To the Editor: A Cochrane systematic review concluded that the use of specific probiotics along with rehydration therapy has beneficial effects in reducing the duration and stool frequency of acute infectious diarrhea. Cochrane experts acknowledged variability among studies and stated that research is needed to guide the use of particular probiotic regimens in specific patient groups. The results of the trial by Schnadower et al. and those of the trial by Freedman et al., which were published in the same issue of the Journal, should be interpreted with caution because of the late use of probiotic therapy and the unverified viability of strains in liquid suspension in both trials. Most children had mild gastroenteritis and were recruited after they had had diarrhea for 2 days. Guidelines recommend probiotic use within the first 24 to 48 hours after symptom onset in order to be effective. Infectious gastroenteritis in Western societies is typically mild and self-limiting, and the use of probiotics may not be critical. This is not the same in less developed areas. It would be advisable to perform a subanalysis focusing only on severe cases of diarrhea treated with reliable probiotic dosing within the first 48 hours after the onset of symptoms in order to properly assess the effectiveness of the intervention.

Peer reviewed