Effect of probiotic Lactobacillus strains in young children hospitalized with acute diarrhea Nitazoxanide vs. probiotics for the treatment of acute rotavirus diarrhea in children: a randomized, single-blind, controlled trial in Bolivian children. Lactobacillus paracasei Strain ST11 Has No Effect on Rotavirus but Ameliorates the Outcome of Nonrotavirus Diarrhea in Children From Bangladesh Effect of probiotic Lactobacillus strains on acute diarrhea in a cohort of nonhospitalized children attending day-care centers Probiotics in the treatment of acute rotavirus diarrhoea. A randomized, double-blind, controlled trial using two different probiotic preparations in Bolivian children Immune response and intestinal permeability in children with acute gastroenteritis treated with Lactobacillus rhamnosus GG: a randomized, double-blind, placebo-controlled trial. A randomized placebo-controlled clinical trial of a multi-strain probiotic formulation (Bio-Kult®) in the management of diarrhea-predominant irritable bowel syndrome Limitations of Probiotic Therapy in Acute, Severe Dehydrating Diarrhea Lactic Acid Bacteria in the Treatment of Acute Rotavirus Gastroenteritis Evaluation of a Diet Containing Probiotics and Zinc for the Treatment of Mild Diarrheal Illness in Children Younger Than One Year of Age Use of VSL♯3 in the Treatment of Rotavirus Diarrhea in Children: Preliminary Results Randomized controlled trial of probiotics to reduce common cold in schoolchildren. Oral bacterial therapy reduces the duration of symptoms and of viral excretion in children with mild diarrhea. Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations The effects of multi-strain probiotic compound on symptoms and quality-of-life in patients with irritable bowel syndrome: A randomized placebo-controlled trial The effect of fermented yogurt on the prevention of diarrhea in a healthy adult population. Randomised controlled clinical trial of Lactobacillus sporogenes (Bacillus coagulans), used as probiotic in clinical practice, on acute watery diarrhoea in children. Probiotic Therapy of the Irritable Bowel Syndrome: Why Is the Evidence Still Poor and What Can Be Done About It? Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis Probiotics and prebiotics in gastrointestinal disorders Prophylactic Lactobacillus GGReduces Antibiotic-Associated Diarrhea in Children With Respiratory Infections: A Randomized Study Effect of chewing gums containing the probiotic bacterium Lactobacillus reuteri on oral malodour
Background . Oral bacteriotherapy promotes recovery from acute childhood diarrhea , but few strains have been shown to have therapeutic potentials . We examined the effect of two newly identified probiotic Lactobacillus strains in acute childhood diarrhea .  Methods . Sixty-nine children were r and omized during hospitalization for acute diarrhea to receive a mixture of Lactobacillus rhamnosus 19070 - 2 and Lactobacillus reuteri DSM 12246 , 1010 colony-forming units of each strain or placebo twice daily for 5 days . Before selection of these stains their potential probiotic characteristics were demonstrated in vitro and in healthy volunteers . Results . In patients receiving probiotics , the diarrheal phase was reduced by 20 % . The duration of diarrhea was 82 h in the treatment group vs. 101 h in the control group ( not significant , P = 0.07 ) . However , 3 of 30 patients from the treatment group vs. 13 of 39 from the control group still had loose stools at the end of the study period ( P = 0.03 ) . In patients with diarrhea for < 60 h before start of treatment ( early intervention ) , a clear effect of the probiotics was demonstrated ( 80 h in the treatment group vs. 130 h in the control group , P = 0.003 ) . After early intervention , the length of hospitalization was reduced by 48 % ( 3.5 vs. 1.7 days , P = 0.03 ) . At the end of the intervention , rotavirus antigen was found in 12 % of patients from the treatment group vs. 46 % from the control group ( P = 0.02 ) . Conclusions . The two probiotics , L. rhamnosus 19070 - 2 and L. reuteri DSM 12246 , ameliorated acute  diarrhea in hospitalized children and reduced the period of rotavirus excretion . Oral bacteriotherapy was associated with a reduced length of hospital stay . The beneficial effects were most prominent in children treated early in the diarrheal phase BACKGROUND In previous studies , nitazoxanide has demonstrated a cytoprotective effect against rotavirus , reducing the duration of diarrhea in comparison to placebo . We design ed a r and omized , single-blind , controlled trial in order to assess the effectiveness of nitazoxanide and probiotics in comparison with a control group . METHODS Seventy-five children aged from 28 days to 24 months , with rotavirus diarrhea , were r and omly assigned to receive either oral nitazoxanide ( 15 mg/kg/day ) twice a day for three days , a combination of oral probiotics , 1 g twice a day for five days , or only oral or systemic rehydration solutions . The duration of diarrhea and of hospitalization were the primary outcome measures , and daily stool frequency , vomiting , and fever were some of the secondary outcome measures analyzed . RESULTS The median duration of hospitalization was significantly shorter ( p = 0.017 ) in patients who received nitazoxanide ( 81 h ) and probiotics ( 72 h ) compared to patients who received oral rehydration solution alone ( 108 h ) . Similarly , the median duration of diarrhea was significantly reduced ( p = 0.009 ) in children who received nitazoxanide ( 54 h ) and probiotics ( 48 h ) compared to the control group ( 79 h ) . CONCLUSIONS Treatment with nitazoxanide and probiotics is effective in the management of children with acute rotavirus diarrhea . Small differences in favor of nitazoxanide were found in comparison with probiotics . Nitazoxanide is an important treatment option for rotavirus diarrhea Background . Previous studies have shown that selected strains of lactobacilli that are administered