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Probiotics for treating infectious diarrhoea

  1. Stephen J Allen1,*,
  2. B Okoko2,
  3. Elizabeth G Martinez3,
  4. Germana V Gregorio3,
  5. Leonila F Dans4

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 19 JUN 2003

DOI: 10.1002/14651858.CD003048.pub2

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How to Cite

Allen SJ, Okoko B, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating infectious diarrhoea. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003048. DOI: 10.1002/14651858.CD003048.pub2.

Author Information

  1. 1

    Swansea University, School of Medicine, Swansea, West Glamorgan, UK

  2. 2

    Medical Research Council Laboratories, Banjul, Gambia

  3. 3

    College of Medicine-Philippine General Hospital, University of the Philippines, Department of Pediatrics, Manila, National Capital Region, Philippines

  4. 4

    Philippine General Hospital, University of the Philippines, Department of Pediatrics and Clinical Epidemiology, Manila, National Capital Region, Philippines

*Stephen J Allen, School of Medicine, Swansea University, Room 314, The Grove Building, Singleton Park, Swansea, West Glamorgan, SA2 8PP, UK. S.J.Allen@swansea.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Bhatnagar 1998 {published data only}
  • Bhatnagar S, Singh KD, Sazawal S, Saxena SK, Bhan MK. Efficacy of milk versus yogurt offered as part of a mixed diet in acute noncholera diarrhea among malnourished children. Journal of Pediatrics 1998;132(6):999-1004.
Boulloche 1994 {published data only}
  • Boulloche J, Mouterde O, Mallet E. Management of acute diarrhoea in infants and young children. Controlled study of the anti-diarrheal efficacy of killed L. acidophilus (LB strain) versus a placebo and a reference drug (loperamide). Annales de Pediatrie 1994;41:457-63.
Bruno 1981 {published data only}
  • Bruno F, Frigerio G. A new therapeutic alternative for the treatment of enteritis -- controlled double-blind tests with the strain SF 68 [Eine neuartige möglichkeit zur behandlung der enteritis - kontrollierte doppel-blindversuche mit dem Stamm SF 68]. Schweizerische Rundschau fur Medizin Praxis 1981;70(39):1717-20.
Bruno 1983 {published data only}
  • Bruno F, Nastasi A, Bruno M. Double-blind controlled study of the effect of the lactogenic enterococcus SF68 strain on various enterocolitis associated manifestations and on salmonella infections [Studio controllato dopio-cieco sull'effecto dell'enterococco lattoproduttore ceppo SF 68 su manifestazione associate a forme enterocolitiche variee a salmonellosi]. La Clinica Terapeutica 1983;105(3):203-7.
Buydens 1996 {published data only}
Carague-Orendain {unpublished data only}
  • Carrague-Orendain A. Randomized, double blind placebo-controlled trial on the efficacy and safety of lactobacillus (Infloran Berna capsules) in the treatment of acute non-bloody diarrhoea in children two to five years of age.
Cetina-Sauri 1994 {published data only}
  • Cetina-Sauri G, Sierra Basto G. Evaluation of Saccharomyces boulardii in children with acute diarrhea [Evaluation therapeutique de Saccharomyces boulardii chez des enfants souffrant de diarrhee aigue]. Annales de Pediatrie 1994;41(6):397-400.
