{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T23:40:05Z","timestamp":1790120405310,"version":"4.0.1"},"reference-count":118,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,11,29]],"date-time":"2021-11-29T00:00:00Z","timestamp":1638144000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Lei Zhang","award":["National Natural Science Foundation of China (Grant number: 81950410639)"],"award-info":[{"award-number":["National Natural Science Foundation of China (Grant number: 81950410639)"]}]},{"name":"Lei Zhang","award":["Outstanding Young Scholars Support Program (Grant number: 3111500001)"],"award-info":[{"award-number":["Outstanding Young Scholars Support Program (Grant number: 3111500001)"]}]},{"name":"Lei Zhang","award":["Xi\u2019an Jiaotong University Basic Research and Profession Grant (Grant number: xtr022019003, xzy032020032)"],"award-info":[{"award-number":["Xi\u2019an Jiaotong University Basic Research and Profession Grant (Grant number: xtr022019003, xzy032020032)"]}]},{"name":"Lei Zhang","award":["Epidemiology modeling and risk assessment (Grant number: 20200344)"],"award-info":[{"award-number":["Epidemiology modeling and risk assessment (Grant number: 20200344)"]}]},{"name":"Lei Zhang","award":["Xi\u2019an Jiaotong University Young Scholar Support Grant (Grant number: YX6J004)"],"award-info":[{"award-number":["Xi\u2019an Jiaotong University Young Scholar Support Grant (Grant number: YX6J004)"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Acute diarrhea is a major cause of morbidity and mortality in children under five. Probiotics are beneficial for treating acute diarrhea in children, but unclear which specific probiotic is the most effective. We performed a Bayesian network meta-analysis to examine the comparative effectiveness of probiotics. By searching EMBASE, PubMed, and the Cochrane Library up to 31 March 2021, randomized clinical trials (RCTs) on probiotics for treating acute diarrhea in children were included. Primary outcomes included the duration of diarrhea and diarrhea lasting \u22652 days, and secondary outcomes included the mean stool frequency on day 2 and duration of hospitalization, fever, and vomiting. We assessed the certainty of the evidence of outcomes according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline. Eighty-four studies with twenty-one different interventions in 13,443 children were included. For the primary outcomes, moderate evidence indicated that, Lactobacillus reuteri [mean difference (MD) = \u22120.84 day; 95% confidence interval (CI), \u22121.39, \u22120.29], Bifidobacterium lactis (MD = \u22120.98 day; 95%CI, \u22121.82, \u22120.14), Saccharomyces boulardii (MD = \u22121.25 day; 95%CI, \u22121.59, \u22120.91), Lactobacillus species (spp.) plus Bifidobacterium spp. plus Saccharomyces spp. (MD = \u22121.19 day; 95%CI, \u22121.81, \u22120.58), and Bacillus spp. plus Enterococcus spp. plus Clostridium spp. (MD = \u22121.1 day; 95%CI, \u22121.84, \u22120.35) significantly reduced the duration of diarrhea when compared with placebo. Saccharomyces boulardii [Odds ratio (OR) = 0.22; 95%CI, 0.11, 0.41] and Lactobacillus reuteri (OR = 0.23; 95%CI, 0.090, 0.60) significantly reduced the risk of diarrhea lasting \u22652 days when compared with placebo or no treatment, with moderate evidence. Among all probiotics, Saccharomyces boulardii may be the most effective in reducing both duration of diarrhea (compared with placebo) and risk of diarrhea lasting \u22652 days (compared with placebo or no treatment), with moderate evidence. To be conclusive, Saccharomyces boulardii may be the most effective probiotic for treating acute diarrhea in children, followed by several other single-strain and multi-strain probiotics.<\/jats:p>","DOI":"10.3390\/nu13124319","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T23:22:56Z","timestamp":1638314576000},"page":"4319","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Which Probiotic Is the Most Effective for Treating Acute Diarrhea in Children? A Bayesian Network Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0237-4458","authenticated-orcid":false,"given":"Zengbin","family":"Li","sequence":"first","affiliation":[{"name":"China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi\u2019an Jiaotong University Health Science Center, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guixian","family":"Zhu","sequence":"additional","affiliation":[{"name":"China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi\u2019an Jiaotong University Health Science Center, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, Global Health Institute, Xi\u2019an Jiaotong University Health Science