Probiotics for Infectious Diarrhea and Traveler's Diarrhea: Guidance for Children and Adults
What reviews and guidelines say about probiotics for infectious diarrhea in children and adults and for traveler's diarrhea, why they disagree, and why oral rehydration comes first.
Content last updated . This page has not been medically reviewed.
How the terms are used
The WHO defines diarrhoea as three or more loose or liquid stools a day. [2] The NIDDK (US) says acute diarrhea typically lasts less than a week and goes away on its own. [4] Traveling to countries with limited sanitation is a risk factor. [4] Evidence labels used below: promising but limited, mixed, insufficient evidence, and Proper evidence not found (we looked and found nothing usable). Each applies only to the strain and group studied.Children with acute gastroenteritis
| Source | What it found | Label |
|---|---|---|
| Cochrane review, 2020 | 82 studies, 12,127 people, mostly children (11,526 under 18; 412 adults). [5] Many studies had high or unclear risk of bias, and results were similar in analyses limited to L. rhamnosus GG and S. boulardii. [5] Probiotics probably make little or no difference to the number with diarrhoea lasting 48 hours or longer, and the effect on duration is uncertain. No serious adverse events were attributed to probiotics. [5] | Mixed |
| AGA guideline (US), 2020 | "Suggests against" probiotics in children with acute infectious gastroenteritis (conditional, moderate certainty). [6] Its technical review found no trial in the US or Canada that reported a benefit, and one US trial of L. rhamnosus ATCC 53103 was no better than placebo for time to normal stool. [7] | No benefit found in North American trials |
| ESPGHAN position paper, 2014 | May be considered in addition to rehydration: Lactobacillus rhamnosus GG and Saccharomyces boulardii (low-quality evidence, strong recommendation each); L. reuteri DSM 17938 less compelling (very low, weak). Recommendations only where at least 2 trials of a named strain existed. [3] | Promising but limited, strain-specific |
| ESPGHAN update, 2023 | Made recommendations for specific strains in acute gastroenteritis; we read only the abstract and cannot list them. [8] | Not verified |
| China guideline, 2024 | Probiotics "moderately advised" for viral watery diarrhea in children. [9] | Promising but limited |
The AGA and ESPGHAN positions differ. The AGA pointed out that most trials were conducted in eastern Europe and Asia, where the common pathogens differ from North America. [7] It also noted that four older L. acidophilus trials tested heat-killed preparations, which do not meet the strict definition of probiotics. [7] Results do not transfer from one strain, or from children to adults; read strain specificity and the LGG evidence profile.
Adults with infectious diarrhea
Proper evidence not found. The Cochrane review included only 412 adults, and we did not find a guideline we could read that gives adult-specific probiotic advice for infectious diarrhea. [5] Adults at higher risk of dehydration should talk to a pharmacist or clinician. [1]Traveler's diarrhea (prevention)
| Source | What it found | Label |
|---|---|---|
| Meta-analysis, 2007 | 12 trials. Pooled risk ratio 0.85 for preventing traveler's diarrhea; S. boulardii and a L. acidophilus/B. bifidum mixture had significant effect. [10] | Promising but limited |
| Meta-analysis, 2018 | 11 trials, same pooled risk ratio 0.85. The author notes that the 2017 International Society of Travel Medicine guideline said there was insufficient evidence to recommend probiotics or prebiotics. [11] | Mixed |
| NCCIH summary | A 2018 review of 11 studies suggested benefit but did not assess study quality; the ISTM 2017 guideline acknowledged a small benefit but varied studies. [12] | Mixed |
| Network review, 2022 | 17 trials. Probiotics beat placebo, but rifaximin (a medicine, not a supplement) was more effective than probiotics, and probiotic types differed. [13] | Mixed |
| Systematic review, 2024 | 10 trials. L. acidophilus alone showed no efficacy unless mixed; studies remain limited. [14] | Insufficient evidence |
Probiotic products are not a substitute for safe food and water habits or a travel clinic's advice. See probiotics and travel and S. boulardii.
Frequently asked questions
Do probiotics help stomach flu in children?
Evidence conflicts. The Cochrane review found little or no difference in diarrhoea lasting 48 hours or longer; the AGA suggests against probiotics in US/Canadian children; ESPGHAN 2014 said LGG or S. boulardii may be considered in addition to rehydration. [5][6][3]
What matters more than a probiotic?
Fluids. The NHS says the most important thing is plenty of fluids, and WHO recommends oral rehydration solution. [1][2]
Do probiotics prevent traveler's diarrhea?
Pooled reviews found a risk ratio of 0.85 (about 15% lower), but the 2017 travel medicine guideline found insufficient evidence, and results vary by strain. [10][11][13]
Are probiotics safe for a baby with diarrhea?
