Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis

Systematic review and meta-analysis of children under 18 years with gastroenteritis in developed countries, mainly in outpatient or emergency department settings. The review synthesized trials of oral rehydration therapy, antiemetics, probiotics, and intravenous fluid strategies, with the probiotic evidence coming from six studies involving 1,170 patients.

Probiotic products were evaluated as adjunctive therapy for pediatric gastroenteritis in outpatient and emergency department settings, generally compared with placebo. The extracted text did not provide consistent probiotic dose, formulation, route, or duration details for the individual trials.

Probiotics did not show a reliable clinical benefit and are not supported for routine use in developed-country pediatric gastroenteritis. In pooled analyses, hospitalization within 7 days was not significantly reduced (RR 0.53, 95% CI 0.26, 1.07), intravenous rehydration within 7 days was not reduced (RR 1.13, 95% CI 0.81, 1.57), and return to the emergency department within 7 days was not reduced (RR 0.78, 95% CI 0.36, 1.67). Most probiotic comparisons were single-trial analyses, and the evidence base was low quality. By contrast, the broader review found better support for antiemetics and oral rehydration therapy than for probiotics.

The probiotic evidence was limited, low quality, and often based on single trials, which reduces confidence in the estimates. Probiotic products were heterogeneous and dosing details were not consistently reported, and adverse-event reporting was sparse. Findings are also indirect for routine practice because the review covered multiple therapy classes rather than a single standardized probiotic regimen.