri was also associated with reductions in the number and duration of febrile episodes per child (mean number 0.4 vs. 1.1, p = 0.03; mean duration 1.2 days vs. 2.8 days, p = 0.03), and the number and duration of respiratory tract infections per child (mean number 0.6 vs. 1.2, p = 0.01; mean duration 1.5 days vs. 4.6 days, p = 0.01). The mean duration of antibiotic use per child was 2.7 days with L. reuteri vs. 4.1 with placebo (p = 0.04). The outcomes above were also significantly reduced with L. reuteri compared to placebo from 3-6 months. No treatment-related adverse events were reported. In addition, L. reuteri was associated with significantly reduced costs in a cost-benefit analysis that included the cost of the intervention, estimated costs of school or work absenteeism, and estimated medical costs for an episode of diarrhea or respiratory infection.

This trial demonstrates that supplementation with Lactobacillus reuteri DSM 17938 reduces both the number and duration of diarrhea episodes in children attending child care. These results are consistent with a previous trial from Israel, which found that Bifidobacterium lactis BB-12 and Lactobacillus reuteri ATCC 55730 each reduced the number and duration of diarrhea episodes in infants aged 4-10 months attending child care (Pediatrics 2005 Jan;115(1):5). These probiotics are commercially available without a prescription, and are available in a variety of formats for young children, including oil drops, powders for mixing with infant formula, and chewable tablets. Further studies will help develop specific recommendations on what bacterial strains and methods of administration will optimize supplementation for acute diarrhea prophylaxis.

For more information see the Prevention of acute diarrhea and Probiotics topics in DynaMed.