The sources we read advise caution: the FDA warns about preterm infants, and the NHS advises calling a clinician about a baby under 12 months. [16][1]
When is diarrhea an emergency?
Seek help for blood, a baby under 12 months, signs of dehydration that continue after rehydration, or a person who cannot keep fluids down. [1] In a US emergency, call 911.
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Fluids first, and when to get help
The NHS lists these reasons to call for urgent advice: worry about a baby under 12 months, bloody diarrhoea, signs of dehydration that remain after oral rehydration sachets, or being unable to keep fluid down. [1] The WHO advises seeing a health professional for blood in the stool or signs of dehydration. [2] People who are pregnant, over 65, taking antibiotics or have a weakened immune system are more likely to have complications. [4] The NHS says not to give children under 12 medicine to stop diarrhoea. [1] The NIDDK says that if you cannot drink enough fluid or oral rehydration solution, dehydration can lead to serious health problems. [4] In a US emergency, call 911. See also diarrhea: causes, dehydration and when to get help.
Safety and who should ask first
- Weakened immune system or serious illness. NCCIH says the risk of harm is greater, and the NHS says to talk to a doctor first. [12][15] See probiotic safety and bloodstream infection reports.
- Babies and preterm infants. The FDA warns of invasive, potentially fatal disease in preterm infants given probiotics. [16] The NHS advises urgent advice if you are worried about a baby under 12 months. [1]
- Medicines. If you take antibiotics or immunosuppressants, ask a pharmacist; see medicine interactions.
- Pregnancy, breastfeeding, kidney or liver conditions, surgery. The sources we read give no specific advice. Ask a clinician.
- Quality. NCCIH notes label mismatches. [12] See quality testing and certifications.
References
- NHS (UK). Diarrhoea and vomiting. Page last reviewed 21 December 2023. Read 2026-10-23.
- World Health Organization. Diarrhoeal disease (fact sheet, 7 March 2024). Read 2026-10-23.
- Szajewska H, et al. Use of probiotics for management of acute gastroenteritis: a position paper by the ESPGHAN Working Group for Probiotics and Prebiotics. J Pediatr Gastroenterol Nutr. 2014;58(4):531-9. Abstract read 2026-10-23.
- NIDDK (US National Institute of Diabetes and Digestive and Kidney Diseases). Definition & Facts for Diarrhea. Last reviewed September 2024. Read 2026-10-23.
- Collinson S, et al. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 2020;12:CD003048. Abstract read 2026-10-23.
- Su GL, et al. AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders. Gastroenterology. 2020;159(2):697-705. Full text read 2026-10-23 on a copy hosted by a Portuguese gastroenterology society; the journal page itself returned an access block.
- Preidis GA, et al. AGA Technical Review on the Role of Probiotics in the Management of Gastrointestinal Disorders. Gastroenterology. 2020;159(2):708-38. Full text read 2026-10-23 (PMC8018518).
- Szajewska H, et al. Probiotics for the management of pediatric gastrointestinal disorders: position paper of the ESPGHAN Special Interest Group on Gut Microbiota and Modifications. J Pediatr Gastroenterol Nutr. 2023;76(2):232-47. Abstract read 2026-10-23 (full text not accessible to us).
- Fang YH, et al. Clinical practice guidelines for acute infectious diarrhea in children in China (2024). World J Pediatr. 2025;21(7):708-19. Abstract read 2026-10-23.
- McFarland LV. Meta-analysis of probiotics for the prevention of traveler's diarrhea. Travel Med Infect Dis. 2007;5(2):97-105. Abstract read 2026-10-23.
- Bae JM. Prophylactic efficacy of probiotics on travelers' diarrhea: an adaptive meta-analysis of randomized controlled trials. Epidemiol Health. 2018;40:e2018043. Abstract read 2026-10-23.
- NCCIH (US National Center for Complementary and Integrative Health). Probiotics: Usefulness and Safety. Read 2026-10-23.
- Fan H, et al. Probiotics and rifaximin for the prevention of travelers' diarrhea: a systematic review and network meta-analysis. Medicine (Baltimore). 2022;101(40):e30921. Abstract read 2026-10-23.
- Alharbi BF, Alateek AA. Investigating the influence of probiotics in preventing traveler's diarrhea: meta-analysis based systematic review. Travel Med Infect Dis. 2024;59:102703. Abstract read 2026-10-23.
- NHS (UK). Probiotics. Page last reviewed 24 November 2022 (next review was listed as November 2025). Read 2026-10-23.
- US Food and Drug Administration. FDA Raises Concerns About Probiotic Products Sold for Use in Hospitalized Preterm Infants. News release, 26 October 2023. Read 2026-10-23.