D'Apuzzo 1982 {published data only}
  • D'Apuzzo V, Salzberg R. The treatment of acute diarrhoea in paediatrics using Streptococcus faecium: results of a double blind trial [Die Behandlung der akuten Diarrho in der Padiatrie mit Streptococcus faecium: Resultae einer doppleblindstudie]. Therapeutische Umschau 1982;39:1033-5.
Guandalini 2000 {published data only}
  • Guandalini S, Pensabene L, Zikri MA, Dias JA, Casali LB, Hoekstra H, et al. Lactobacillus GG administered in oral rehydration solution to children with acute diarrhoea: a multicenter European trial. Journal of Pediatric Gastroenterology and Nutrition 2000;30(1):54-60.
Guarino 1997 {published data only}
  • Canani RB, Albano F, Spagnuolo MI, Di Benedetto L, Stabile A, Guarino A. Effect of oral administration of Lactobacillus GG on the duration of diarrhea and on rotavirus excretion in ambulatory children (Abstract). Journal of Pediatric Gastroenterology and Nutrition 1997;24:469.
  • Guarino A, Canani RB, Spagnuolo MI, Albano F, Di Benedetto L. Oral bacterial therapy reduces the duration of symptoms and viral excretion in children with mild diarrhoea. Journal of Pediatric Gastroenterology and Nutrition 1997;25(5):516-9.
Hochter 1990 {published data only}
  • Höchter W, Chase D, Hagenhoff G. Saccharomyces boulardii in the treatment of acute adult diarrhoea. [Saccharomyces boulardii bei acuter Erwachsenendiarrhoea]. Münchener medizinische Wochenschrift 1990;132:188-92.
Isolauri 1994 {published data only}
Oandasan 1999 {unpublished data only}
  • Oandasan M, Gatcheco F, Kapahmgan S. Randomized, double blind placebo-controlled clinical trial on the efficacy and safety of Infloran berna capsules in the treatment of acute non-bloody diarrhea in infants.
Pant 1996 {published data only}
  • Pant AR, Graham SM, Allen SJ, Harikul S, Sabchareon A, Cuevas L, et al. Lactobacillus GG and acute diarrhoea in young children in the tropics. Journal of Tropical Pediatrics 1996;42(3):162-5.
Raza 1995 {published data only}
  • Raza S, Graham SM, Allen SJ, Sultana S, Cuevas L, Hart CA. Lactobacillus GG promotes recovery from acute nonbloody diarrhoea in Pakistan. The Pediatric Infectious Disease Journal 1995;14(2):107-11.
Rosenfeldt 2002a {published data only}
  • Rosenfeldt V, Michaelsen KF, Jakobsen M, Larsen CN, Moller PL, Pedersen P. Effect of probiotic Lactobacillus strains in young children hospitalized with acute diarrhea. The Pediatric Infectious Disease Journal 2002;21(5):411-6.
Rosenfeldt 2002b {published data only}
  • Rosenfeldt V, Michaelsen KF, Jakobsen M, Larsen CN, Moller PL, Tvede M, et al. Effect of probiotic Lactobacillus strains on acute diarrhea in a cohort of nonhospitalized children attending day-care centers. The Pediatric Infectious Disease Journal 2002;21(5):417-9.
Shornikova 1997a {published data only}
  • Shornikova AV, Isolauri E, Burkanova L, Lukovnikova S, Vesikari T. A trial in the Karelian Republic of oral rehydration and Lactobacillus GG for treatment of acute diarrhoea. Acta Paediatrica 1997;86(5):460-5.
    Direct Link:
Shornikova 1997b {published data only}
Shornikova 1997c {published data only}