Center, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Lai","sequence":"additional","affiliation":[{"name":"China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi\u2019an Jiaotong University Health Science Center, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5105-0532","authenticated-orcid":false,"given":"Xin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, Global Health Institute, Xi\u2019an Jiaotong University Health Science Center, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2343-084X","authenticated-orcid":false,"given":"Lei","family":"Zhang","sequence":"additional","affiliation":[{"name":"China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi\u2019an Jiaotong University Health Science Center, Xi\u2019an 710061, China"},{"name":"Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC 3053, Australia"},{"name":"Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3800, Australia"},{"name":"Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e255","DOI":"10.1016\/S2214-109X(18)30045-7","article-title":"Global disability-adjusted life-year estimates of long-term health burden and undernutrition attributable to diarrhoeal diseases in children younger than 5 years","volume":"6","author":"Troeger","year":"2018","journal-title":"Lancet Glob. Health"},{"key":"ref_2","unstructured":"GBD 2017 Diarrhoeal Disease Collaborators (2020). Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years: An analysis of the Global Burden of Disease Study 2017. Lancet Infect. Dis., 20, 37\u201359."},{"key":"ref_3","unstructured":"World Health Organization (1988). Persistent diarrhoea in children in developing countries: Memorandum from a WHO meeting. Bull. World Health Organ., 66, 709\u2013717."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1038\/nrgastro.2012.239","article-title":"The impoverished gut\u2014A triple burden of diarrhoea, stunting and chronic disease","volume":"10","author":"Guerrant","year":"2013","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"625210","DOI":"10.3389\/fcimb.2021.625210","article-title":"Gut Microbiota and Diarrhea: An Updated Review","volume":"11","author":"Li","year":"2021","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1111\/apt.15659","article-title":"Systematic review with meta-analysis: Saccharomyces boulardii for treating acute gastroenteritis in children\u2014A 2020 update","volume":"51","author":"Szajewska","year":"2020","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Collinson, S., Deans, A., Padua-Zamora, A., Gregorio, G.V., Li, C., Dans, L.F., and Allen, S.J. (2020). Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst. Rev., 12.","DOI":"10.1002\/14651858.CD003048.pub4"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1038\/s41591-019-0439-x","article-title":"The pros, cons, and many unknowns of probiotics","volume":"25","author":"Suez","year":"2019","journal-title":"Nat. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"148","DOI":"10.4161\/gmic.1.3.11712","article-title":"Probiotics-host communication: Modulation of signaling pathways in the intestine","volume":"1","author":"Thomas","year":"2010","journal-title":"Gut Microbes"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"454","DOI":"10.3389\/fcimb.2019.00454","article-title":"How Probiotics Affect the Microbiota","volume":"9","author":"Wieers","year":"2019","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1007\/s11894-014-0376-2","article-title":"Oral rehydration therapy in the second decade of the twenty-first century","volume":"16","author":"Binder","year":"2014","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3329\/cmoshmcj.v18i1.42128","article-title":"Clinical Efficacy of Bacillus clausii Probiotic in the Management of Acute Diarrhoea in Children","volume":"18","author":"Islam","year":"2019","journal-title":"Chattagram Maa-O-Shishu Hosp. Med. Coll. J."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Depoorter, L., and Vandenplas, Y. (2021). Probiotics in Pediatrics. A Review and Practical Guide. Nutrients, 13.","DOI":"10.3390\/nu13072176"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Tremblay, A., Xu, X., Colee, J., and Tompkins, T.A. (2021). Efficacy of a Multi-Strain Probiotic Formulation in Pediatric Populations: A Comprehensive Review of Clinical Studies. Nutrients, 13.","DOI":"10.3390\/nu13061908"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Malag\u00f3n-Rojas, J.N., Mantziari, A., Salminen, S., and Szajewska, H. (2020). Postbiotics for Preventing and Treating Common Infectious Diseases in Children: A Systematic Review. Nutrients, 12.","DOI":"10.3390\/nu12020389"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1111\/apt.15267","article-title":"Systematic review with meta-analysis: Lactobacillus rhamnosus GG for