Use of Probiotics For The Management of Acute Gastroenteritis. A Position Paper By The Espghan Working Group For Probiotics.

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 four categories of the quality of the evidence (high; moderate; low; and very low) and two 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: L. rhamnosus GG (low quality of evidence; strong recommendation) and S. boulardii (low quality of evidence; strong recommendation). Less compelling evidence is available for L. reuteri DSM 17938 (very low quality of evidence; weak recommendation) and heat-inactivated L. 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