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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Efficacy of Lactobacillus rhamnosus GG in treatment of acute pediatric diarrhea: A systematic review with meta-analysis
Ya-Ting Li, Hong Xu, Jian-Zhong Ye, Wen-Rui Wu, Ding Shi, Dai-Qiong Fang, Yang Liu, Lan-Juan Li
Ya-Ting Li, Jian-Zhong Ye, Wen-Rui Wu, Ding Shi, Dai-Qiong Fang, Lan-Juan Li, State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Ya-Ting Li, Jian-Zhong Ye, Wen-Rui Wu, Ding Shi, Dai-Qiong Fang, Lan-Juan Li, Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Hong Xu, Department of Orthopedics, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou 310003, Zhejiang Province, China
Yang Liu, Department of Orthopedics, Clinical Sciences, Lund, Lund University, Lund 22185, Sweden
Author contributions: Li YT, Xu H, and Ye JZ contributed equally to this work; Li YT and Xu H identified eligible articles and extracted applicable data; Li YT, Xu H, and Ye JZ contributed to the design of the study; Wu WR contributed to the analysis and interpretation of the outcomes; Liu Y, Fang DQ, and Shi D participated in writing and editing the article; all authors approved the final draft of the manuscript.
Supported by the National Natural Science Foundation of China, No. 81330011.
Conflict-of-interest statement: None.
PRISMA 2009 Checklist statement: The guidelines of the PRISMA 2009 Statement have been adopted in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lan-Juan Li, MD, PhD, Academic Research, Doctor, Professor, Senior Researcher, State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou 310003, Zhejiang Province, China. ljli@zju.edu.cn
Telephone: +86-571-87236759 Fax: +86-571-87236459
Received: April 28, 2019
Peer-review started: April 28, 2019
First decision: May 30, 2019
Revised: July 4, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: September 7, 2019
BACKGROUND
Diarrhea is a major infectious cause of childhood morbidity and mortality worldwide. In clinical trials, Lactobacillus rhamnosus GG ATCC 53013 (LGG) has been used to treat diarrhea. However, recent randomized controlled trials (RCTs) found no evidence of a beneficial effect of LGG treatment.
AIM
To evaluate the efficacy of LGG in treating acute diarrhea in children.
METHODS
The EMBASE, MEDLINE, PubMed, Web of Science databases, and the Cochrane Central Register of Controlled Trials were searched up to April 2019 for meta-analyses and RCTs. The Cochrane Review Manager was used to analyze the relevant data.
RESULTS
Nineteen RCTs met the inclusion criteria and showed that compared with the control group, LGG administration notably reduced the diarrhea duration [mean difference (MD) -24.02 h, 95% confidence interval (CI) (-36.58, -11.45)]. More effective results were detected at a high dose ≥ 1010 CFU per day [MD -22.56 h, 95%CI (-36.41, -8.72)] vs a lower dose. A similar reduction was found in Asian and European patients [MD -24.42 h, 95%CI (-47.01, -1.82); MD -32.02 h, 95%CI (-49.26, -14.79), respectively]. A reduced duration of diarrhea was confirmed in LGG participants with diarrhea for less than 3 d at enrollment [MD -15.83 h, 95%CI (-20.68, -10.98)]. High-dose LGG effectively reduced the duration of rotavirus-induced diarrhea [MD -31.05 h, 95%CI (-50.31, -11.80)] and the stool number per day [MD -1.08, 95%CI (-1.87, -0.28)].
CONCLUSION
High-dose LGG therapy reduces the duration of diarrhea and the stool number per day. Intervention at the early stage is recommended. Future trials are expected to verify the effectiveness of LGG treatment.
Core tip: The treatment effectiveness of Lactobacillus rhamnosus GG (LGG) for acute diarrhea in children was assessed in our study. LGG was confirmed to effectively reduce the duration of diarrhea and the stool number per day. LGG was particularly efficacious in patients treated at a dose > 1010 CFU/day, those treated at an early stage of illness, and those diagnosed with rotavirus-positive diarrhea.