orally result in a modest reduction of diarrhea duration . However , duration alone is not considered optimal for therapeutic evaluation of any agent in diarrhea . Objective . To examine the effect of a new probiotic , Lactobacillus paracasei strain ST11 ( ST11 ) , in acute childhood diarrhea by using evaluation criteria recommended by the World Health Organization . Methods . In a r and omized , double-blind , placebo-controlled clinical trial , 230 male infants and young children , 4 to 24 months of age , presenting with diarrhea of < 2 days ' duration were admitted to the metabolic research ward of the International Centre for Diarrheal Disease Research , Bangladesh , and fed 1010 colony-forming units of lyophilized ST11 or placebo daily for 5 days . Stool output and frequency , oral rehydration solution intake , and excretion of rotavirus were monitored daily . Results . No effect of ST11 treatment on severe rotavirus diarrhea was observed . However , the probiotic treatment did significantly reduce cumulative stool output ( 225 ± 218 vs 381 ± 240 mL/kg ) , stool frequency ( 27.9 ± 17 vs 42.5 ± 26 ) , and oral rehydration solution intake ( 180 ± 207 vs 331 ± 236 mL/kg ) in children with less-severe nonrotavirus diarrhea compared with those receiving placebo treatment . A significantly higher proportion of nonrotavirus children receiving ST11 had their diarrhea resolve within 6 days of therapy ( ST11 versus placebo : 76 % vs 49 % ) . Conclusions . ST11 has a clinical ly significant benefit in the management of children with nonrotavirus-induced diarrhea , but it is ineffective in those with rotavirus diarrhea Background . Certain strains of lactobacilli have been shown to promote recovery from rotavirus enteritis in hospitalized children . Few studies have examined the effect of probiotics in nonhospitalized children with mild diarrhea . Methods . We studied in a r and omized placebo-controlled trial the effect of lyophilized Lactobacillus rhamnosus 19070 - 2 and Lactobacillus reuteri DSM 12246 , 1010 colony-forming units of each strain twice daily for 5 days , on acute diarrhea in children in a cohort of children recruited from local day-care centers . The duration of diarrhea and assessment of stool consistency were recorded by the parents . Results . In patients treated with the selected Lactobacillus strains , the mean duration of diarrhea after intervention was reduced ( 76 h in patients treated with probiotics vs. 116 h in the placebo group;P = 0.05 ) . In patients with diarrhea for < 60 h before start of treatment ( early intervention ) , a more pronounced effect of probiotics was found . The time to recovery after early treatment was 79 h vs. 139 h in the placebo group ( P = 0.02 ) ; 1 of 17 patients treated early vs. 6 of 13 in the control group still had loose stools 120 h after start of treatment ( P = 0.03 ) . Conclusions . In children from day-care centers with mild gastroenteritis , the combination of L. rhamnosus 19070 - 2 and L. reuteri DSM 12246 was effective in reducing the duration of diarrhea Background Evidence suggests that probiotics reduce  rotavirus diarrhoea duration . Although there are several probiotic strains potentially useful , daily practice is often limited by the type and number of products locally available . In general , information about combined products is scarce . In this study we compare the effect of two probiotic products in the treatment of diarrhoea in children less than 2 years of age . Methods A R and omized double-blind controlled clinical trial in children hospitalized for acute rotavirus diarrhoea , in the Paediatric Centre Albina Patino , Cochabamba , Bolivia . Participants were children aged 1 - 23 months , who were r and omly assigned to receive one of three treatments : Oral rehydration therapy plus placebo ; Oral rehydration solution plus Saccharomyces boulardii ; or Oral rehydration solution plus a compound containing Lactobacillus acidophilus , Lactobacillus rhamnosus , Bifidobacterium longum and Saccharomyces boulardii . Sample size was 20 per group and the outcomes were duration of diarrhoea , of fever , of vomiting and of hospitalization . Results 64 cases finished the protocol . On admission , patients ' characteristics were similar . Median duration of diarrhoea ( p = 0.04 ) in children who received the single species product ( 58 hours ) was shorter than in controls ( 84.5 hrs ) . Comparing children that received the single probiotic product and controls showed shorter duration of fever ( 18 vs 67 hrs ) ( p = 0.0042 ) and the mixed probiotic of vomiting ( 0 vs 42.5 hrs ) ( p = 0.041 ) . There was no effect on duration of hospitalization ( p = 0.31 ) . When experimental groups were merged , statistical significance of changes increased ( total duration of diarrhoea , fever and vomiting P = 0.025 , P = 0.025 and P = 0.014 , respectively ) . Conclusions Both products decreased the duration of diarrhoea compared to oral rehydration solution alone . This decrease was significant only for the single species product which also decreased the duration of fever . With the multiple species product there was no vomiting subsequent to the initiation of treatment . The quantity of probiotic bacteria needed for optimum treatment of gastroenteritis remains to be determined , particularly when multiple species are included in the product . Trial Registration Clinical Trials ( NCT ) : BACKGROUND Probiotics have a possible role in the treatment of pediatric acute gastroenteritis . We report the effect of the probiotic Lactobacillus rhamnosus GG ( LGG ) on intestinal function , immune response , and clinical outcomes in Indian children with cryptosporidial or rotavirus diarrhea . METHODS Children with gastroenteritis aged 6 months to 5 years , testing positive for either rotavirus or Cryptosporidium species in stool ( coinfections were excluded ) , were r and omized to LGG ( ATCC 53103 ) or placebo , once daily for 4 weeks . Baseline demographic