Lactobacillus rhamnosus GG (LGG)

LGG was long promoted as standard for paediatric acute gastroenteritis – based on older Cochrane Allen 2010 RCTs, ESPGHAN 2014 endorsement and wide clinical practice. Large multicentre RCT Schnadower 2018 (PECARN, NEJM, 943 children with acute gastroenteritis) showed NO effect of LGG 1×10^10 CFU twice daily × 5 days vs placebo on diarrhoea duration, vomiting episodes or outpatient visits. Parallel Canadian Freedman 2018 RCT (NEJM, 886 children with combined LGG + L. helveticus R0052 probiotic) was also negative. AGA 2020 does not recommend probiotics in children or adults with acute infectious gastroenteritis. Primary therapy for acute gastroenteritis is oral rehydration (ORS); severe dehydration – intravenous infusion. If LGG was recommended as a substitute for rehydration, consider seeking a second opinion from a paediatrician.

LGG is offered in bacterial vaginosis as «vaginal microbiota restoration after metronidazole» or monotherapy. WHO STI 2021 and IUSTI 2018 list metronidazole 500 mg twice daily × 7 days oral or metronidazole 0.75% vaginal gel × 5 days or clindamycin 2% cream × 7 days first-line for bacterial vaginosis. Probiotics (including LGG and L. crispatus) – option with limited evidence base; small RCTs showed heterogeneous results with adjunct post-antibiotic use to reduce recurrence rates. In women with recurrent BV, STI workup (chlamydia, gonorrhoea, trichomoniasis) and risk factor discussion (new or multiple sexual partners, douching) are mandatory. If LGG was recommended as a metronidazole substitute or without diagnostic confirmation (Amsel criteria or Nugent score), consider seeking a second opinion from a gynaecologist.

LGG is sold as «natural thrush remedy» in oral and intravaginal capsule forms. There are no quality data on LGG specifically in vulvovaginal candidiasis: small probiotic studies are heterogeneous and mostly involve other Lactobacillus species, with no systematic reviews reaching convincing conclusions. IUSTI 2018 lists fluconazole 150 mg single dose first-line for vulvovaginal candidiasis (or topical clotrimazole/miconazole); for recurrent – fluconazole 150 mg every 3 days × 3 doses + 6-month maintenance therapy. Lactobacilli are not in first-line guideline recommendations. If LGG was recommended as a substitute for antifungal therapy or in recurrent candidiasis without diabetes, HIV and other predisposing factor screening, consider seeking a second opinion from a gynaecologist.