Probiotics, including several Lactobadllus species. Bifuloboctcria hulls, and Saccharomyces boulardii, are commonly used to manage or prevent acute, uncomplicated diarrhea. As normal inhabitants of the human Cl tract, these lactic acid-producing bacteria help maintain normal CI flora and reduce colonization by pathogenic bacteria. The exact mechanisms underlying the effects of these bacteria are not clear: Lactobadllus is suggested to enhance immune responses, produce antimicrobial substances, and compete with bacteria for intestinal mucosal binding sites.

Evidence demonstrates that probiotic therapy, especially with Lactobadllus rhamnosus GG (but also Lactobacillus casei, Lactobadllus addophilus, and Lactobadllus rented), prevents or shortens the course of mild viral diarrhea in infants and young children rhamnosus GG therapy can shorten duration of acute infectious diarrhea in children by an average of 0.7 days and reduce diarrhea frequency on day 2 of treatment by an average of 1.6 stools.Therapy with L. rhamnosus GG, L. addophilus, and .S. boulardii may also offer clinical benefit in antibiotic-associated diarrhea; a recent meta-analysis reported odds ratios favoring active treatment with these live organisms over placebo in preventing this condition. Probiotics appear to be safe; major side effects, such as Lactobadllus sepsis, have been reported only rarely. The role of probiotics in bacterial gastroenteritis and moderate-to-severe diarrhea is not supported conclusively by available evidence. The Food and Agriculture Organization of the United Nations and WHO have recognized the benefits of probiotics in the prevention and treatment of acute diarrhea. However, probiotics are not recognized as medications by FDA: their classification as dietary supplements or components of functional foods limits the health claims that can be made. Therefore, probiotics cannot be recommended to treat or prevent acute, uncomplicated diarrhea, but they can be recommended for maintenance of gastrointestinal tract function.

Several large studies performed in developing countries have shown that daily zinc supplementation in young children with acute diarrhea reduces total stool output, frequency of watery stools, and duration and severity of diarrhea. These children who are at risk for diarrheal disease are zinc-deficient because of poor nutrition; in addition, diarrhea increases intestinal losses of zinc considerably, further compromising zinc status, even in those with normal plasma zinc concentrations. Zinc deficiency is associated with impaired cellular and humoral immunity, as well as adverse gastrointestinal effects such as impaired water and electrolyte absorption, increased secretion in response to bacterial endotoxin. and decreased brush border enzymes. WHO/UNICEF recommend that children with acute diarrhea also receive zinc (10 mg of elemental zinc/day for infants younger than 6 months: 20 mg of elemental zinc/day for older infants and children) for 10 to 14 days. The role of zinc supplementation in young children with diarrhea in developed countries is not yet defined.

There is no evidence to substantiate the safety and effectiveness of herbal and homeopathic therapies in the treatment of acute diarrheal diseases; their use cannot be recommended.

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