What are the most effective probiotics for treating diarrhea?

From the Guidelines

For treating diarrhea, the most effective probiotics are Lactobacillus rhamnosus GG and Saccharomyces boulardii, as they have shown the strongest evidence for reducing the duration and severity of diarrhea, particularly in cases of antibiotic-associated diarrhea and acute infectious diarrhea. These specific strains have been recommended by the ESPGHAN working group for adjunct treatment in acute gastroenteritis and for prevention of antibiotic-associated diarrhea 1. The use of L. rhamnosus GG (LGG) at more than 10^9 CFU/day has been specifically recommended for the prevention of nosocomial diarrhea 1.

Key Points to Consider:

• For adults, a typical dose is 1-2 capsules containing 5-10 billion CFU (colony forming units) taken twice daily until symptoms resolve, usually for 5-7 days.
• For children, products specifically formulated for pediatric use should be chosen, with dosing typically at 5 billion CFU once or twice daily.
• These probiotics work by restoring the balance of gut bacteria, strengthening the intestinal barrier, competing with harmful pathogens, and modulating the immune response in the digestive tract.
• They are most effective when started at the first sign of diarrhea or, in the case of antibiotic-associated diarrhea, when beginning antibiotic treatment.
• For best results, take probiotics between meals and store them according to package instructions, as many require refrigeration to maintain potency.
• If diarrhea persists beyond 3-4 days or is accompanied by fever, severe pain, or blood in stool, medical attention should be sought as probiotics should complement, not replace, conventional medical treatment.

Safety Considerations:

• The use of probiotics is generally safe, although caution is recommended in premature neonates, immunocompromised patients, critically ill patients, those with a central venous catheter, cardiac valvular disease, and short-gut syndrome 1.
• Specific probiotics with a history of safe use in preterm and term infants can be recommended for the prevention of necrotizing enterocolitis 1.

Evidence Summary:

• A meta-analysis of studies on probiotics for acute gastroenteritis found that probiotics may decrease the mean duration of diarrhea by 21.91 hours (95% CI, 16.17–27.64 hours) 1.
• The most frequently studied probiotic, S. boulardii, has been evaluated in 22 trials enrolling children with acute gastroenteritis, with evidence suggesting it may reduce the number of hours with diarrhea and the frequency of prolonged diarrhea 1.

From the Research

Effective Probiotics for Diarrhea

The most effective probiotics for treating diarrhea are:

• Lactobacillus rhamnosus GG (LGG) 2, 3, 4
• Saccharomyces boulardii 2, 3, 5, 4, 6

Probiotic Strains and Their Efficacy

The efficacy of probiotics in treating diarrhea varies depending on the strain and the type of diarrhea:

• LGG and S. boulardii have been shown to reduce the duration of acute gastroenteritis by 1 day 2
• LGG and S. boulardii have also been found to be effective in preventing antibiotic-associated diarrhea (AAD) 2, 4, 6
• S. boulardii has been shown to be effective in treating recurrent Clostridium difficile disease as an adjunct to antibiotics 6

Considerations for Probiotic Use

When using probiotics to treat diarrhea, consider the following:

• The timing of administration is important, with some studies suggesting that probiotics should be administered upon initiation of antibiotic treatment or within 48 hours 4
• The dosage of the probiotic is also important, with adequately dosed probiotics showing greater efficacy in preventing or resolving antibiotic-associated dysbiosis 4
• Probiotics are generally considered safe, but rare side effects such as septicaemia and fungaemia have been reported in high-risk situations 3