and clinical details were obtained . Sera were tested for immunoglobulin G ( IgG ) and immunoglobulin A ( IgA ) antibodies to Cryptosporidium and rotavirus , and the lactulose to mannitol ratio for intestinal permeability was determined at baseline and at the end of follow-up . RESULTS Of the 124 children enrolled , 82 and 42 had rotavirus and cryptosporidial diarrhea , respectively . Median diarrheal duration was 4 days ; one-third of the children had severe diarrhea . Baseline and clinical parameters were comparable between children receiving LGG and placebo . At the end of follow-up , fewer children with rotavirus diarrhea on LGG had repeated diarrheal episodes ( 25 % vs 46 % ; P = .048 ) and impaired intestinal function ( 48 % vs 72 % ; P = .027 ) . Significant increase in IgG levels postintervention ( 456 vs 2215 EU ; P = .003 ) was observed in children with rotavirus diarrhea receiving LGG . Among children with cryptosporidial diarrhea , those receiving LGG showed significant improvement in intestinal permeability . CONCLUSIONS LGG has a positive immunomodulatory effect and may be useful in decreasing repeated episodes of rotavirus diarrhea . Improvement in intestinal function in children with rotavirus and cryptosporidial gastroenteritis emphasizes the role of probiotics in treating intestinal impairment after infection . CLINICAL TRIALS REGISTRATION CTRI/2010/091/000339 Background Accumulating evidence supports the view that an imbalance of gut bacteria contributes to IBS , and that increasing the mass of beneficial species may reduce the numbers of pathogenic bacteria and help alleviate symptoms . Methods In this double-blind trial 400 adult patients with moderate-to-severe symptomatic diarrhea-predominant IBS ( IBS-D ) were r and omized to treatment with the multi-strain probiotic Bio-Kult ® ( 14 different bacterial strains ) or placebo for 16 weeks . The change in severity and frequency of abdominal pain was the primary outcome measure . Results Probiotic treatment significantly improved the severity of abdominal pain in patients with IBS-D. A 69 % reduction for probiotic versus 47 % for placebo ( p < 0.001 ) equates to a 145 point reduction on the IBS-severity scoring system ( IBS-SSS ) . The proportion of patients who rated their symptoms as moderate-to-severe was reduced from 100 % at baseline to 14 % for the multi-strain probiotic at follow-up ( month 5 ) versus 48 % for placebo ( p < 0.001 ) . Also , the number of bowel motions per day from month 2 onwards was significantly reduced in the probiotic group compared with the placebo group ( p < 0.05 ) . In addition to relieving symptoms , the probiotic markedly improved all dimensions of quality of life in the 34-item IBS- Quality of Life ( IBS-QoL ) question naire . No serious adverse events were reported . Conclusions The multi-strain probiotic was associated with significant improvement in symptoms in patients with IBS-D and was well-tolerated . These results suggest that probiotics confer a benefit in IBS-D patients which deserves further investigation . Trial registration [ Clinical trials.gov NCT03251625 ; retrospectively registered on August 9 , 2017 ] Background Recent studies have shown that probiotics , most commonly Lactobacillus GG , may be useful in treating acute gastroenteritis . However , beneficial effects appear to be limited to a modest decrease in the duration of diarrhea . No studies have evaluated this therapy in moderate to severe dehydrating diarrhea in a metabolic facility . Methods Male children less than 2 years of age were admitted to a metabolic unit of the Department of Pediatrics at the Federal University of Bahia , Brazil , with moderate dehydration and were r and omized in a double-blind , placebo-controlled fashion . Oral rehydration solution ( ORS ) was administered per protocol and either placebo or Lactobacillus GG was given in combination with the ORS .  Output of urine , stool , and vomitus was recorded along with stool weight , nude body weight , and st and ard laboratory assessment s for hydration . Results There was no significant reduction in diarrhea duration and stool output in the Lactobacillus GG group . However , Kaplan-Meier survival analysis demonstrated that , even in moderate to severe diarrhea , resolution of the illness occurred so rapidly , that statistically significant benefits of probiotic therapy could not be demonstrated . Conclusion Our data implies that colonization must occur before benefits of probiotics can be realized . Probiotics are , therefore , likely to be of limited benefit in treating diarrheal illnesses of short duration such as viral enteritis . The beneficial effects of probiotics may be limited to prophylactic usage in high-risk population We compared different lactic acid bacteria for their effect on the immune response to rotavirus in children with acute rotavirus gastroenteritis . After initial oral rehydration , 49 children aged 6 to 35 months with rotavirus gastroenteritis r and omly received cither Lactobacillus casei subsp . casei strain GG ( LGG ) , L. casei subsp . rhamnosus ( Lactophilus ) , or a combination of Streptococcus thermophilus and L. delbriickii subsp . bulgaricus ( Yalacta ) twice daily for 5 days . Serum antibodies to rotavirus , total number of immunoglobulin-sec rct ing cells ( ISC ) , and specific antibody-secreting cells ( sASC ) to rotavirus were measured at the acute stage and at convalescence . The mean ( SD ) duration of diarrhea was 1.8 ( 0.8 ) days in children who received LGG , 2.8 ( 1.2 ) days in those receiving Lactophilus , and 2.6 ( 1.4 ) days in those receiving Yalacta ( F = 3.3 , p = 0.04 ) . The ISC response was comparable in the three study groups , but the rotavirus-specific immune responses were different . LGG therapy was associated with an enhancement of IgA sASC to rotavirus and serum IgA antibody level at convalescent stage . We conclude that certain strains of lactic acid bacteria , particularly LGG , promote serum