Probiotics in Clinical Practice:
Updated Guideline Recommendations on Acute Diarrhea and Antibiotic-Associated Diarrhea Management
13 October 2026
Prof. Hania SZAJEWSKA M.D.
The Medical University of Warsaw, Department of Paediatrics
Abstract
Probiotics are widely used for acute gastroenteritis and antibiotic-associated diarrhea (AAD), yet guideline recommendations, dosing, and product quality vary considerably between societies and products. The gut microbiota contributes to immune regulation, resistance to pathogens, and nutrient metabolism; both acute gastroenteritis and antibiotic exposure disrupt this balance, a state termed dysbiosis, underlying interest in probiotics as adjunctive therapy. Evidence supports specific strains, notably Saccharomyces boulardii and Lacticaseibacillus rhamnosus (formerly Lactobacillus rhamnosus) GG, though effects are strain-specific and not generalizable across products. This presentation reviews updated European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) and World Gastroenterology Organization (WGO) recommendations and addresses practical considerations, populations with limited evidence, and reflects on how recommendations continue to evolve as evidence accumulates.
Prof. Hania SZAJEWSKA M.D.
The Medical University of Warsaw, Department of Paediatrics
Professor and Chair of Pediatrics at the Medical University of Warsaw, she serves on the Board of the International Association for Probiotics and Prebiotics (ISAPP). Former roles include Editor-in-Chief of the Journal of Pediatric Gastroenterology and Nutrition, General Secretary of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), ESPGHAN Nutrition Committee Secretary, and AI Task Force Chair. Her research focuses on gut microbiota modulation, pediatric nutrition, and early dietary interventions affecting long-term health outcomes. She has made important contributions to the field through her involvement in numerous international clinical guidelines and position papers, including ESPGHAN recommendations on the use of biotics in pediatrics. Active in several EU-funded projects, she is a strong advocate for evidence-based medicine. She has authored more than 430 PubMed-indexed papers and 30 book chapters, received over 26,400 citations, has an H-index of 86, and ranks among the world’s top 2% most-cited researchers.