Comparative efficacy of multi-strain and single-strain probiotics in the comprehensive treatment of rotavirus infections in children

Introduction. Rotavirus infection (RVI) remains one of the leading causes of acute intestinal infections in children and is accompanied by pronounced clinical manifestations and the risk of complications. Despite the widespread use of probiotics in the comprehensive treatment of RVI, the comparative efficacy of multi-strain and single-strain probiotic supplements have not been studied in sufficient detail.

Aim. To conduct a comparative evaluation of the efficacy of multi-strain to that of single-strain probiotics as part of comprehensive treatment of rotavirus infection in children.

Materials and methods. We conducted a prospective, two-center, randomized, open-label study of 327 children aged 1–7 years with laboratory-confirmed RVI. The patients were divided into four groups: inpatient ones (C1 — multi-strain probiotic, C2 – Saccharomyces boulardii) and outpatient ones (A1 — multi-strain probiotic, A2 — Saccharomyces boulardii). All patients received standard treatment. The duration of clinical symptoms, changes in stool frequency and consistency, pain severity, and changes in gut microbiota parameters (in inpatient groups) were assessed. Parametric and non-parametric statistical techniques were applied to analyse the data.

Results. The multi-strain probiotic was found to be associated with a more rapid reduction in stool frequency by days 2 of therapy (p < 0.05), as well as with accelerated normalization of stool consistency. The duration of diarrhea in outpatients in the multi-strain probiotic group was significantly shorter than that in the single-strain group (2.5 ± 0.7 versus 3.2 ± 1.2 days; p = 0.042). In the inpatient groups, there was a statistically significant reduction in the duration of fever (p = 0.029), abdominal pain (p = 0.014), and nausea (p = 0.039). The multi-strain probiotic turned out to be more effective in rebuilding damaged gut microbiome. No adverse events were reported.

Conclusions. Multi-strain probiotics as part of comprehensive treatment of rotavirus infections in children showed higher clinical efficacy as compared to the single-strain Saccharomyces boulardii probiotic supplement and provided faster symptom relief and restoration of gut microbiota.

1. Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidencebased guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr Gastroenterol Nutr. 2014;59(1):132–152. https://doi.org/10.1097/MPG.0000000000000375.

2. Szajewska H, Kołodziej M. Systematic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Aliment Pharmacol Ther. 2015;42(7):793–801. https://doi.org/10.1111/apt.13344.

3. Lebeer S, Vanderleyden J, De Keersmaecker SC. Genes and molecules of lactobacilli supporting probiotic action. Microbiol Mol Biol Rev. 2008;72(4):728–764. https://doi.org/10.1128/MMBR.00017-08.

4. Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 2010;(11):CD003048. https://doi.org/10.1002/14651858.CD003048.pub3.

5. Szajewska H, Guarino A, Hojsak I, Indrio F, Kolacek S, Orel R et al. Use of Probiotics for the Management of Acute Gastroenteritis in Children: An Update. J Pediatr Gastroenterol Nutr. 2020;71(2):261–269. https://doi.org/10.1097/MPG.0000000000002751.

6. Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506–514. https://doi.org/10.1038/nrgastro.2014.66.

7. Belkaid Y, Hand TW. Role of the microbiota in immunity and inflammation. Cell. 2014;157(1):121–141. https://doi.org/10.1016/j.cell.2014.03.011.

8. Лобзин ЮВ, Жданов КВ, Усков АН, Бехтерева МК, Рычкова СВ, Комарова АМ и др. Вирусные кишечные инфекции (гастроэнтериты) у детей: клинические рекомендации. 2025. Режим доступа: https://diseases.medelement.com/disease/84-2025/18806.

9. Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs. 1988;14(1):9–17. Available at: https://pubmed.ncbi.nlm.nih.gov/3344163/.

10. Collinson S, Deans A, Padua-Zamora A, Gregorio GV, Li C, Dans LF, Allen SJ. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 2020;(12):CD003048. https://doi.org/10.1002/14651858.CD003048.pub4.

11. Ramig RF. Pathogenesis of intestinal and systemic rotavirus infection. J Virol. 2004;78(19):10213–10220. https://doi.org/10.1128/JVI.78.19.10213-10220.2004.

12. Miquel S, Martín R, Rossi O, Bermúdez-Humarán LG, Chatel JM, Sokol H et al. Faecalibacterium prausnitzii and human intestinal health. Curr Opin Microbiol. 2013;16(3):255–261. https://doi.org/10.1016/j.mib.2013.06.003.

13. Koh A, De Vadder F, Kovatcheva-Datchary P, Bäckhed F. From Dietary Fiber to Host Physiology: Short-Chain Fatty Acids as Key Bacterial Metabolites. Cell. 2016;165(6):1332–1345. https://doi.org/10.1016/j.cell.2016.05.041.

14. McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol. 2010;16(18):2202–2222. https://doi.org/10.3748/wjg.v16.i18.2202

15. Cryan JF, O’riordan KJ, Cowan CSM, Sandhu KV, Bastiaanssen TFS, Boehme M et al. The microbiota-gut-brain axis. Physiol Rev. 2019;99(4):1877–2013. https://doi.org/10.1152/physrev.00018.2018.