and intestinal immune responses to rotavirus , and thus may be important in establishing immunity against rotavirus Objectives : Supplementation of probiotics and supplementation of zinc during acute gastroenteritis in children have been shown to exert positive effects on diarrhea duration and severity . Our aim was to evaluate a new diet enriched with zinc and probiotic bacteria in the treatment of acute gastroenteritis in young children . Methods : In a double blind prospect i ve study , 65 children aged 6–12 months were r and omized to receive 6 × 109 colony forming units of Streptococcus thermophilus , Bifidobacterium lactis , Lactobacillus acidophilus ( 2 × 109 of each strain ) , 10 mg of zinc/day , and 0.3 grams of fructo-oligosaccharides in the supplemented group ( n = 33 ) or placebo ( n = 32 ) , given in a soy protein based rice cereal . For each child , age , sex , weight , degree of dehydration , the presence of fever or vomiting , stool frequency and consistency were recorded daily until diarrhea resolution . Results : Diarrhea resolution occurred after 1.43 ± 0.71 days in the supplemented group vs. 1.96 ± 1.24 in the control group ( p = 0.017 ) . In the subset of children who presented with vomiting , time to vomiting resolution was 0.27 ± 0.59 vs. 0.81 ± 0.91 days in the supplemented and control groups , respectively ( p = 0.06 ) . On day 3 , there was only 1 child with watery stools in the supplemented group versus 10 children in the control group ( p = 0.02 ) . Conclusions : In our series , the feeding of a cereal containing Streptococcus thermophilus , Bifidobacterium lactis , Lactobacillus acidophilus and zinc , reduced the severity and duration of acute gastroenteritis in young children . However , whether this combination is better than either the addition of probiotics or zinc alone is yet to be determined We conducted a double-blind r and omized placebo-controlled study to evaluate efficacy and tolerability of VSL♯3 ( CD Pharma India ) in the treatment of acute rotavirus diarrhea in children . The patients were r and omly assigned to receive 4 days of oral treatment with VSL♯3 probiotic mixture or placebo in addition to usual care for diarrhea . Results : Out of 230 rotavirus-positive acute diarrhea children , 224 children completed the study , ( 113 in the drug group and 111 in the placebo group ) . At recruitment on Day 1 , there were no significant differences between the 2 groups in terms of frequency of vomiting , mean loose stool frequency , stool consistency , and mean frequency of oral rehydration salts ( ORS ) and intravenous fluids administered . On Day 2 , a lower mean stool frequency and improved stool consistency was noted in the drug group , which achieved statistical significance . This was also reflected in the lower volume of ORS administration in the drug group . Even on Day 3 , mean loose stool frequency and frequency of ORS use and frequency of intravenous fluid use was significantly lower in the drug group . The differences in the frequency of loose stools persisted till 8 hours of Day 4 . After this , as the placebo group also showed spontaneous improvement the difference between the 2 groups in terms of the overall stools frequency became comparable . However , the overall ORS requirement continued to be significantly lower in the drug group even on Day 4 . The overall recovery rates were significantly better in the drug group compared with placebo . No side effects were noted with the use of the probiotic mixture . Use of probiotic mixture VSL♯3 in acute rotavirus diarrhea result ed in earlier recovery and reduced frequency of ORS administration reflecting decreased stool volume losses during diarrhea BACKGROUND The common cold is responsible for the largest proportion of school and work absenteeism and causes a huge economic burden . None of the current interventions is greatly effective for prevention . Our aim was to assess the efficacy of a two-strain combination probiotic for prevention of common cold symptoms in healthy schoolchildren . METHODS A double-blind r and omized controlled trial was performed during the winter season in a public school of central Thail and . Children , aged 8 - 13 years , were r and omized to receive either a two-strain combination probiotic ( Lactobacillus acidophilus and Bifidobacterium bifidum ) or placebo given twice a day for 3 months . The primary outcome was any symptom of cold during the 3-month study period while vomiting , diarrhea , use of antibiotics , school absence due to any cause , school absence due to cold and duration of all symptoms were secondary outcomes . RESULTS Of the 40 children in each group , 31 ( 77 % ) in the probiotic group , compared to 38 ( 95 % ) in the placebo group ( P= 0.048 ) , developed at least one symptom of cold . Children in the probiotics group had significantly lower risk of fever , cough , rhinorrhea , school absence and school absence related to common cold compared to children in the placebo group . There was no impact on diarrhea and vomiting . CONCLUSION A two-strain probiotic combination given twice a day for 3 months was able to reduce the symptoms of the common cold and school absenteeism in schoolchildren BACKGROUND Oral administration of live Lactobacillus casei strain GG is associated with the reduction of duration of diarrhea in children admitted to the hospital because of diarrhea . The purpose s of this work were to investigate the clinical efficacy of oral administration of Lactobacillus in children with mild diarrhea who were observed as out patients , and to see whether Lactobacillus GG can reduce the duration of rotavirus excretion . METHODS Duration of diarrhea was recorded in 100 children seen by family pediatricians and r and omly assigned to receive oral rehydration or oral rehydration followed by the administration of lyophilized Lactobacillus casei , strain GG .  