  • Shornikova AV, Casas IA, Isolauri E, Mykkanen H, Vesikari T. Lactobacillus reuteri as a therapeutic agent in acute diarrhea in young children. Journal of Pediatric Gastroenterology and Nutrition 1997;24(4):399-404.
Simakachorn 2000 {published data only}
  • Simakachorn N, Pichaipat V, Rithipornpaisarn P, Kongkaew C, Tongpradit P, Varavithya W. Clinical evaluation of the addition of lyophilized, heat-killed Lactobacillus acidophilus LB to oral rehydration therapy in the treatment of acute diarrhoea in children. Journal of Pediatric Gastroenterology and Nutrition 2000;30(1):68-72.
  • Simakachorn N, Pichaipat V, Rithipornpaisarn P, Kongkaew C, Tongpradit P, Varavithya W. Erratum. Journal of Pediatric Gastroenterology 2000;30(2):228.
Sugita 1994 {published data only}
  • Sugita T, Togawa M. Efficacy of Lactobacillus preparation bioloactis powder in children with rotavirus enteritis. Japan Journal of Pediatrics 1994;47:2755-62.
Wunderlich 1989 {published data only}
  • Wunderlich PF, Braun L, Fumagalli I, D'Apuzzo V, Heim F, Karly M, et al. Double-blind report of the efficacy of lactic acid-producing Enterococcus SF68 in the prevention of antibiotic-associated diarrhoea and in the treatment of acute diarrhoea. The Journal of International Medical Research 1989;17(4):333-8.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Alexander 1971 {published data only}
  • Alexander JG. Lactobacillus casei tablets in the treatment of intestinal infection. The Journal of the Royal College of General Practitioners 1971;21(111):623-4.
Alvisi 1982 {published data only}
  • Alvisi V, Tralli M, Loponte A, Pavani F, Massari M. Double-blind study of treatment with SF 68 or with antibiotics in acute enteritis in adults [Studio in doppio cieco sul trattamento con SF68 o con antibiotici nelle enteritis acute dell'adulto]. La Clinica Terapeutica 1982;101(6):581-6.
Barone 2000 {published data only}
  • Barone C, Pettinato R, Avola E, Alberti A, Greco D, Failla P, et al. Comparison of three probiotics in the treatment of acute diarrhea in mentally retarded children. Minerva Pediatrica 2000;52(3):161-5.
Beck 1961 {published data only}
  • Beck C, Necheles H. Beneficial effects of administration of Lactobacillus acidophilus in diarrheal and other intestinal disorders. The American Journal of Gastroenterology 1961;35:522-30.
Bellomo 1979 {published data only}
  • Bellomo G, Finocchiaro C, Frigerio G. A new approach for the treatment of enteritides in paediatrics [Une novelle approche pour le traitement des entérites en pédiatrie]. Medecine et Hygiene 1979;37:3781-4.
Bellomo 1980 {published data only}
  • Bellomo G, Mangiagle A, Nicastro L, Frigeria G. A controlled double-blind study of SF68 strain as a new biological preparation for the treatment of diarrhoea in pediatrics. Current Therapeutic Research: clinical and experimental 1980;28:927-35.
Bellomo 1982 {published data only}
  • Bellomo G, Finocchiaro C, Frigerio G, Mangiagli A, Nicastro L. Controlled study of Enterococcus LAB strain SF68 in acute enteritis in children with concomitant respiratory infection [Studio controllato sull'enterococco L.A.B. ceppo SF 68 nelle enteriti acute del bambino concomitanti ad infezioni delle vie respiratorie]. Clinica Pediatrica 1982;64:219-27.
