Systematic review with meta-analysis: Lactobacillus reuteri DSM 17938 for diarrhoeal diseases in children

Background Not all probiotics are equal. Aim To investigate the efficacy of Lactobacillus reuteri DSM 17938 (L. reuteri) in the management of various types of diarrhoeal diseases in children. Methods Medline, Embase, the Cochrane Library, trial registries and reference lists of included studies were searched in January 2016, with no language restriction, for randomised controlled trials (RCTs). Results Eight RCTs (n = 1229) met the inclusion criteria. In treatment trials, L. reuteri administration reduced the duration of diarrhoea (three RCTs, n = 256, mean difference, MD -24.82 h, 95% CI -38.8 to -10.8) and increased the cure rate on day 1 and day 2. However, heterogeneity and wide confidence intervals call for caution in interpreting results. In preventive trials carried out in hospitalised children, based on the findings from two RCTs (n = 290), there was no significant reduction in the risk of nosocomial diarrhoea, rotavirus diarrhoea or diarrhoea of any origin with L. reuteri administration. Based on one RCT (n = 97), there was no effect of L. reuteri on the risk of antibiotic-associated diarrhoea. However, the evidence is limited because the overall frequency of diarrhoea was surprisingly low. In preventive studies carried out in apparently healthy children, L. reuteri reduced diarrhoeal outcomes in one RCT; the evidence from another trial was less convincing. Conclusions In therapeutic settings, L. reuteri administration reduces the duration of diarrhoea and increases the chance of cure. In preventive settings, L. reuteri has the potential to reduce the risk of community-acquired diarrhoea in otherwise healthy children.