Rotavirus was looked for in the stools of all children and in those in whom results were positive , stools were examined again 6 days after the onset of diarrhea . RESULTS In 61 children results were positive for rotavirus and in 39 results were negative . Duration of diarrhea was reduced from 6 to 3 days in children receiving Lactobacillus GG , with a similar pattern in rotavirus-positive and -negative children . Six days after the onset of diarrhea , stools in only 4 out of 31 children that received Lactobacillus GG were positive for rotavirus compared with positive findings in 25 out of 30 control subjects . CONCLUSIONS Oral administration of Lactobacillus GG is effective in rotavirus-positive and rotavirus-negative ambulatory children with diarrhea . Furthermore , it reduces the duration of rotavirus excretion BACKGROUND The probiotic Lactobacillus GG is effective in promoting a more rapid recovery of acute , watery diarrhea in children with rotavirus enteritis . Very limited information is available , however , on the potential role of such agents in non-rotaviral diarrheal episodes . Furthermore , no evidence is available concerning the efficacy of Lactobacillus GG administered in the oral rehydration solution during oral rehydration therapy . A multicenter trial was conducted to evaluate the efficacy of Lactobacillus GG administered in the oral rehydration solution to patients with acute-onset diarrhea of all causes . METHODS Children 1 month to 3 years of age with acute-onset diarrhea were enrolled in a double-blind , placebo-controlled investigation . Patients were r and omly allocated to group A , receiving oral rehydration solution plus placebo , or group B , receiving the same preparation but with a live preparation of Lactobacillus GG ( at least 10(10 ) CFU/250 ml ) . After rehydration in the first 4 to 6 hours , patients were offered their usual feedings plus free access to the same solution until diarrhea stopped . RESULTS One hundred forty children were enrolled in group A , and 147 in group B. There were no differences at admission between the groups in age , sex , previous types of feeding , previous duration of diarrhea , use of antibiotics , weight , height , weight-height percentile , prevalence of fever , overall status , degree of dehydration , and percentage of in- versus out patients . Duration of diarrhea after enrollment was 71.9 + /- 35.8 hours in group A versus 58.3 + /- 27.6 hours in group B ( mean + /- SD ; P = 0.03 ) . In rotavirus-positive children , diarrhea lasted 76.6 + /- 41.6 hours in group A versus 56.2 + /- 16.9 hours in groups B ( P < 0.008 ) . Diarrhea lasted longer than 7 days in 10.7 % of group A versus 2.7 % of group B patients ( P < 0.01 ) . Hospital stays were significantly shorter in group B than in group A. CONCLUSIONS Administering oral rehydration solution containing Lactobacillus GG to children with acute diarrhea is safe and results in shorter duration of diarrhea , less chance of a protracted course , and faster discharge from the hospital Objective To compare the efficacy of five probiotic preparations recommended to parents in the treatment of acute diarrhoea in children . Design R and omised controlled clinical trial in collaboration with family paediatricians over 12 months . Setting Primary care . Participants Children aged 3 - 36 months visiting a family paediatrician for acute diarrhoea . Intervention Children 's parents were r and omly assigned to receive written instructions to purchase a specific probiotic product : oral rehydration solution ( control group ) ; Lactobacillus rhamnosus strain GG ; Saccharomyces boulardii ; Bacillus clausii ; mix of L delbrueckii var bulgaricus , Streptococcus thermophilus , L acidophilus , and Bifidobacterium bifidum ; or Enterococcus faecium SF68 . Main outcome measures Primary outcomes were duration of diarrhoea and daily number and consistency of stools . Secondary outcomes were duration of vomiting and fever and rate of admission to hospital . Safety and tolerance were also recorded . Results 571 children were allocated to intervention .  Median duration of diarrhoea was significantly shorter ( P<0.001 ) in children who received L rhamnosus strain GG ( 78.5 hours ) and the mix of four bacterial strains ( 70.0 hours ) than in children who received oral rehydration solution alone ( 115.0 hours ) . One day after the first probiotic administration , the daily number of stools was significantly lower ( P<0.001 ) in children who received L rhamnosus strain GG and in those who received the probiotic mix than in the other groups . The remaining preparations did not affect primary outcomes . Secondary outcomes were similar in all groups . Conclusions Not all commercially available probiotic preparations are effective in children with acute diarrhoea . Paediatricians should choose bacterial preparations based on effectiveness data . Trial registration number Current Controlled Trials IS RCT N56067537 Background : Evidence has shown beneficial effects of probiotics in the treatment of irritable bowel syndrome ( IBS ) ; however , there is still a lack of data in this regard . We evaluated the efficacy of a multi-strain probiotic compound on IBS symptoms and quality -of-life ( QOL ) . Material s and Methods : Adult IBS patients ( n0=132 ) were r and omized to receive a probiotic compound containing seven bacteria species including Lactobacillus strains , Bifidobacterium strains and Streptococcus thermophiles or similar placebo , twice daily after a meal for 14 consecutive days . Improvement of IBS symptoms was assessed in categories of abdominal pain and distension and improvement of bowel habit . Improvement in patients QOL was assessed by the IBS-QOL instrument . Patients were evaluated for symptoms and QOL at baseline and then 1 month after completion of the treatment . Results : After treatment , there was a decrease in abdominal pain and distension severity in both probiotic and the placebo groups ( P<0.001 ) , but there was no difference between the two groups in this regard ( P>0.05 ) . Improvement