Probiotics for Diarrhea and Gastrointestinal Disorders

Introduction to Probiotic Use

The American Gastroenterological Association (AGA) recommends against probiotic use in children with acute infectious gastroenteritis in North America, based on moderate-quality evidence 1, 2
The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommends Lactobacillus reuteri (DSM 17938) as an adjunct treatment for acute gastroenteritis in children outside North America, with low-quality evidence 3

Saccharomyces boulardii reduces diarrhea duration by approximately 28.9 hours (95% CI: 16.78-41.03 hours) in children with acute gastroenteritis, with very low to low quality evidence 1, 2, 4, 5
Lactobacillus rhamnosus GG (LGG/ATCC 53103) reduces diarrhea duration by approximately 23.13 hours (95% CI: 12.33-33.94 hours) in children with acute gastroenteritis, with low-quality evidence 1, 2, 6, 4, 7
Lactobacillus reuteri (DSM 17938) reduces diarrhea duration by approximately 24.36 hours (95% CI: 33.55-13.17 hours) in children with acute gastroenteritis, with low-quality evidence 3, 4, 7

Lactobacillus rhamnosus GG or Saccharomyces boulardii can prevent antibiotic-associated diarrhea in both children and adults, with moderate to high quality evidence 8, 3
Probiotics reduce the risk of antibiotic-associated diarrhea by approximately 50%, with moderate-quality evidence 8

Saccharomyces boulardii (1g, 3×10^10 CFU/day) as adjunct to standard antibiotic therapy may increase cessation of diarrhea (RR 1.33; 95% CI: 1.02-1.74) and decrease recurrence of diarrhea (RR 0.59; 95% CI: 0.35-0.98) in patients with CDI, with low-quality evidence 9, 10
Probiotics reduce the risk of developing CDI by 64% when given with antibiotics, with moderate-quality evidence 8

Combination probiotics containing Lactobacillus spp. + Bifidobacterium spp., or single-strain B. animalis subsp. lactis, L. reuteri, or L. rhamnosus can prevent necrotizing enterocolitis (NEC) in preterm infants <37 weeks gestational age, with moderate to high quality evidence 1, 2

The American Gastroenterological Association (AGA) states that evidence is insufficient to recommend specific probiotics for IBS, though treatment duration should not exceed 12 weeks if attempted, with very low quality evidence 11

Higher doses (≥10^10 CFU/day) of probiotics are generally more effective, with low-quality evidence 7
Duration of probiotic treatment for acute diarrhea is typically 5 days, with low-quality evidence 6, 5
Duration of probiotic treatment for IBS should not exceed 12 weeks, with very low quality evidence 11

Probiotics are generally safe, but caution should be exercised in immunocompromised patients, premature neonates, patients with central venous catheters, critically ill patients, cardiac valvular disease, and short-gut syndrome, with low-quality evidence 3