treating acute gastroenteritis in children\u2014A 2019 update","volume":"49","author":"Szajewska","year":"2019","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ianiro, G., Rizzatti, G., Plomer, M., Lopetuso, L., Scaldaferri, F., Franceschi, F., Cammarota, G., and Gasbarrini, A. (2018). Bacillus clausii for the Treatment of Acute Diarrhea in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients, 10.","DOI":"10.3390\/nu10081074"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/MPG.0000000000002751","article-title":"Use of Probiotics for the Management of Acute Gastroenteritis in Children: An Update","volume":"71","author":"Szajewska","year":"2020","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"b2535","DOI":"10.1136\/bmj.b2535","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"339","author":"Moher","year":"2009","journal-title":"BMJ"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"777","DOI":"10.7326\/M14-2385","article-title":"The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations","volume":"162","author":"Hutton","year":"2015","journal-title":"Ann. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"g5630","DOI":"10.1136\/bmj.g5630","article-title":"A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis","volume":"349","author":"Puhan","year":"2014","journal-title":"BMJ"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jclinepi.2017.10.005","article-title":"Advances in the GRADE approach to rate the certainty in estimates from a network meta-analysis","volume":"93","author":"Bonner","year":"2018","journal-title":"J. Clin. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jclinepi.2010.03.016","article-title":"Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: An overview and tutorial","volume":"64","author":"Salanti","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e2019013","DOI":"10.4178\/epih.e2019013","article-title":"Network meta-analysis: Application and practice using R software","volume":"41","author":"Shim","year":"2019","journal-title":"Epidemiol. Health"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Wan, X., Wang, W., Liu, J., and Tong, T. (2014). Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range. BMC Med. Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-135"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1177\/0962280216669183","article-title":"Optimally estimating the sample mean from the sample size, median, mid-range, and\/or mid-quartile range","volume":"27","author":"Luo","year":"2018","journal-title":"Stat. Methods Med. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1002\/jrsm.1429","article-title":"Optimally estimating the sample standard deviation from the five-number summary","volume":"11","author":"Shi","year":"2020","journal-title":"Res. Synth. Methods"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4054","DOI":"10.26452\/ijrps.v11i3.2603","article-title":"Analysis of impact of ors with zinc & probiotics supplements in curing acute diarrhoea","volume":"11","author":"Vaghela","year":"2020","journal-title":"Int. J. Res. Pharm. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e22192","DOI":"10.1097\/MD.0000000000022192","article-title":"Effect of a new Lactobacillus plantarum product, LRCC5310, on clinical symptoms and virus reduction in children with rotaviral enteritis","volume":"99","author":"Shin","year":"2020","journal-title":"Medicine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e347","DOI":"10.1097\/INF.0000000000002849","article-title":"A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of Saccharomyces boulardii in Infants and Children with Acute Diarrhea","volume":"39","author":"Mourey","year":"2020","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"464","DOI":"10.5223\/pghn.2020.23.5.464","article-title":"Efficacy of the Probiotic Probiotical Confirmed in Acute Gastroenteritis","volume":"23","author":"Kluijfhout","year":"2020","journal-title":"Pediatr. Gastroenterol. Hepatol. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"339","DOI":"10.3920\/BM2020.0046","article-title":"A combination of three probiotic strains for treatment of acute diarrhoea in hospitalised children: An open label, randomised controlled trial","volume":"11","author":"Chen","year":"2020","journal-title":"Benef. Microbes"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e237","DOI":"10.1097\/INF.0000000000002355","article-title":"Lack of Efficacy of Lactobacillus reuteri DSM 17938 for the Treatment of Acute Gastroenteritis: A Randomized Controlled Trial","volume":"38","author":"Szajewska","year":"2019","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"149","DOI":"10.3920\/BM2018.0094","article-title":"Bacillus clausii UBBC-07 reduces