Bin Li Xie 1995 {published data only}
  • Bin Li Xie. Controlled clinical trial of Lacteol Fort Sachet versus furazolidone or berberine in treatment of acute diarrhoea in children [Étude contrôlée du Lactéol Fort sachets versus furazolidone ou berbérine dans le traitement des diarrhées aiguës de l'enfant]. Annales de Pediatrie 1995;42:396-401.
Camarri 1981 {published data only}
Chapoy 1985 {published data only}
  • Chapoy P. Treatment of acute infantile diarrhea: controlled trial of Saccharomyces boulardii [Traitement des diarrhées aiguës infantiles]. Annales de Pediatrie 1985;32(6):561-3.
Chicoine 1973 {published data only}
  • Chicoine L, Joncas JH. Use of lactic enzymes in non-bacterial gastroenteritis [Emploi des ferments lactiques dans la gastro-entérite non bactérienne]. L'Union Médicale du Canada 1973;102(5):1114-5.
Costa-Ribeiro 2000a {published data only}
  • Costa-Ribeiro H, Ribeiro TCM, Mattos AP, Almeida PS, Valois SS, Vanderhoof JA. Use of Lactobacillus GG in the treatment of severe, acute diarrhoea in adverse environmental conditions.. Journal of Pediatric Gastroenterology 2000;31 Suppl 2:251-2.
Costa-Ribeiro 2000b {published data only}
  • Costa-Ribeiro H, Ribeiro TCM, Mattos AP, Lins EV, Neri DA, Valois SS, Vanderhoof JA. Prophylactic administration of Lactobacillus GG to children in a daycare center. Journal of Pediatric Gastroenterology and Nutrition 2000;31 Suppl 2:252.
de dios Pozo-O 1978 {published data only}
  • de dios Pozo-Olano J, Warram JH Jr, Gomez RG, Cavazos MG. Effect of a lactobacilli preparation on traveler's diarrhoea. A randomised, double blind clinical trial. Gastroenterology 1978;74(5 Pt 1):829-30.
Frigerio 1986 {published data only}
  • Frigerio G. A lactic acid producer enterococcus in the prevention of antibiotic-associated diarrhoea and in the treatment of acute diarrhoeal disorders: a double-blind multicentre placebo-controlled clinical trial (Abstract). Digestive Diseases and Sciences 1986;31 Suppl:496.
Girola 1995 {published data only}
  • Girola M, Ventura P. Efficacy of probiotic preparation with living, freeze-dried lactic acid bacteria and yeast on child diarrhoea [Efficacia di un prodotto probiotico a base di fermenti lattici e lievito vitali liofilizzati nel trattamento della diarrea del bambino]. Archivio di Medicina Interna 1995;47(2-3):61-72.
Gracheva 1996 {published data only}
  • Gracheva NM, Gavrilov AF, Solov'eva AI, Smirnov VV, Sorokulova IB, Reznik SR, et al. The efficacy of the new bacterial preparation biosporin in treating acute intestinal infections. Zhurnal Mikrobiologii, Epidemiologii, i Immunobiologii 1996;1:75-7.
Isolauri 1991 {published data only}
  • Isolauri E, Juntunen M, Rautanen T, Sillanaukee P, Koivula T. A human Lactobacillus strain (Lactobacillus casei GG) promotes recovery from acute diarrhea in children. Pediatrics 1991;88(1):90-7.
Kaila 1992 {published data only}
  • Kaila M, Isolauri E, Soppi E, Virtanen E, Laine S, Arvilommi H. Enhancement of the circulating antibody secreting cell response in human diarrhea by a human Lactobacillus strain. Pediatric Research 1992;32(2):141-4.
Kaila 1995 {published data only}
Korviakova 2000 {published data only}
