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PECARN Pie: Probiotics

David Schnadower, MD and Jason Woods, MD
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Jason Woods and Julia Magana, Associate Professor at UC Davis, discuss the use of probiotics for treatment of pediatric gastroenteritis with Senior Academic Director of Emergency Medicine and Professor of Pediatrics at University of Cincinnati David Schnadower.

  • Diarrheal illness in children is common.

    • Worldwide it is one of the leading causes of pediatric deaths; in the United States, it leads to many sick visits

    • There is not much to change the course of disease; there is supportive care in prevention of dehydration/rehydration

    • When commercial probiotics came on the market, there was some hope they could treat diarrheal disease.

      • However, a 2010 Cochrane review showed that a majority of the papers and studies that had been done to justify the use of probiotics in diarrheal illness were of poor quality

        • This is a good example of when one uses meta-analysis results, one must be critical of the studies and results.

          • In fact, ⅓ of all meta-analysis results are later reversed by well conducted studies. 

  • Dr. Schnadower’s paper was published in 2018 in the NEJM and concluded that probiotic use in children with diarrheal illness did NOT improve outcomes in acute gastroenteritis.

    • The study was a randomized control trial of about 1,000 children 3 mo - 49 mo of age with acute gastroenteritis, meaning less than 7 days of diarrhea.  Half got placebo and half got probiotic for 5 days.  Stools were also collected at 14 days.

    • The main outcome was a modified Vesikari score - a score that includes diarrhea, vomiting, fever, doctor’s visits, hospitalizations and use of IV fluids.

      • The study assessed other outcomes and subpopulations and in no setting did probiotics make a difference.

  • Currently the American Gastroenterology Society does not recommend probiotics in acute gastroenteritis.  

  • Another study by Dr. Steven Friedman published in the same 2018 NEJM issue found the same thing, a different probiotic did not change the outcomes for children with acute gastroenteritis. 

  • To remember, probiotics are not regulated by the FDA as drugs.

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Hippo Peds RAP January 2022 Written Summary 170 KB - PDF

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