Probiotic selection for acute pediatric diarrhea

reference

asmat s, Shaukat F, Asmat R, Bakhat HfSG, ASMAT TM. Clinical effectiveness comparison of saccharomyces boulardii and lactic acid as probiotics in acute pediatric diarrhea. J Coll Doctors Surg Pak . 2018; 28 (3): 214-217.

objective

to compare the effectiveness of oral rehydration and antibiotic treatment plus the addition of both sancharomyces boulardii or lactic acid producing probiotics for the treatment of acute pediatric diarrhea.

draft

randomized study

participant

In the study, children (n = 200) were included in the age of 6 months to 5 years who were hospitalized due to acute diarrhea (3 or more loose, watery chairs per day) with a period of less than 14 days. Children who have already been treated with probiotics or antibiotics or suffered from immune deficiency, malnutrition or severe dehydration were excluded from participation in the study.

The participants were randomized in 2 groups: group A (n = 100; 61 at the age of 6 months to 3 years and 39 aged 4 to 5 years; 48 boys and 52 girls) received s accaromyces boulardii during group B (n = 100; 62 at the age of 6 months to 3 years and 38 aged 4 to 5 years; 57 boys and 43 girls) Probiotics received.

Intervention

group A received an oral dose of saccharomyces boulardii 150 mg (for the age of 6 months to 1 year) or 250 mg (for the age of 2 to 5 years), divided into 2 cans and administered into 20 ml of water, twice a day for 5 days.

group B received an oral dose of lactic acid producing probiotics, 150 mg (for the age of 6 months to 1 year) or 250 mg (for the age of 2 to 5 years), divided into 2 cans and twice in 20 ml of water for 5 days.

All participants were treated with intravenous ceftriaxon antibiotics and oral rehydration.

study parameters evaluated

At the beginning, a complete blood count, urine analysis and a physical examination were carried out. Data about the frequency and consistency of the bowel movement per day was collected during the entire study.

primary result measurements

Disconnecting acute diarrhea (less than 3 loose, aqueous chairs per day).

important knowledge

There was a statistically significant difference in the treatment effect between groups A and B. In group A, 45 participants were effectively treated with saccharomyces boulardii ; In group B, 26 participants were treated effectively with lactic acid -producing probiotics ( p = 0.004). In other words, 45 % of the participants took saccharomyces boulardii (group A) had a resolution of acute diarrhea, compared to only 26 % of those who produce lactic acid in profile (group B).

Stratification after treatment duration showed that within 1 to 7 days of the start of treatment, 21 participants in group A and 15 participants in group B had a dissolution of acute diarrhea ( p = 0.34), which was statistically not significant. Within 7 to 13 days after the start of the treatment, however, 24 participants in group A and 11 participants in group B occurred to dissolve the acute diarrhea, which was statistically significant ( p = 0.001).

practice implications

diarrhea in children are a global crisis of public health. Diarrhea is the second most common cause of death in children worldwide and demands life of 1.5 to 2 million children under 5 years of age every year. Children in areas with limited resources around the world have an average of 3 episodes of diarrhea per year; Infants experience an average of 6 episodes per year.

A growing number of evidence indicates that probiotics as an additional therapy can be helpful in acute pediatric diarrhea. The results of the present study support the conclusions of a comprehensive systematic review and meta -analysis, which in 2014 by Feizizadeh et al. was published. The review that analyzed 22 clinical studies came to the conclusion that saccharomyces boulardii reduces the duration of the acute pediatric diarrhea. ^{2 A systematic overview and meta -analysis from 2015 by Ahmadi et al. In which 14 articles were analyzed, the duration came to the end Acute Rotavirus diarrhea in children by the administration of reduced lactobacillus rhamnosus GG and other probiotics compared to control.}

In the future, clinical practice can continue to be directed by research, which focuses on which tribes and in which doses are most effective.

Many of the previous studies have been the placebo -controlled studies and not direct comparisons of different probiotics. We can now assume that probiotics in the treatment of pediatric diarrhea are more effective than placebo. In the future, clinical practice can continue to be directed by research, which focuses on which tribes and in which doses are most effective.

in the present study by ASMAT et al. saccharomyces boulardii was effective in more patients than lactic acid -producing probiotics for the treatment of acute pediatric diarrhea, whereby the diarrhea declined in 26 % in 45 %. The present study confirms the results of a study by Eren et al. From 2010, in which saccharomyces boulardii to yogurt was contained lactobacillus Bulgaricus and s thermophile as an additional treatment for acute pediatric diarrhea. On day 3 of the study, 48.5 % of the participants dealt with saccharomyces boulardii compared to 25.5 % of those treated had a resolution of the diarrhea lactobacillus Bulgaricus and s thermophile 4 Both studies support that saccharomyces Boulardii should be seen as a probiotic of the first choice for the supplementary treatment of acute diarrhea.

In the present study, the finding was fascinating that the response to treatment between the two groups was comparable in the first 7 days (21 % vs. 15 %). It was no significant difference up to the days of 7 to 13 when further 24 % of the participants in group A had a dissolution of the diarrhea, compared to only 11 % in group B.

Although not examined in this study, it would be interesting to see whether participants in both groups who, after 2 weeks of treatment with oral rehydration, antibiotics and probiotics (which 55 % of saccharomyces boulardii treated group A and 74 % of group B), would have for longer treatment, higher doses or a more varied mixture of probiotic stamina addressed.

In view of the effects of diarrhea on public health, especially in countries with limited resources, and millions of children who die annually, the positive results of the probiotic therapy should cause further examinations in order to provide the effectiveness of saccharomyces boulardii and lactobacillus rhamnosus promising varieties. In addition, the combination of tribes with a well -known benefit for acute diarrhea can increase effectiveness and offer a more foolproof path to achieve the highest response rate to treatment.

The present study had some problem areas that justify caution when interpreting the results. The methodology did not indicate the exact probiotic products used in the study, who delivered them, how they were stored, whether they were tested for sustainability or the number of colony -forming units contained in every dose. In addition, the only description we have for the product used for group B participants is "lactic acid producing probiotics" and not any specific bacterial tribe.

Another occasion for concern was Table II, in which the results for age -based stratification were presented. The numbers for effectiveness in group B in Table II did not add up correctly to the effectiveness data presented in Table I and could therefore not be interpreted as precisely; As a result, these numbers were not included in the "key results" section of this review. The mistake was probably a simple mistake, but since it was not discovered in any development, peer review or publication, he gives rise to considering the overall quality of the study.

The decision was also interesting to treat all participants with antibiotic therapy associated with their own risks (e.g. antibiotic-associated diarrhea) and is not considered first-line treatment for diarrhea, which are usually viral origin. There can be specific indications for the use of antibiotics that are not listed in the publication and relate to the geographical area in which the study was carried out (Pakistan). Finally,

The study design, which compared 2 complementary probiotic interventions, could possibly be improved by adding a placebo control arm and a probiotic combination arm.

Despite its defects, the paper deserves attention in view of the constantly growing evidence that supports a wide range of therapeutic applications for probiotics. At best, probiotics can offer a symptom benefit with a very low risk of side effects, which is always something that is worth pursuing.