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Lactobacillus rhamnosus GG (LGG)

Most-studied single probiotic strain, Cochrane support for paediatric acute infectious diarrhoea and AAD prevention.

Why

Lactobacillus rhamnosus GG (LGG, strain ATCC 53103) is the single most-studied probiotic strain in the world, with over 1,000 RCTs across multiple indications. The strongest evidence is for acute paediatric infectious diarrhoea (where Cochrane found ~1 day shortening of duration) and for antibiotic-associated diarrhoea prevention. Smaller bodies support use in atopic eczema prevention in high-risk infants and in C. difficile-positive diarrhoea.

How it works

Surface SpaCBA pili mediate adherence to intestinal mucus, displacing pathogens by competitive exclusion. Bacteriocin secretion inhibits Gram-negative pathogens. Stimulates IgA secretion and modulates Treg/Th17 balance, basis of the atopic prevention signal.

Expected onset · Acute diarrhoea: 1–2 days. AAD prevention: requires concurrent dosing.

How to take

Dosage

Acute diarrhoea: 10¹⁰ CFU twice daily for 5–7 days. AAD prevention: 10⁹–10¹⁰ CFU/day during antibiotic course and 1 week after. Capsules and sachets dose by CFU not weight.

Timing

Daily; with or without food; separate from antibiotic by 2 hours where possible

On the label

Stated 'L. rhamnosus GG' or 'LGG' or 'ATCC 53103', strain identity matters (different L. rhamnosus strains are not equivalent). CFU dose stated at end of shelf life, not at manufacture.

Ideal for

Children with acute infectious diarrhoea (alongside oral rehydration); children and adults starting antibiotic courses; high-risk infants for eczema prevention (with paediatric guidance).

Safety

Avoid in critically ill, immunocompromised, central-line-bearing, short-bowel patients, rare bacteraemia reports. Generally very well tolerated in healthy people. Coordinate with the prescribing clinician in complex paediatric conditions.

Evidence

At a glance

Szajewska 2019 Aliment Pharmacol Ther meta-analysis (15 RCTs, n=2,963): LGG reduced acute paediatric diarrhoea duration by ~1 day and stool frequency on day 2 vs placebo. Cochrane 2017 SR confirmed reduction in AAD risk. ESPGHAN paediatric guideline lists LGG as one of two probiotics with sufficient evidence to recommend for acute gastroenteritis adjunctive use.

Where to get it

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