in bowel habit was observed in 33.3 % of the probiotic and 36.5 % of the placebo group ( P = 0.910 ) . There was no significant difference between the two groups in QOL after the treatment ( P > 0.05 ) . Conclusions : We found no beneficial effects over placebo for a 2-week treatment with the above mentioned multi-strain probiotic compound in the treatment of IBS . Further , trials are yet required before a clear conclusion in this regards BACKGROUND Probiotic dairy products are increasingly gaining popularity . Although the role of probiotic bacteria in the prevention and treatment of pediatric and antibiotic associated diarrhea is fairly well established , their role in the prevention of adult infectious diarrhea has not been well investigated . METHODS Five hundred forty-one , young male military recruits were enrolled and r and omly assigned to receive a yogurt containing Lactobacillus casei ( n = 275 ) or a nonprobiotic yogurt ( n = 266 ) . The incidence and duration of diarrhea were documented and stool sample s examined for bacteria and parasites . RESULTS Five hundred and two participants were eligible for final analysis , 254 receiving probiotic yogurt and 248 in the control group . Seventy-one participants ( 14.14 % ) experienced diarrhea during the study period . The incidence of diarrhea in the probiotic group and the control group was 12.2 % and 16.1 % , respectively ( P = .207 ) . The mean duration of diarrhea was 3 + /- 1.95 days in the probiotic group and 2.6 + /- 1.08 days in the control group ( P = .276 ) . CONCLUSION Our study demonstrated a nonsignificant trend for reduction of the incidence of diarrhea among healthy young adults consuming yogurt containing Lactobacillus casei . Further study is needed to evaluate the role of probiotics in adults OBJECTIVE To assess the clinical efficacy of Lactobacillus sporogenes ( Bacillus coagulans ) , as probiotic preparation , against  dehydrating diarrhoea in children .  METHODS Double-blind , r and omised , placebo-controlled , hospital-based clinical trial with children aged 6 - 24 months who had diarrhoea with some dehydration . Children received tablets of L. sporogenes ( B. coagulans ) or placebo ( control group ) and oral rehydration salt solution for correction of initial dehydration as well as maintenance therapy . Duration , frequency , volume of diarrhoea and intake of ORS of two groups were compared as outcome variables . RESULTS One hundred and forty-eight children participated , of whom 78 ( Study group ) received L. sporogenes ( B. coagulans ) and 70 received placebo ( Control group ) . Differences in recovery rate ( P=0.2 ) , duration ( P=0.5 ) , frequency ( P=0.05 ) , volume ( P=0.1 ) of diarrhoea , intake of ORS ( P=0.2 ) and other fluids ( P=0.1 ) were not significant between both groups . Neither did a subgroup analysis of children who had rotavirus as sole enteropathogens show any significant differences in duration ( P=0.5 ) , frequency ( P=0.6 ) , volume ( P=0.8 ) of diarrhoea , intake of ORS ( P=0.8 ) and other fluids ( P=0.8 ) among both groups . CONCLUSION L. sporogenes ( B. coagulans ) , as an adjunct to ORS , had no therapeutic impact on management of acute dehydrating diarrhoea of diverse etiology including rotavirus associated diarrhoea in children Background / Aims Despite numerous r and omized clinical trials and meta-analyses , there is no increased evidence for the efficacy of  probiotics  in the treatment of irritable bowel syndrome ( IBS ) . We review this evidence , identify and analyse the reasons for this lack of evidence and propose method ological improvements for future studies . Methods Based on a literature search , we identified 56 papers that matched the purpose of our analyses . Twenty-seven studies used multi-species bacterial preparations and 29 used single-strain probiotics . They were analysed regarding  patients included , treatment duration , probiotic dosage , and outcome measures . Results Trials in both groups suffered from heterogeneity with respect to probiotic concentration , duration of treatment , and other method ological issues ( crossover design and underpowered studies ) . This heterogeneity did not allow the application of a meta-analytic approach and a systematic review was therefore performed instead . Multi-strain preparations combined 2 to 8 different bacterial subspecies , mostly lactobacilli or bifidobacteria , and used variable lengths of treatments . Overall , more than 50 % of trials presented negative outcomes . The majority of the single-strain probiotic trials employing lactobacilli or Saccharomyces were negative , whereas trials employing bifidobacteria showed positive results . Conclusions The heterogeneity of the studies of probiotics in IBS questions the value of meta-analyses . The use of different bacterial strains and different mixtures of these strains , as well as different dosages , are the main contributors to this heterogeneity . Current data provides limited evidence for the efficacy of a small number of  single-strain probiotics  in IBS ( mostly bifidobacteria ) and sound studies following strict trial guidelines ( Food and Drug Administration and European Medicines Agency guidelines for clinical trials ) are needed . We summarised and proposed some method ological issues for future studies in the field Background Gastroenteritis accounts for approximately 1.7 million visits to the emergency department ( ED ) by children in the United States every year . Data to determine whether the use of probiotics improves outcomes in these children are lacking . Methods We conducted a r and omized , double‐blind trial involving 886 children 3 to 48 months of age with gastroenteritis who presented to six pediatric EDs in Canada . Participants received a 5‐day course of a combination probiotic product containing Lactobacillus rhamnosus R0011 and L. helveticus R0052 , at a dose of 4.0 × 109 colony‐forming units twice daily or placebo . The primary outcome was