The effectiveness of Lactobacillus reuteri DSM 17938 (L. reuteri) for the management of acute gastroenteritis (AGE) has been recently questioned.
Some evidence also supports their efficacy in reducing the duration of hospitalisation. However, as the term ‘probiotics’ refers to a heterogeneous group of live bacteria with species- and strain-specific properties, general statements regarding their effectiveness in the treatment of AGE cannot be applied to each probiotic product.
Patro-Gotl b. et al performed a systematic review to update evidence on L. reuteri for treating AGE in children. The authors searched MEDLINE, EMBASE, the Cochrane Library databases, and additional data sources from January 2016 (end of search for the 2016 systematic review) to August 2019. The primary outcomes were stool volume and duration of diarrhoea. Four randomised, controlled trials (RCTs) were included. None of them evaluated stool volume. Compared with placebo or no treatment, L. reuteri reduced diarrhoea duration (four RCTs, n = 347, mean difference, MD −0.87 days, 95% CI [−1.43, −0.31]). L. reuteri use was also associated with a reduced duration of hospitalisation (three RCTs, n = 284, MD −0.54 days, 95% CI [−1.09, 0.0]). The small effect sizes of limited clinical relevance and methodological limitations of the included trials should be noted when interpreting these findings.
Different Lactobacillus reuteri strains have been proposed to act as therapeutic agents in AGE in children. One of the commercially available strains is L. reuteri DSM 17938. This strain is derived from L. reuteri ATCC 55730 by the removal of two plasmids, resulting in its loss of resistances to tetracycline and lincomycin. The mechanisms explaining beneficial effects of L. reuteri DSM 17938 are not clear. However, it has been postulated that these mechanisms may include interference with pathogen attachment, interaction with the gut microbiota, and immunomodulatory effects.
This updated meta-analysis of RCTs confirms that in children with AGE, the addition of L. reuteri DSM 17938 to standard rehydration therapy compared with placebo or no intervention reduced the duration of diarrhoea by approximately 21 hours. It also reduced hospitalisation duration in inpatients by approximately 13 hours, although the pooled effect size was smaller (5.3 hours) when only studies with adequate blinding and allocation concealment were analysed. The addition of L. reuteri DSM 17938 to standard rehydration therapy also increased the chance for cure on the first two days of treatment only. However, it had no significant effect on the number of watery stools. Adverse events were not observed, or rates were similar in both study groups.
The findings of this review may inform guideline development groups about the efficacy of L. reuteri DSM 17938 for treating children with AGE.
Reference available on request.