The significance of probiotics as an adjuvant therapy by acute gastroenteritis in children under 5 years old


  • M. Teslenko Shupyk National Medical Academy of Postgraduate Education, Kуiv, Ukraine, Ukraine


children, acute gastroenteritis, probiotics, rotavirus


Acute gastroenteritis (AGE) is one of the most common diseases worldwide. Most cases are self-limited and do not required medication. However, in the world there are various recommendations about the use of probiotics in addition to oral rehydration solutions in treatment of AGE.
Aim. To substantiate the choice of probiotics as adjuvant therapy for AGE, including rotavirus etiology, in children under 5 years by comparing the significance of probiotics with different types of evidence.
Materials and methods. 265 children under 5 who were hospitalized at infectious department with symptoms of AGE were monitored from 2015 to 2017. The choice of probiotic drug was accidental and depended on the availability of a type of probiotics at the time of hospitalization. The following clinical criteria were evaluated: number of episodes of rare faeces per day, duration of hospitalization, and duration of diarrheal syndrome. Non-parametric statistical criteria were used for the calculation.
Results. There are a significant difference in the episodes of stool per day by rotavirus AGE. Lactobacillus rhamnosus GG (LGG) or Saccharomyces boulardii (S. boulardii) have shown the better effect in reduction of stool frequency then L reuteri DSM 17938 (p<0.05). We received the same affect when compared LGG / S. boulardii with probiotics with insufficient evidence (European Society for Paediatric Gastroenterology, Hepatology and Nutrition, 2014). There are no significant differences between the probiotics in the duration of hospitalization and the duration of diarrheal syndrome.
Conclusions. Probiotics reduce the stool frequency, but they have any effect on the duration of diarrhea syndrome and duration of hospitalization. Probiotics which have insufficient evidence have shown the best results in rotavirus AGE. Among probiotics, which lack evidence base, the least effect was a multiprobiotic with the following composition: Lactobacillus casei, Lactobacillus rhamnosus, Streptococcus thermophylus, Bifidobacterium breve, Lactobacillus acidophylus, Bifidobacterium infantis, Lactobacillus bulgaricus.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee (LEC) of an participating institution. The informed consent of the patient was obtained for conducting the studies.


State Register of Medicines of Ukraine.]

Chernyshova L, Teslenko M еt al. (2016). Longitudinal surveillance of rotavirus infection in children under 5 hospitalized in two centers in Ukraine in 2006–2015. Zdorov'ye rebenka. 7: 117–123.

Chernyshova LI, Teslenko MYu, Radionova NM, Kasyan OI. (2017). Clinical course of rotavirus gastroenteritis in children younger than 5 years in recent times. Sovremennaya pediatriya. 4(84): 96–100.

Ahmadi E, Alizadeh;Navaei R, Rezai MS. (2015). Efficacy of probiotic use in acute rotavirus diarrhea in children: A systematic review and meta-analysis. Casp J Intern Med.6;4: 187–195.

Allen SJ et al. (2010). Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst. Rev.11: CD003048.; PMid:21069673 PMCid:PMC6532699

Canani RB et al. (2007). Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations. BMJ. 335;7615: 340.; PMid:17690340 PMCid:PMC1949444

Elliott EJ. (2007). Acute gastroenteritis in children. BMJ.334;7583: 35–40.; PMid:17204802 PMCid:PMC1764079

Erdogan O et al. (2012). The Comparition of the Efficacy of Two Different Probiotics in Rotavirus Gastroenteritis in Children. Journal of Tropical Medicine. 2012, Article ID 787240.; PMid:22778754 PMCid:PMC3388355

Francavilla R, Lionetti E, Castellaneta S, Ciruzzi F et al. (2012, Aug). Randomised clinical trial: Lactobacillus reuteri DSM 17938 vs. placebo in children with acute diarrhoea — a double-blind study. Aliment Pharmacol Ther. 36(4): 363–9.; PMid:22680836

Guarino A et al. (2014). European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence;based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr Gastroenterol Nutr. 59;1: 132–152.; PMid:24739189

Jose van den Berg, Marjolein Y Berger. (2011). Guidelines on acute gastroenteritis in children: a critical appraisal of their quality and applicability in primary care. BMC Family Practice 12, Article number: 134.; PMid:22136388 PMCid:PMC3331832

King CK et al. (2003). Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm. Rep. Morb. Mortal. Wkly. Rep. Recomm. Rep. 52;RR–16: 1–16.

Mirzayeva R et al. (2009). Rotavirus burden among children in the newly independent states of the former union of soviet socialist republics: literature review and first;year results from the rotavirus surveillance network. J Infect Dis. 200;1: S203–214.; PMid:19817601

Rosenfeldt V et al. (2002). Effect of probiotic Lactobacillus strains on acute diarrhea in a cohort of nonhospitalized children attending day;care centers. Pediatr Infect Dis J.21;5: 417.; PMid:12150179

Rosenfeldt V et al. (2003). Effect of probiotic Lactobacillus strains in children with atopic dermatitis. J Allergy Clin Immunol. 111;2: 389–395.; PMid:12589361

Shornikova AV, Casas IA, Isolauri E, Mykkanen H, Vesikari T. (1997, Apr). Lactobacillus reuteri as a therapeutic agent in acute diarrhea in young children. J Pediatr Gastroenterol Nutr. 24(4): 399–404.; PMid:9144122

Shornikova AV, Casas IA, Mykkanen H, Salo E, Vesikari T. (1997, Dec). Bacteriotherapy with Lactobacillus reuteri in rotavirus gastroenteritis. Pediatr Infect Dis J.16(12): 1103–7.; PMid:9427453

Szajewska H et al. (2014). Use of Probiotics for Management of Acute Gastroenteritis: A Position Paper by the ESPGHAN Working Group for Probiotics and Prebiotics. J Pediatr Gastroenterol Nutr. 58;4: 531.; PMCid:PMC3969152

Szajewska H, Skorka A, Dylag M. (2007). Meta;analysis: Saccharomyces boulardii for treating acute diarrhoea in children. Aliment Pharmacol Ther. 25;3: 257–264.; PMid:17269987

Szajewska H, Urbanska M, Chmielewska A, Weizman Z, Shamir R. (2014, Sep). Meta;analysis: Lactobacillus reuteri strain DSM 17938 (and the original strain ATCC 55730) for treating acute gastroenteritis in children. Benef Microbes. 5(3): 285–93.; PMid:24463209.

WHO. Global Rotavirus Information and Surveillance Bulletin.



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