The combination of <i>Lactobacillus acidophilus</i> DSMZ 26280 and <i>Limosilactobacillus reuteri</i> DSMZ 25441 has an impact on clinical course and gut microbiota of children with acute infectious diarrhea

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Goktas N. T., Guven S., DİNLEYİCİ E. Ç.

FRONTIERS IN MICROBIOLOGY, cilt.17, 2026 (SCI-Expanded, Scopus)

Özet

Introduction: Previous studies and society guidelines have proposed probiotics as a complementary therapy for acute infectious diarrhea, which may shorten the disease course, yet strain-specific effects and microbiome correlates remain incompletely defined. We aim to evaluate the effect of a combination of Lactobacillus acidophilus and Limosilactobacillus reuteri on the duration of diarrhea and gut microbiota composition in children with acute infectious diarrhea. Patient and methods: In a prospective, randomized, controlled, open-label trial at a tertiary pediatric emergency department (March-August 2024), children aged 1-6 years with acute infectious diarrhea lasting less than 24 h were allocated 1:1 to standard therapy (oral rehydration +/- intravenous fluids) with or without 5-day probiotic (L. acidophilus DSMZ 26280; 108 CFU) and (L. reuteri DSMZ 25441; 108 CFU). Primary outcomes were duration of diarrhea and the proportion diarrhea-free at 72 h. The secondary outcome measures included the proportion of diarrhea-free children during first 10th day of the study. A subgroup analysis for gut microbiota composition at Day 0, 10th and 30th days of the study have been performed. Results: Of 145 enrolled children, 79 in the probiotic group (34 girls, 45 boys) and 66 in the control (30 girls and 36 boys); baseline demographics were comparable. The duration of diarrhea was significantly reduced in the probiotic group compared to the control group (46.4 +/- 29.6 h vs. 81.6 +/- 38.5 h, p < 0.001). The percentage of diarrhea-free children was significantly larger in the probiotic group at 72 h compared to the control (86.0% vs. 33.3%, p < 0.001). Persistence of diarrhea was lower in the probiotic group at 24, 48, and 96 h (all p < 0.001) and at day 6 (2.5% vs. 15.1%; p < 0.05); by days 7-10, persistence was rare in both groups. The probiotic combination is well-tolerated, and no adverse events have been reported. Alpha diversity indices were unchanged within/between groups. Bray-Curtis and Jaccard PCoA showed no between-group separation; unweighted UniFrac revealed differences within the probiotic group (day 1 vs. day 30) and between groups at day 30 (p < 0.05). LEfSe indicated enrichment of taxa associated with recovery in the probiotic arm and control group, and there is difference between group at Day 30. Conclusion: This study evaluates a specific combination of L. acidophilus DSMZ 26280 and L. reuteri DSMZ 25441 in a randomized controlled setting, adding to the growing body of strain-specific probiotic research in pediatric acute infectious diarrhea. Adding probiotics to treatment is well-tolerated and reduces the duration of diarrhea by approximately 35 h when it starts in the early hours of infection. This probiotic combination use is associated with modest phylogenetics shifts in gut microbiota composition, with enrichment of certain taxa that have been previously associated with gut homeostasis in other contexts; however, their functional and clinical significance in this setting remains unclear. Larger blinded trials are warranted to confirm durability and detailed metagenomic analysis including metabolomics.