severity of diarrhoea in children under 5 years of age: A double blind placebo controlled study","volume":"10","author":"Sudha","year":"2019","journal-title":"Benef. Microbes"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Vidjeadevan, D., Vinoth, S., and Ramesh, S. (2018). Role of Saccharomyces boulardii and Bacillus clausii in reducing the duration of diarrhea: A three-armed randomised controlled trial. Int. J. Contemp. Pediatr., 5.","DOI":"10.18203\/2349-3291.ijcp20183511"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.1056\/NEJMoa1802598","article-title":"Lactobacillus rhamnosus GG versus Placebo for Acute Gastroenteritis in Children","volume":"379","author":"Schnadower","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_38","first-page":"212","article-title":"Effect of oral Saccharomyces boulardii supplementation on the duration of acute watery diarrhea in children","volume":"12","author":"Javeed","year":"2018","journal-title":"Pak. J. Med. Health Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/INF.0000000000001712","article-title":"A Double-blind, Randomized, Placebo-controlled Trial of Lactobacillus acidophilus for the Treatment of Acute Watery Diarrhea in Vietnamese Children","volume":"37","author":"Ngoc","year":"2018","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.1056\/NEJMoa1802597","article-title":"Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis","volume":"379","author":"Freedman","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.18203\/2349-3291.ijcp20182582","article-title":"Efficacy of probiotics in acute diarrhoea in children","volume":"5","author":"Bhat","year":"2018","journal-title":"Int. J. Contemp. Pediatr."},{"key":"ref_42","first-page":"68","article-title":"Role of Saccharomyces boulardii in management of acute diarrhoea of children\u2014A randomized controlled trial","volume":"4","author":"Sirsat","year":"2017","journal-title":"MedPulse Int. J. Pediatr."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Park, M.S., Kwon, B., Ku, S., and Ji, G.E. (2017). The Efficacy of Bifidobacterium longum BORI and Lactobacillus acidophilus AD031 Probiotic Treatment in Infants with Rotavirus Infection. Nutrients, 9.","DOI":"10.3390\/nu9080887"},{"key":"ref_44","first-page":"112","article-title":"Efficacy of Saccharomyces boullardii in children with acute diarrhea","volume":"28","author":"Burki","year":"2017","journal-title":"Med. Forum Mon."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"537","DOI":"10.5152\/tjg.2016.16396","article-title":"Effects of zinc or synbiotic on the duration of diarrhea in children with acute infectious diarrhea","volume":"27","author":"Yazar","year":"2016","journal-title":"Turk. J. Gastroenterol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s12602-016-9221-2","article-title":"The Effect of a Yeast Probiotic on Acute Diarrhea in Children","volume":"8","author":"Sharif","year":"2016","journal-title":"Probiotics Antimicrob. Proteins"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Menor, E., Garc\u00eda-Mar\u00edn, F., Vecino-L\u00f3pez, R., Horcajo-Mart\u00ednez, G., de Ibarrondo Guerrica-Echevarr\u00eda, M.J., G\u00f3mez-Gonz\u00e1lez, P., Velasco-Ortega, S., Su\u00e1rez-Almarza, J., and Nieto-Magro, C. (2016). A Multicenter, Prospective, Randomized Controlled Trial to Evaluate the Additional Benefit of a Multistrain Synbiotic (Prodefen\u00ae) in the Clinical Management of Acute Viral Diarrhea in Children. Glob. Pediatr. Health, 3.","DOI":"10.1177\/2333794X16679587"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"250","DOI":"10.3126\/jnps.v36i3.15539","article-title":"Efficacy of probiotic Saccharomyces boulardii as an adjuvant therapy in acute childhood diarrhoea","volume":"36","author":"Dash","year":"2016","journal-title":"J. Nepal Paediatr. Soc."},{"key":"ref_49","first-page":"464","article-title":"Efficacy and Safety of Saccharomyces boulardii in Acute Rotavirus Diarrhea: Double Blind Randomized Controlled Trial from a Developing Country","volume":"62","author":"Das","year":"2016","journal-title":"J. Trop. Pediatr."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.clinre.2014.09.006","article-title":"Probiotic bacteria, B. longum and L. acidophilus inhibit infection by rotavirus in vitro and decrease the duration of diarrhea in pediatric patients","volume":"39","author":"Lee","year":"2015","journal-title":"Clin. Res. Hepatol. Gastroenterol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1007\/s12098-014-1408-5","article-title":"A double blind randomized trial showing probiotics to be ineffective in acute diarrhea in Indonesian children","volume":"82","author":"Hegar","year":"2015","journal-title":"Indian J. Pediatr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1177\/0009922815569200","article-title":"Emergency Department Treatment of Children with Diarrhea who Attend Day Care: A Randomized Multidose Trial of a Lactobacillus helveticus and Lactobacillus rhamnosus Combination Probiotic","volume":"54","author":"Freedman","year":"2015","journal-title":"Clin. Pediatr."