Scenario

While working on a busy child assessment unit you review an 11-month-old boy who has a 36-hour history of acute diarrhoea felt to be infectious in nature. He is the third patient you have seen that day with the same problem. You have overheard that probiotics may reduce the duration of diarrhoea so decide to explore whether their use can help your patients.

Structured clinical question

In individuals younger than 18 years of age with suspected or confirmed acute infectious diarrhoea (patient), do oral probiotics (intervention) compared with placebo or no intervention (comparison) shorten the duration of diarrhoea (outcome)?

Search strategy

An Ovid Medline and EMBASE (1947 to May 2017 week 1) search was conducted on 11 May 2017 using the search terms diarrhoea OR diarrhea AND probiotics OR Lactobacill* OR Lactococc* OR Bifidobact* AND paediatric OR pediatric. Results were limited to humans. A total of 383 results were identified and screened to ensure relevance. The Cochrane database was also searched and all references reviewed to find other papers.

Four relevant papers were identified once irrelevant results and those which were duplicates included within reviews were excluded. These 4 papers were inclusive of 1 Cochrane review (inclusive of 63 randomised controlled trials (RCTs)), 1 meta-analysis (inclusive of 11 RCTs—all of which were also included in the 2010 Cochrane review) and 2 additional RCTs.

The four relevant papers were critically appraised that can be …