Probiotics in infectious diarrhoea: are they indicated?

Abstract

Infectious gastroenteritis continues to be a leading cause of mortality and morbidity worldwide and while ROTA-vaccination will certainly reduce prevalence, it is unlikely to impact significantly in this condition. The cornerstone of treatment remains replacement of water and electrolyte losses with oral rehydration solution. In areas with low vitamin A status, supplementation of the latter may be of benefit and in the future, the addition of zinc may become routine.

A few years ago, probiotics were discussed primarily in the context of alternative medicine. Probiotics are now entering mainstream medical practice since they have been shown to decrease the severity and shorten the duration of infectious gastroenteritis by approximately 24 hours and are therefore a potent add-on therapy. Curtailing the duration of diarrhoea as well as reducing hospital stay, suggests a relevant social and economic benefit of probiotic treatment in adjunction to ORS in acute infectious gastroenteritis in children. Evidence in viral gastroenteritis is more convincing than in bacterial or parasitic infection. Mechanisms of action are strain specific and only those probiotic strains for which there is evidence of clinical efficacy should be recommended. In acute gastroenteritis, there is evidence of efficacy for some strains of lactobacilli (Lactobacillus (L) caseii GG and L. reuteri) and for Saccharomyces boulardii. Although probiotics are “generally regarded as safe”, side effects such as septicemia have very rarely been reported.