moderate‐to‐severe gastroenteritis , which was defined according to a post‐enrollment modified Vesikari scale symptom score of 9 or higher ( scores range from 0 to 20 , with higher scores indicating more severe disease ) . Secondary outcomes included the duration of diarrhea and vomiting , the percentage of children who had unscheduled physician visits , and the presence or absence of adverse events . Results Moderate‐to‐severe gastroenteritis within 14 days after enrollment occurred in 108 of 414 participants ( 26.1 % ) who were assigned to probiotics and 102 of 413 participants ( 24.7 % ) who were assigned to placebo ( odds ratio , 1.06 ; 95 % confidence interval [ CI ] , 0.77 to 1.46 ; P=0.72 ) . After adjustment for trial site , age , detection of rotavirus in stool , and frequency of diarrhea and vomiting before enrollment , trial‐group assignment did not predict moderate‐to‐severe gastroenteritis ( odds ratio , 1.06 ; 95 % CI , 0.76 to 1.49 ; P=0.74 ) . There were no significant differences between the probiotic group and the placebo group in the median duration of diarrhea ( 52.5 hours [ interquartile range , 18.3 to 95.8 ] and 55.5 hours [ interquartile range , 20.2 to 102.3 ] , respectively ; P=0.31 ) or vomiting ( 17.7 hours [ interquartile range , 0 to 58.6 ] and 18.7 hours [ interquartile range , 0 to 51.6 ] , P=0.18 ) , the percentages of participants with unscheduled visits to a health care provider ( 30.2 % and 26.6 % ; odds ratio , 1.19 ; 95 % CI , 0.87 to 1.62 ; P=0.27 ) , and the percentage of participants who reported an adverse event ( 34.8 % and 38.7 % ; odds ratio , 0.83 ; 95 % CI , 0.62 to 1.11 ; P=0.21 ) . Conclusions In children who presented to the emergency department with gastroenteritis , twice‐daily administration of a combined L. rhamnosus – L. helveticus probiotic did not prevent the development of moderate‐to‐severe gastroenteritis within 14 days after enrollment . ( Funded by the Canadian Institutes of Health Research and others ; PROGUT Clinical Trials.gov number , NCT01853124 . Purpose of review This review summarizes the clinical efficacy of probiotics and prebiotics in gastrointestinal disorders and examines the mechanisms of action related to their therapeutic effect . Recent findings The demonstration that immune and epithelial cells can discriminate between different microbial species has extended the known mechanism(s ) of action of probiotics beyond simple barrier and antimicrobial effects . It has also confirmed that probiotic bacteria modulate mucosal and systemic immune activity and epithelial function . The progressive unraveling of these mechanisms of action has led to new credence for the use of probiotics and prebiotics in clinical medicine . Level I evidence now exists for the therapeutic use of probiotics in infectious diarrhea in children , recurrent Clostridium difficile – induced infections and postoperative pouchitis . Level II evidence is emerging for the use of probiotics in other gastrointestinal infections , prevention of postoperative bacterial translocation , irritable bowel syndrome , and in both ulcerative colitis and Crohn disease . Nevertheless , one consistent feature has emerged over the past year : Not all probiotic bacteria have similar therapeutic effects . Future clinical trials will need to incorporate this fact into trial planning and design . Summary The use of probiotics and prebiotics as therapeutic agents for gastrointestinal disorders is rapidly moving into the “ mainstream . ” Mechanisms of action explain the therapeutic effects and r and omized ; controlled trials provide the necessary evidence for their incorporation into the therapeutic armamentarium Objectives . Antimicrobial treatment may disturb the colonization resistance of gastrointestinal microflora , which may induce clinical symptoms , most commonly diarrhea . The severity of antibiotic-associated diarrhea may range from a brief , self-limiting disease to devastating diarrhea with electrolyte disturbances , dehydration , crampy abdominal pain , pseudomembranous colitis , toxic megacolon , or even death . The incidence of diarrhea in children receiving a single antimicrobial treatment is unclear . In addition to more critical use of antimicrobials , adjunctive preventive measures to antibiotic-associated diarrhea are needed . The objective of this study was to evaluate the incidence of diarrhea after antimicrobial treatment in children with no history of antimicrobial use during the previous 3 months . Another aim of this study was to assess the preventive potential of Lactobacillus rhamnosus GG ( Lactobacillus GG ; American Type Culture Collection 53103 ) , a probiotic strain with a documented safety record and a therapeutic effect in viral gastroenteritis on antibiotic-associated diarrhea . Methods . Oral antimicrobial agents were prescribed for the treatment of acute respiratory infections at the clinics of the Health Care Center of the City of Tampere or Tampere University Hospital , Finl and , to 167 patients who were invited to participate in the study . Of the patients , 48 were lost to follow-up ; therefore , the final study population consisted of 119 children from 2 weeks to 12.8 years of age ( mean : 4.5 years ) . All study subjects met the inclusion criteria : they had not received any antimicrobial medication during the previous 3 months , they did not suffer from gastrointestinal disorders , and they did not need intravenous antimicrobial treatment . The patients were r and omized to receive placebo or 2 × 1010 colony-forming units of Lactobacillus GG in capsules given twice daily during the antimicrobial treatment . Lactobacillus GG and placebo capsules were indistinguishable in appearance and taste . The parents kept a daily symptom diary and recorded stool frequency and consistency at home for 3 months . Diarrhea was defined as at least three watery or loose stools per day for a minimum of 2 consecutive days . In the case of diarrhea , viral ( adenovirus , rotavirus , calicivirus and astrovirus ) and bacterial ( Salmonella , Shigella , Yersinia , Campylobacter , Clostridium difficile , Staphylococcus aureus , and yeasts ) analyses were studied in fecal sample s. The metabolic activity of the gut microflora was assessed by analysis of fecal urease , β-glucosidase , and β-glucuronidase activities . The primary outcome measure was diarrhea during the first 2 weeks after the beginning of the antimicrobial treatment , because this period most likely reflects the effects of antimicrobial use . Secondary outcome measures were the activities of fecal urease , β-glucuronidase , and β-glucosidase . Results . On the entire follow-up , 80 % of any gastrointestinal symptoms were reported during the first 2 weeks after the beginning of the antimicrobial treatment . The incidence of diarrhea was 5 % in the  Lactobacillus GG group and 16 % in the placebo group within 2 weeks of antimicrobial therapy ( χ2 = 3.82 ) . The treatment effect ( 95 % confidence interval ) of Lactobacillus GG was −11 % ( −21%–0 % ) . In diarrheal episodes , the viral and bacterial analyses were positive for Clostridium difficile in 2 cases and for Norwalk-like calicivirus in 3 cases . The age of the patients with diarrhea was between 3 months and 5 years in 75 % of cases in both groups .  The severity of diarrhea was comparable in the study groups , as evidence d by similar stool frequency ( mean : 5 per day ; range : 3–6 ) and the duration of diarrhea ( mean : 4 days ; range : 2–8 ) . The activities of fecal urease and β-glucuronidase , but not β-glucosidase , changed significantly after the beginning of the antimicrobial treatment in the Lactobacillus GG group and in the placebo group alike . The decrease in urease and β-glucuronidase activities was reversible in patients with no diarrhea , but in patients with diarrhea , the modifications in gut microflora were more profound and prolonged . The activities of the three enzymes were normalized within 3 weeks , evidence d by stable enzyme activities in sample s collected 3 weeks , 1 month , and 3 months after the beginning of the antimicrobial treatment , compared with those obtained before treatment . Discussion . In the present study , after a single antimicrobial treatment , the incidence of diarrhea was 16 % . The higher incidence of antibiotic-associated diarrhea in previous reports may be attributable to a recent antimicrobial therapy that disturbs intestinal flora and exposes to complications . Also , in the present study , changes in the metabolic activity of the intestinal flora were observed , evidence d by a transient decline in fecal enzyme activities . Different probiotic preparations , including lactobacilli , are recommended frequently to prevent antibiotic-associated diarrhea . Although probiotics have been shown to be efficient in the prevention and the treatment of viral gastroenteritis , their usefulness during antimicrobial therapy in children has not been eluci date d before . We observed that the administration of Lactobacillus GG to children receiving antimicrobial therapy for respiratory infection reduced the incidence of antibiotic-associated diarrhea to one third . The beneficial effect may be mediated by a number of functions of probiotics , ie , production of antimicrobial substances , local competition of adhesion receptors and nutrients , and stimulation of intestinal antigen specific and nonspecific immune responses . Conclusion . A probiotic strain , Lactobacillus GG , is effective in the prevention of diarrhea in children receiving antimicrobial treatment to respiratory infections Abstract Objective . To evaluate the effect of chewing gums containing probiotic bacteria on  oral malodour .  The null hypothesis was that no difference would be displayed compared with placebo gums . Material s and methods . Twenty-five healthy young adults with self-reported malodorous morning breath completed this r and omized double-blind placebo-controlled cross-over trial . The design included run-in and wash-out periods interspersed by two intervention periods of 14 days each . The subjects were instructed to chew one gum in the morning and one in the evening containing either two strains of probiotic lactobacilli ( L. reuteri DSM 17938 and L. reuteri ATCC PTA 5289 ) or placebo . The outcome measures were ( i ) organoleptic scores ( 0–5 ) by a certified test panel , ( ii ) concentration of volatile sulphur compounds ( VSC ) measured with a Halimeter and ( iii ) concentration of VSC after a cysteine rinse . Registration s were made at baseline and after each intervention period . Differences between the groups were assessed by non-parametric paired statistics and chi-square test . Results . The median organoleptic score was similar ( score 2 ) in both groups at baseline . After 14 days of treatment , the organoleptic scores were significantly lower in the probiotic group compared with the placebo group ( p < 0.05 ) . Assessment s of the VSC levels displayed no significant differences between the groups , either before or after rinsing with L-cysteine . No adverse effects were registered . Conclusion . The results demonstrated that probiotic chewing gums may have some beneficial effect on oral malodour assessed by organoleptic scores . The results indicate that the probiotic gum may affect bacteria that produce malodourous compounds other than VSCs
The pooled estimate of efficacy of lactobacillus rhamnosus GG and other probiotics significantly reduced the duration of diarrhea .
In conclusion , probiotics exert positive effect in reducing the duration of acute rotavirus diarrhea  compared with control
BACKGROUND Probiotic therapies with different strains demonstrated some beneficial effects , although some studies did not show any significant effects .
This study assessed systematic ally the current knowledge on the effect of probiotic bacteria on duration of  acute rotavirus diarrhea in children compared with control .