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"403","DOI":"10.3889\/oamjms.2015.088","article-title":"Bifidobacterium lactis in treatment of children with acute diarrhea. A randomized double blind controlled trial","volume":"3","author":"Said","year":"2015","journal-title":"Maced. J. Med. Sci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"415","DOI":"10.3920\/BM2014.0086","article-title":"Saccharomyces boulardii CNCM I-745 reduces the duration of diarrhoea, length of emergency care and hospital stay in children with acute diarrhoea","volume":"6","author":"Dinleyici","year":"2015","journal-title":"Benef. Microbes"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.jped.2014.10.009","article-title":"Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting","volume":"91","author":"Dinleyici","year":"2015","journal-title":"J. Pediatr."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1093\/cid\/ciu065","article-title":"Immune response and intestinal permeability in children with acute gastroenteritis treated with Lactobacillus rhamnosus GG: A randomized, double-blind, placebo-controlled trial","volume":"58","author":"Sindhu","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e300","DOI":"10.1111\/apa.12617","article-title":"Lactobacillus reuteri DSM 17938 effectively reduces the duration of acute diarrhoea in hospitalised children","volume":"103","author":"Dinleyici","year":"2014","journal-title":"Acta Paediatr."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/MCG.0b013e31828f1c6e","article-title":"Three-combination probiotics therapy in children with salmonella and rotavirus gastroenteritis","volume":"48","author":"Huang","year":"2014","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_59","first-page":"213","article-title":"Efficacy of probiotics (Saccharomyces bulardii) in acute watery diarrhoea in children","volume":"18","author":"Azim","year":"2014","journal-title":"J. Rawalpindi Med. Coll."},{"key":"ref_60","first-page":"379","article-title":"Lactobacillus GG for treatment of acute childhood diarrhoea: An open labelled, randomized controlled trial","volume":"139","author":"Aggarwal","year":"2014","journal-title":"Indian J. Med. Res."},{"key":"ref_61","first-page":"1065","article-title":"Cost-benefit analysis of the probiotic treatment of children hospitalized for acute diarrhea in Bangkok, Thailand","volume":"44","author":"Phavichitr","year":"2013","journal-title":"Southeast Asian J. Trop. Med. Public Health"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1007\/s00431-012-1903-5","article-title":"The effect of a multispecies synbiotic mixture on the duration of diarrhea and length of hospital stay in children with acute diarrhea in Turkey: Single blinded randomized study","volume":"172","author":"Dinleyici","year":"2013","journal-title":"Eur. J. Pediatr."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"205","DOI":"10.4103\/0976-500X.114603","article-title":"Comparison of efficacy of Saccharomyces boulardii strain in the treatment of acute diarrhea in children: A prospective, single-blind, randomized controlled clinical trial","volume":"4","author":"Burande","year":"2013","journal-title":"J. Pharmacol. Pharmacother."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1007\/s12098-011-0573-z","article-title":"Efficacy and safety of Saccharomyces boulardii in acute childhood diarrhea: A double blind randomised controlled trial","volume":"79","author":"Riaz","year":"2012","journal-title":"Indian J. Pediatr."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1097\/PEC.0b013e31826cad9f","article-title":"The effect of Lactobacillus GG on acute diarrheal illness in the pediatric emergency department","volume":"28","author":"Nixon","year":"2012","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_66","first-page":"122","article-title":"Clinical efficacy of use of probiotic \u201cSaccharomyces boulardii\u201d in children with acute watery diarrhea","volume":"36","author":"Khan","year":"2012","journal-title":"Pak. Paediatr. J."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1111\/j.1365-2036.2012.05180.x","article-title":"Randomised clinical trial: Lactobacillus reuteri DSM 17938 vs. placebo in children with acute diarrhoea\u2014A double-blind study","volume":"36","author":"Francavilla","year":"2012","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_68","first-page":"787240","article-title":"The comparition of the efficacy of two different probiotics in rotavirus gastroenteritis in children","volume":"2012","author":"Tanyeri","year":"2012","journal-title":"J. Trop. Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1111\/j.1365-2036.2011.04835.x","article-title":"Randomised clinical trial: The synbiotic food supplement Probiotical vs. placebo for acute gastroenteritis in children","volume":"34","author":"Vandenplas","year":"2011","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1111\/j.1365-3156.2011.02745.x","article-title":"Randomised controlled clinical trial of Lactobacillus sporogenes (Bacillus coagulans), used as probiotic in clinical practice, on acute watery diarrhoea in children","volume":"16","author":"Dutta","year":"2011","journal-title":"Trop. Med. Int. Health"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1111\/j.1442-200X.2011.03325.x","article-title":"Probiotic, zinc and lactose-free formula in children with rotavirus diarrhea: Are they effective?","volume":"53","author":"Dalgic","year":"2011","journal-title":"Pediatr. Int."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1097\/MPG.0b013e31822b7ab0","article-title":"Treatment of acute diarrhea with Saccharomyces boulardii in infants","volume":"53","author":"Penna","year":"2011","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1097\/MPG.0b013e3181bbf53d","article-title":"Efficacy of Lactobacillus GG in aboriginal children with acute diarrhoeal disease: A randomised clinical trial","volume":"50","author":"Ritchie","year":"2010","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1179\/146532810X12858955921159","article-title":"Lactobacillus acidophilus and Bifidobacterium bifidum stored at ambient temperature are effective in the treatment of acute diarrhoea","volume":"30","author":"Rerksuppaphol","year":"2010","journal-title":"Ann. Trop. Paediatr."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Grandy, G., Medina, M., Soria, R., Ter\u00e1n, C.G., and Araya, M. (2010). Probiotics in the treatment of acute rotavirus diarrhoea. A randomized, double-blind, controlled trial using two different probiotic preparations in Bolivian children. BMC Infect. Dis., 10.","DOI":"10.1186\/1471-2334-10-253"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/INF.0b013e3181b530bf","article-title":"Probiotics have clinical, microbiologic, and immunologic efficacy in acute infectious diarrhea","volume":"29","author":"Chen","year":"2010","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.jpeds.2009.01.060","article-title":"A randomized controlled trial to evaluate the efficacy of Lactobacillus GG in infantile diarrhea","volume":"155","author":"Misra","year":"2009","journal-title":"J. Pediatr."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.ijid.2008.09.014","article-title":"Nitazoxanide vs. probiotics for the treatment of acute rotavirus diarrhea in children: A randomized, single-blind, controlled trial in Bolivian children","volume":"13","author":"Teran","year":"2009","journal-title":"Int. J. Infect. Dis."},{"key":"ref_79","first-page":"204","article-title":"Probiotics in the treatment of acute diarrhea in young children","volume":"34","author":"Kianifar","year":"2009","journal-title":"Iran. J. Med. Sci."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1097\/MCG.0b013e31815a5780","article-title":"Efficacy of high-dose Lactobacillus rhamnosus GG in controlling acute watery diarrhea in Indian children: A randomized controlled trial","volume":"43","author":"Basu","year":"2009","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_81","first-page":"13","article-title":"Lactobacillus acidophilus yogurt and supplement in children with acute diarrhea: A clinical trial","volume":"2","author":"Rafeey","year":"2008","journal-title":"Res. J. Med. Sci."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1007\/s12098-008-0134-2","article-title":"Randomized double blinded controlled trial to evaluate the efficacy and safety of Bifilac in patients with acute viral diarrhea","volume":"75","author":"Narayanappa","year":"2008","journal-title":"Indian J. Pediatr."},{"key":"ref_83","first-page":"30","article-title":"Effect of a lactose-free milk formula supplemented with bifidobacteria and streptococci on the recovery from acute diarrhoea","volume":"17","author":"Mao","year":"2008","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1111\/j.1651-2227.2007.00191.x","article-title":"Saccharomyces boulardii in acute childhood diarrhoea: A randomized, placebo-controlled study","volume":"96","author":"Villarruel","year":"2007","journal-title":"Acta Paediatr."