Applegate Jennifer A, Fischer Walker Christa L, Ambikapathi Ramya, Black Robert E
BMC Public Health. 2013;13 Suppl 3(Suppl 3):S16. doi: 10.1186/1471-2458-13-S3-S16. Epub 2013 Sep 17.
Oral rehydration salts (ORS), zinc, and continued feeding are the recommended treatments for community-acquired acute diarrhea among young children. However, probiotics are becoming increasingly popular treatments for diarrhea in some countries. We sought to estimate the effect of probiotics on diarrhea morbidity and mortality in children < 5 years of age.
We conducted a systematic review of randomized controlled trials to estimate the effect of probiotic microorganisms for the treatment of community-acquired acute diarrhea in children. Data were abstracted into a standardized table and study quality was assessed using the Child Health Epidemiology Reference Group (CHERG) adaption of the GRADE technique. We measured the relative effect of probiotic treatment in addition to recommended rehydration on hospitalizations, duration and severity. We then calculated the average percent difference for all continuous outcomes and performed a meta-analysis for discrete outcomes.
We identified 8 studies for inclusion in the final database. No studies reported diarrhea mortality and overall the evidence was low to moderate quality. Probiotics reduced diarrhea duration by 14.0% (95% CI: 3.8-24.2%) and stool frequency on the second day of treatment by 13.1% (95% CI: 0.8 - 25.3%). There was no effect on the risk of diarrhea hospitalizations.
Probiotics may be efficacious in reducing diarrhea duration and stool frequency during a diarrhea episode. However, only few studies have been conducted in low-income countries and none used zinc (the current recommendation) thus additional research is needed to understand the effect of probiotics as adjunct therapy for diarrhea among children in developing countries.
口服补液盐（ORS）、锌以及继续喂养是推荐用于治疗社区获得性幼儿急性腹泻的方法。然而，在一些国家，益生菌正日益成为治疗腹泻的常用方法。我们试图评估益生菌对5岁以下儿童腹泻发病率和死亡率的影响。
我们对随机对照试验进行了系统评价，以评估益生菌微生物治疗儿童社区获得性急性腹泻的效果。数据被提取到一个标准化表格中，并使用儿童健康流行病学参考组（CHERG）对GRADE技术的改编版来评估研究质量。除了推荐的补液治疗外，我们还测量了益生菌治疗对住院率、病程和严重程度的相对影响。然后，我们计算了所有连续性结局的平均百分比差异，并对离散性结局进行了荟萃分析。
我们确定了8项研究纳入最终数据库。没有研究报告腹泻死亡率，总体证据质量低至中等。益生菌使腹泻病程缩短了14.0%（95%置信区间：3.8 - 24.2%），并使治疗第二天的大便次数减少了13.1%（95%置信区间：0.8 - 25.3%）。对腹泻住院风险没有影响。
益生菌可能在缩短腹泻发作期间的病程和减少大便次数方面有效。然而，在低收入国家进行的研究很少，而且没有一项研究使用锌（目前的推荐方法），因此需要更多研究来了解益生菌作为发展中国家儿童腹泻辅助治疗方法的效果。
