Probiotics for treating acute infectious diarrhoea

 

Abstract

Background

Probiotics may offer a safe intervention in acute infectious diarrhoea to reduce the duration and severity of the illness.

Objectives

To assess the effects of probiotics in proven or presumed acute infectious diarrhoea.

Search methods

We searched the Cochrane Infectious Diseases Group's trials register (July 2010), the Cochrane Controlled Trials Register (The Cochrane Library Issue 2, 2010), MEDLINE (1966 to July 2010), EMBASE (1988 to July 2010), and reference lists from studies and reviews. We also contacted organizations and individuals working in the field, and pharmaceutical companies manufacturing probiotic agents.

Selection criteria

Randomized and quasi-randomized controlled trials comparing a specified probiotic agent with a placebo or no probiotic in people with acute diarrhoea that is proven or presumed to be caused by an infectious agent.

Data collection and analysis

Two reviewers independently assessed the methodological quality of the trial and extracted data. Primary outcomes were the mean duration of diarrhoea, stool frequency on day 2 after intervention and ongoing diarrhoea on day 4. A random-effects model was used.

Main results

Sixty-three studies met the inclusion criteria with a total of 8014 participants. Of these, 56 trials recruited infants and young children. The trials varied in the definition used for acute diarrhoea and the end of the diarrhoeal illness, as well as in the risk of bias. The trials were undertaken in a wide range of different settings and also varied greatly in organisms tested, dosage, and participants' characteristics. No adverse events were attributed to the probiotic intervention.

Probiotics reduced the duration of diarrhoea, although the size of the effect varied considerably between studies.

The average of the effect was significant for mean duration of diarrhoea (mean difference 24.76 hours; 95% confidence interval 15.9 to 33.6 hours; n=4555, trials=35) diarrhoea lasting ≥4 days (risk ratio 0.41; 0.32 to 0.53; n=2853, trials=29) and stool frequency on day 2 (mean difference 0.80; 0.45 to 1.14; n=2751, trials=20).

The differences in effect size between studies was not explained by study quality, probiotic strain, the number of different strains, the viability of the organisms, dosage of organisms, the causes of diarrhoea, or the severity of the diarrhoea, or whether the studies were done in developed or developing countries.

Authors' conclusions

Used alongside rehydration therapy, probiotics appear to be safe and have clear beneficial effects in shortening the duration and reducing stool frequency in acute infectious diarrhoea. However, more research is needed to guide the use of particular probiotic regimens in specific patient groups.

 

Plain language summary

Probiotics for treating acute infectious diarrhoea

Episodes of acute infectious diarrhoea remain a major disease burden throughout the world, especially in developing countries. They are due to infection by many different organisms. Most episodes are self-limiting and usually investigations are not done to identify the infectious agent. The main risk to health is dehydration and management aims to improve and maintain hydration status. However, rehydration fluids do not reduce the stool volume or shorten the episode of diarrhoea. Probiotics are "friendly" bacteria that improve health and are not harmful in themselves. A number of randomized controlled trials have been done to see whether probiotics are beneficial in acute infectious diarrhoea. We have searched for as many of these trials as possible and collected together the data in a systematic way to try to discover whether or not probiotics are beneficial in acute diarrhoea. We identified 63 trials, which included a total of 8014 people - mainly infants and children. Probiotics were not associated with any adverse effects. Nearly all studies reported a shortened duration of diarrhoea and reduced stool frequency in people who received probiotics compared to the controls. Overall, probiotics reduced the duration of diarrhoea by around 25 hours, the risk of diarrhoea lasting four or more days by 59% and resulted in about one fewer diarrhoeal stool on day 2 after the intervention. However, there was very marked variability in the study findings and so these estimates are approximate. We concluded that these results were very encouraging but more research is needed to identify exactly which probiotics should be used for which groups of people, and also to assess the cost effectiveness of this treatment.

 

摘要

背景

益生菌在感染性腹瀉之治療

益生菌是對宿主健康及福祉有益的微生物細胞製劑或是微生物細胞成分。益生菌對於急性感染性腹瀉可以提供一個安全的介入，以減緩疾病病程和嚴重度。

目標

評估益生菌對於已確診或疑似感染性腹瀉的療效。

搜尋策略

我們搜尋了the Cochrane Infectious Diseases Group's trials register (December 2002), the Cochrane Controlled Trials Register (The Cochrane Library Issue 4, 2002), MEDLINE (1966 to 2002), EMBASE(1988 to 2002)，以及研究和回顧性評論文章所列出的參考文獻。我們還聯繫了在這個領域工作的機構和個人，以及生產益生菌的製藥公司。

選擇標準

隨機對照試驗針對被確診或疑似由感染源引起的急性腹瀉病人使用某特定益生菌製劑和安慰劑(或未用益生菌)的效果差異比較。

資料收集與分析

兩位審查員獨立評估試驗方法學品質及擷取資料。

主要結論

總計23個研究共1917個受試者符合納入標準，試驗主要是在總死亡率低的國家所進行。益生菌的檢驗、劑量、試驗方法學的品質，以及腹瀉定義和測量結果在不同試驗上都不盡相同。益生菌在3天內減少了腹瀉的危險(相對風險relative risk 0.66，95%信賴區間confidence interval 0.55至0.77，隨機效應模式random effects model；15個研究)，減少了腹瀉平均持續時間達30.48小時(95% confidence interval, 18.51至42.46小時，隨機效應模式，12個研究)。以益生菌測試、輪狀病毒腹瀉，國家死亡率及受試者年齡所做的進一步次群組分析則無法完全解釋不同研究間的異質性。

作者結論

在成人及兒童急性感染性腹瀉的補充體液治療上，益生菌似乎是一個有用的輔助治療。需要更多研究來得知某特定益生菌治療方案對於某特殊病人族群的使用。

翻譯人

本摘要由三軍總醫院洪乃勻翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

無總結