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1177\/147323000703500204","article-title":"Effect of Saccharomyces boulardii in children with acute gastroenteritis and its relationship to the immune response","volume":"35","author":"Ozkan","year":"2007","journal-title":"J. Int. Med. Res."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1136\/bmj.39272.581736.55","article-title":"Probiotics for treatment of acute diarrhoea in children: Randomised clinical trial of five different preparations","volume":"335","author":"Canani","year":"2007","journal-title":"BMJ"},{"key":"ref_87","first-page":"863","article-title":"The probiotic E. coli line Nissle 1917 (EcN) stops acute diarrhoea in infants and small children. Results of a confirming study","volume":"44","author":"Henker","year":"2006","journal-title":"Z. Gastroenterol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1111\/j.1440-1754.2007.01201.x","article-title":"Efficacy of Lactobacillus rhamnosus GG in acute watery diarrhoea of Indian children: A randomised controlled trial","volume":"43","author":"Basu","year":"2007","journal-title":"J. Paediatr. Child Health"},{"key":"ref_89","first-page":"S126","article-title":"Randomized control trial of live Lactobacillus acidophilus plus Bifidobacterium infantis in treatment of infantile acute watery diarrhea","volume":"89","author":"Vivatvakin","year":"2006","journal-title":"J. Med. Assoc. Thail."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1111\/j.1365-2036.2006.02740.x","article-title":"Treatment of acute infectious diarrhoea in infants and children with a mixture of three Lactobacillus rhamnosus strains\u2014A randomized, double-blind, placebo-controlled trial","volume":"23","author":"Pejcz","year":"2006","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"4557","DOI":"10.3748\/wjg.v12.i28.4557","article-title":"Role of a probiotic (Saccharomyces boulardii) in management and prevention of diarrhoea","volume":"12","author":"Billoo","year":"2006","journal-title":"World J. Gastroenterol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"e221","DOI":"10.1542\/peds.2004-2334","article-title":"Lactobacillus paracasei strain ST11 has no effect on rotavirus but ameliorates the outcome of nonrotavirus diarrhea in children from Bangladesh","volume":"116","author":"Sarker","year":"2005","journal-title":"Pediatrics"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/j.1651-2227.2005.tb01786.x","article-title":"Effects of Saccharomyces boulardii in children with acute diarrhoea","volume":"94","year":"2005","journal-title":"Acta Paediatr."},{"key":"ref_94","first-page":"295","article-title":"Efficacy of Trilac\u00ae in the treatment of acute diarrhoea in infants and young children\u2014A multicentre, randomized, double-blind placebo-controlled study","volume":"6","author":"Fyderek","year":"2004","journal-title":"Pediatr. Wspolczesna"},{"key":"ref_95","first-page":"112","article-title":"Limitations of probiotic therapy in acute, severe dehydrating diarrhea","volume":"36","author":"Ribeiro","year":"2003","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1097\/00006454-200205000-00013","article-title":"Effect of probiotic Lactobacillus strains on acute diarrhea in a cohort of nonhospitalized children attending day-care centers","volume":"21","author":"Rosenfeldt","year":"2002","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1097\/00006454-200205000-00012","article-title":"Effect of probiotic Lactobacillus strains in young children hospitalized with acute diarrhea","volume":"21","author":"Rosenfeldt","year":"2002","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_98","first-page":"432","article-title":"The efficacy of Saccharomyces boulardii in the treatment of acute watery diarrhea in children: A multicentre randomized controlled trial","volume":"12","author":"Hafeez","year":"2002","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_99","first-page":"81","article-title":"Evaluation of the efficacy of Saccharomyces boulardii in children with acute diarrhoea","volume":"20","author":"Urganci","year":"2001","journal-title":"Arch. Gastroenterohepatol."},{"key":"ref_100","first-page":"301","article-title":"Oral bacterial therapy promotes recovery from acute diarrhea in children","volume":"42","author":"Lee","year":"2001","journal-title":"Acta Paediatr. Taiwanica"},{"key":"ref_101","first-page":"307","article-title":"Effect of feeding yogurt versus milk in children with acute diarrhea and carbohydrate malabsorption","volume":"33","author":"Boudraa","year":"2001","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_102","first-page":"54","article-title":"Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: A multicenter European trial","volume":"30","author":"Guandalini","year":"2000","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_103","first-page":"87","article-title":"Clinical therapeutic affect of Saccharomyces boulardii on children with acute diarrhea","volume":"11","author":"Hernandez","year":"1998","journal-title":"Rev. Enferm. Infecc. Pediatr."