School of Medicine, University of Crete, Heraklion, Greece.
Department of Pediatrics, Venizeleion General Hospital of Heraklion, 71409, Heraklion, Crete, Greece.
Eur J Pediatr. 2021 Sep;180(9):2907-2920. doi: 10.1007/s00431-021-04046-7. Epub 2021 Apr 6.
Acute diarrhea is one of the most frequent causes of doctor visits and hospital admissions for children. Our objective was to evaluate the association between probiotics administration and reduction of acute infectious diarrhea duration in children dwelling in developed countries. Bibliographic databases, gray literature, and reference lists were searched up to September 29, 2019. Double-blind, randomized controlled trials that examined probiotics efficacy in children with acute infectious diarrhea residing in developed countries were included. Data were synthesized by generic inverse variance method using fixed- and random-effects model. Twenty trials met the eligibility criteria (n = 3469 patients) and were included in the qualitative synthesis, and 19 studies in meta-analysis. Twelve trials (n = 840) were assessed as high/unclear risk of bias and eight (n = 2629) as low risk of bias. Comparisons revealed a moderate effectiveness of probiotics in low risk of bias studies (MD = - 13.45 h; 95% CI - 24.26, - 2.62; p = 0.02, Bayesian meta-analysis pooled effect MD = - 0.38, 95% CrI - 2.3, 1.58) and a notable effect in studies with high/unclear risk for bias (MD = - 19.70 h; 95% CI - 28.09, - 11.31; p = 0.0004). In trials of optimal methodological quality (n = 1989), probiotics effect was absent (MD = - 3.32 h; 95% CI - 8.78, 2.13, p = 0.23).Conclusion: Outcomes suggest that probiotics do not demonstrate sufficient clinical impact in reducing diarrhea duration in children in the developed countries.Systematic Review Registration: This review is registered at PROSPERO (ID: CRD42020152966). What is Known: • Probiotics, due to the conflicting study results, are administered without adequate evidence as an adjuvant therapeutic agent for eliminating duration of acute infectious diarrhea in pediatric patients. What is New: • In developed countries, probiotics are demonstrated as ineffective in reducing the duration of acute infectious diarrhea in children.
急性腹泻是儿童就诊和住院最常见的原因之一。我们的目的是评估在发达国家居住的儿童中，益生菌给药与减少急性感染性腹泻持续时间之间的关系。截至 2019 年 9 月 29 日，检索了文献数据库、灰色文献和参考文献列表。纳入了评估益生菌对发达国家急性感染性腹泻儿童疗效的双盲、随机对照试验。使用固定效应模型和随机效应模型，通过通用逆方差法对数据进行综合分析。20 项试验符合入选标准（n=3469 例患者），并纳入定性综合分析，19 项研究纳入荟萃分析。12 项试验（n=840 例）被评估为高/不确定偏倚风险，8 项试验（n=2629 例）为低偏倚风险。比较结果显示，低偏倚风险研究中益生菌具有中等有效性（MD=-13.45 h；95%CI-24.26，-2.62；p=0.02，贝叶斯荟萃分析合并效应 MD=-0.38，95%CrI-2.3，1.58），而高/不确定偏倚风险研究中则具有显著效果（MD=-19.70 h；95%CI-28.09，-11.31；p=0.0004）。在方法学质量最佳的试验（n=1989 例）中，益生菌的效果不存在（MD=-3.32 h；95%CI-8.78，2.13，p=0.23）。结论：研究结果表明，在发达国家，益生菌在减少儿童腹泻持续时间方面没有足够的临床效果。系统评价登记：本综述在 PROSPERO（ID：CRD42020152966）上注册。已知情况：•由于研究结果相互矛盾，益生菌作为一种辅助治疗药物，在消除儿科患者急性感染性腹泻的持续时间方面，其使用并没有足够的证据支持。新情况：•在发达国家，益生菌在减少儿童急性感染性腹泻的持续时间方面被证明是无效的。