  • Korviakova EP. Use of loading doses of Bifidumbacterin forte for the treatment of patients with acute enteric infections. Zhurnal Mikrobiologii, Epidemiologii, i Immunobiologii 2000, (6):58-61.
Majamaa 1995 {published data only}
Michielutti 1995 {published data only}
  • Michielutti F, Bertini M, Presciuttini B, Andreotti G. Clinical assessment of a new oral bacterial treatment for children with acute diarrhea [Valutazione clinica di un nuovo batterioterapico orale in pazienti di eta pediatrica con diarrea acuta]. Minerva Medica 1996;87(11):545-50.
Mitra 1990 {published data only}
  • Mitra AK, Rabbini GH. A double-blind, controlled trial of bioflorin (Streptococcus faecium SF68) in adults with acute diarrhea due to Vibrio chlolerae and entertoxigenic Escherichia coli. Gastroenterology 1990;99(4):1149-52.
Niv 1963 {published data only}
Ortlieb 1974 {published data only}
Pearce 1974 {published data only}
Pedone 1999 {published data only}
  • Pedone CA, Bernabeu AO, Postaire ER, Bouley CF, Reinert P. The effect of supplementation with milk fermented by Lactobacillus casei (strain DN-114 001) on acute diarrhoea in children attending day care centres. International Journal of Clinical Practice 1999;53(3):179-84.
Pedone 2000 {published data only}
  • Pedone CA, Arnaud CC, Postaire ER, Bouley CF, Reinert P. Multicentric study of the effect of milk fermented by Lactobacillus casei on the incidence of diarrhoea. International Journal of Clinical Practice 2000;54(9):568-71.
Pene 1966 {published data only}
  • Pene P, Linhard J, Bernou JC. The colibacillus-lactobacillus combination in the treatment of diarrhea in adults, children and infants [L'association colibacilles-lactobacilles dans le traitement des diarrhées de l'adulte, de l'enfant et du nourrisson]. La Semaine Des Hopitaux 1966;42(4):241-4.
Rautanen 1998 {published data only}
  • Rautanen T, Isolauri E, Salo E, Vesikari T. Management of acute diarrhoea with low osmolarity oral rehydration solutions and Lactobacillus strain GG. Archives of Disease in Childhood 1998;79(2):157-60.
Saint-Marc 1991 {published data only}
  • Saint-Marc T, Rossello-Prats L, Touraine JL. Efficacy of Saccharomyces boulardii in the treatment of diarrhea in AIDS [Efficacite de Saccharomyces boulardii dans le traitement des diarrhees du SIDA]. Annales de Medecine Interne 1991;142(1):64-5.
Satoh 1984 {published data only}
  • Satoh Y, Iwata S, Iwata Y, Yamashita N, Oikawa T, Osano M, et al. Effect of Bifidobacterium breve administration on clinical course and intestinal flora in children with acute diarrhea [Abstract]. Nippon Shonikagakkai Zasshi 1984;88:2178-9.
Sepp 1995 {published data only}
  • Sepp E, Tamm E, Torm S, Lutsar I, Mikelsaar M, Salminen S. Impact of a Lactobacillus probiotic on the faecal microflora in children with shigellosis. Microecology and Therapy 1995;23:74-80.
Singh 1987 {published data only}
  • Singh T. Yoghurt feeding during acute diarrhea. Indian Pediatrics 1987;24(6):530.
Tojo 1987 {published data only}
  • Tojo M, Oikawa T, Morikawa Y, Yamashita N, Iwata S, Satoh Y, et al. The effects of Bifidobacterium breve administration on camylobacter enteritis. Acta Paediatrica Japonica; Overseas edition 1987;29(1):160-7.