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1111\/j.1651-2227.1997.tb08913.x","article-title":"A trial in the Karelian Republic of oral rehydration and Lactobacillus GG for treatment of acute diarrhoea","volume":"86","author":"Shornikova","year":"1997","journal-title":"Acta Paediatr."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1097\/00006454-199712000-00002","article-title":"Bacteriotherapy with Lactobacillus reuteri in rotavirus gastroenteritis","volume":"16","author":"Shornikova","year":"1997","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_106","first-page":"399","article-title":"Lactobacillus reuteri as a therapeutic agent in acute diarrhea in young children","volume":"24","author":"Shornikova","year":"1997","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_107","first-page":"516","article-title":"Oral bacterial therapy reduces the duration of symptoms and of viral excretion in children with mild diarrhea","volume":"25","author":"Guarino","year":"1997","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1093\/tropej\/42.3.162","article-title":"Lactobacillus GG and acute diarrhoea in young children in the tropics","volume":"42","author":"Pant","year":"1996","journal-title":"J. Trop. Pediatr."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"2595","DOI":"10.1007\/BF02087695","article-title":"Oral bacteriotherapy for viral gastroenteritis","volume":"39","author":"Isolauri","year":"1994","journal-title":"Dig. Dis. Sci."},{"key":"ref_110","first-page":"397","article-title":"Evaluation of Saccharomyces boulardii for the treatment of acute diarrhea in pediatric patients","volume":"41","year":"1994","journal-title":"Ann. Pediatr."},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Baral, R., Nonvignon, J., Debellut, F., Agyemang, S.A., Clark, A., and Pecenka, C. (2020). Cost of illness for childhood diarrhea in low- and middle-income countries: A systematic review of evidence and modelled estimates. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-08595-8"},{"key":"ref_112","doi-asserted-by":"crossref","unstructured":"Patro-Go\u0142\u0105b, B., and Szajewska, H. (2019). Systematic Review with Meta-Analysis: Lactobacillus reuteri DSM 17938 for Treating Acute Gastroenteritis in Children. An Update. Nutrients, 11.","DOI":"10.3390\/nu11112762"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"2090","DOI":"10.3201\/eid2708.210018","article-title":"Fungemia and Other Fungal Infections Associated with Use of Saccharomyces boulardii Probiotic Supplements","volume":"27","author":"Rannikko","year":"2021","journal-title":"Emerg. Infect. Dis."},{"key":"ref_114","doi-asserted-by":"crossref","unstructured":"Uusitupa, H.M., Rasinkangas, P., Lehtinen, M.J., Makela, S.M., Airaksinen, K., Anglenius, H., Ouwehand, A.C., and Maukonen, J. (2020). Bifidobacterium animalis subsp. lactis 420 for Metabolic Health: Review of the Research. Nutrients, 12.","DOI":"10.3390\/nu12040892"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.tim.2015.03.002","article-title":"Fate, activity, and impact of ingested bacteria within the human gut microbiota","volume":"23","author":"Derrien","year":"2015","journal-title":"Trends Microbiol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1053\/j.gastro.2020.05.096","article-title":"Probiotics Reduce Mortality and Morbidity in Preterm, Low-Birth-Weight Infants: A Systematic Review and Network Meta-analysis of Randomized Trials","volume":"159","author":"Morgan","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1097\/MPG.0000000000001897","article-title":"Probiotics for Preterm Infants: A Strain-Specific Systematic Review and Network Meta-analysis","volume":"67","author":"Szajewska","year":"2018","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1111\/pai.13305","article-title":"Comparative effectiveness of probiotic strains for the treatment of pediatric atopic dermatitis: A systematic review and network meta-analysis","volume":"32","author":"Mantaring","year":"2021","journal-title":"Pediatr. Allergy Immunol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/12\/4319\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:37:25Z","timestamp":1760168245000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/12\/4319"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,29]]},"references-count":118,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["nu13124319"],"URL":"https:\/\/doi.org\/10.3390\/nu13124319","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,29]]}}}