References to studies awaiting assessment

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Cetina-Sauri 1990 {published data only}
  • Cetina-Sauri G, Sierra Basto G. Therapeutic evaluation of Saccharomyces boulardii in children with acute diarrhoea [Evaluacion terapeutica de Saccharomyces boulardii en ninos con diarrea aguda]. Tribuna Medica (Bogota) 1990;81(3):141-4.
Contreras 1983 {published data only}
  • Contreras G. Compend Invest Clin Latinoam 1983;3:114-6.
Fourrier 1968 {published data only}
  • Fourrier A, Lequien P. The treatment of infantile gastroenteritis by the use solely of a combination of colibacillus and lactobacillus. Apropos of 56 cases. Annales de Pediatrie 1968;15:491-5.
Salazar-Lindo {published data only (unpublished sought but not used)}
  • Salazar-Lindo E. [LGG versus placebo in infants with acute watery diarrhoea, Peru, 1990s].
Salgado {published data only}
  • Salgado AJ, Garcia Jara JA. Use of heat-killed Lactobacillus acidophilus, Lacteol strain in the treatment of acute diarrhoea. Open trial. Revista del Hospital de la Muyer 2.
Taborska 1997 {published data only}
  • Táborská J, Pazdiora P. [Smecta a Lactobacillus acidophilus ND v lécbe akutních detských prujmu]. Cs. Pediat. 1997;1:29-33.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Anonymous 1988
  • Anonymous. Persistent diarrhoea in children in developing countries: memorandum from a WHO meeting. Bulletin of the World Health Organization 1988;66(6):709-17.
Bern 1992
Black 1986
  • Black RE. Pathogens that cause traveler's diarrhea in Latin America and Africa. Reviews of Infectious Diseases 1986;8 Suppl 2:131-5.
Clarke 2003
  • Clarke M, Oxman A, editors. Optimal search strategy. Cochrane Reviewers' Handbook 4.2 [updated March 2003]; Appendix 5c. In: The Cochrane Library. The Cochrane Collaboration. Chichester, UK: John Wiley & Sons, Ltd.; 2003, Issue 3.
Cunliffe 1998
  • Cunliffe NA, Kilgore PE, Bresee JS, Steele AD, Luo N, Hart CA, et al. Epidemiology of rotavirus diarrhoea in Africa: a review to assess the need for rotavirus immunization. Bulletin of the World Health Organization 1998;76(5):525-37.
FAO/WHO 2001
  • Food and Agriculture Organization of the United Nations (FAO)/World Health Organization (WHO). Joint FAO/WHO expert consultation on evaluation of health and nutritional properties of probiotics in food including powder milk and live lactic acid bacteria. ftp://ftp.fao.es/esn/food/probio_report_en.pdf 2001.
Gismondo 1999
Goldin 1998
  • Goldin BR. Health benefits of probiotics. The British Journal of Nutrition 1998;80 Suppl(4):203-7.
Guerrant 1990
  • Guerrant RL, Hughes JM, Lima NL, Crane J. Diarrhea in developed and developing countries: magnitude, special settings, and etiologies. Reviews of Infectious Diseases 1990;12 Suppl 1:41-50.
Hata 1988
Huilan 1991
  • Huilan S, Zhen LG, Mathan MM, Mathew MM, Olarte J, Espejo R, et al. Etiology of acute diarrhoea among children in developing countries: a multicentre study in five countries. Bulletin of the World Health Organization 1991;69(5):549-55.
Juni 1999
Klein 1998
Naidu 1999
Piarroux 1999
Reid 1999
  • Reid G. Testing the efficacy of probiotics. In: Tannock GW editor(s). Probiotics: a critical review. Norfolk, UK: Horizon Scientific Press, 1999:129-40. [: ISBN: 1-898486-15-8]
Salminen 1998
Salminen 1999
Savarino 1993
  • Savarino SJ, Bourgeois AL. EpiDiarrhoeal disease: current concepts and future challenges. Epidemiology of diarrhoeal diseases in developed countries. Transactions of the Royal Society of Tropical Medicine and Hygiene 1993;87 Suppl 3:7-11.
Saxelin 1996
  • Saxelin M, Chuang NH, Chassy B, Rautelin H, Makela PH, Salminen S, et al. Lactobacilli and bacteremia in southern Finland, 1989-1992. Clinical Infectious Diseases 1996;22(3):564-6.
Sussman 1986
  • Sussman J, Baron E, Goldberg S, Kaplan M, Pizzarello R. Clinical manifestations and therapy of Lactobacillus endocarditis: report of a case and review of the literature. Reviews of Infectious Diseases 1986;8(5):771-6.
Szajewska 2001
  • Szajewska H, Mrukowicz JZ. Probiotics in the treatment and prevention of acute infectious diarrhoea in infants and children; a systematic review of published randomized, double-blind, placebo-controlled trials. Journal of Pediatric Gastroenterology and Nutrition 2001;33 Suppl 2:17-25.
Van Niel 2002
Vanderhoof 1998
Walker-Smith 1993
  • Walker-Smith JA. Diarrhoeal disease: current concepts and future challenges. Malnutrition and infection. Transactions of the Royal Society of Tropical Medicine 1993;87 Suppl 3:13-5.
WHO 1990
  • Division of Diarrhoeal and Acute Respiratory Disease Control. The treatment of diarrhoea. A manual for physicians and other senior health workers. Geneva: World Health Organization, 1990:20-1.
WHO 2001
  • World Health Organization. The world health report : 2001: Mental health : new understanding, new hope. Geneva: World Health Organization, 2001.
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