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Probiolyte
PROBIOLYTE
Efficacy of a New Hypotonic Oral Rehydration Solution Containing Zinc and Prebiotics in the Treatment of Childhood Acute Diarrhea: A Randomized Controlled Trial
Passariello A. et al.
Objective: To evaluate the efficacy of a hypotonic oral rehydration solution (ORS) containing zinc and prebiotics for treatment of acute diarrhea in children.
Study design We conducted a single-blind, prospective, controlled trial including children (age range, 3-36 months) with acute diarrhea randomly assigned to standard hypotonic ORS (group 1) or to new hypotonic ORS containing zinc and prebiotics (group 2). The main outcome was the rate of resolution of diarrhea at 72 hours.
Results: A total of 60 children in group 1 (34 male; mean age, 18.58months; 95%CI, 15.5-21.6) and 59 in group 2 (36 male; mean age, 19.26 months; 95% CI, 15.9-22.6) completed the study protocol. The rate of diarrhea resolution at 72 hours was higher in group 2 (50% versus 72.9%, P = .010). Total ORS intake in the first 24 hours was higher in group 2 (50 mL/kg; 95% CI, 41-59 versus 22 mL/kg; 95%CI, 17-29; P < .001). The mean number of missed working days by the parents of children in group 2 was lower (0.39; 95% CI, 0.08-0.70 versus 1.45; 95% CI 1.02-1.88;
P < .001). Fewer patients in group 2 needed adjunctive drugs for the treatment of diarrhea 6/59 versus 19/60, P = .004. No adverse events were observed in either of the two groups.
Conclusion: The addition of zinc and prebiotics to ORS limits diarrhea duration in children. (J Pediatr 2011;158:288-92).
J Pediatr. 2011 Feb;158(2):288-92.e1. doi: 10.1016/j.jpeds.2010.07.055. Epub 2010 Sep 9. PMID: 20828714. https://pubmed.ncbi.nlm.nih.gov/20828714/
Probiotics for Children With Diarrhea : an update
Stefano Guandalini
Abstract: This review focuses on the efficacy of probiotics for diarrhea in children in different settings: day-care centers, diarrhea acquired in the hospital, antibiotic-associated diarrhea,
and treatment of acute infectious diarrhea. For prevention of diarrhea acquired in day-care centers, 5 randomized and placebo-controlled trials have been published. Probiotics tested
were Lactobacillus GG, Bifidobacterium lactis (alone or in combination with Streptococcus thermophilus), and Lactobacillus reuteri. The evidence of their efficacy in these settings is only
modest: statistically significant for some strains only and in any case of minimal to mild clinical importance. Few trials have examined the potential role of probiotics in preventing the
spread of diarrhea in hospitalized children, an event most commonly due to either rotavirus or Clostridium difficile, and they have yielded conflicting results. Overall, these studies provide only weak evidence on the efficacy of probiotics. On the other hand, a large number of trials on the role of probiotics in preventing the onset of antibiotic-associated diarrhea have been
published. Most commonly employed probiotics were Lactobacillus GG, Bifidobacterium spp., Streptococcus spp., and the yeast Saccharomyces boulardii. In general, these trials do show
clear evidence of efficacy, with the 2 most effective strains being Lactobacillus GG and S. boulardii. Today, we have a large number of published clinical trials on the role of probiotics in treating sporadic infectious diarrhea in children, and many of them are randomized, blinded, and controlled. They consistently show a statistically significant benefit and moderate clinical
benefit of a few, well-identified probiotic strains—mostly Lactobacillus GG and S. boulardii, but also L. reuteri—in the treatment of acute watery diarrhea, primarily rotaviral, in infants and young children of developed countries. Such a beneficial effect seems to result in a reduction of diarrhea duration of little more than 1 day, and to be exerted mostly on diarrhea due to rotavirus. The effect is not only strain dependent, but also dose-dependent, with doses of at least 10 billion/d being necessary.
J Clin Gastroenterol. 2008 Jul;42 Suppl 2:S53-7. doi: 10.1097/MCG.0b013e3181674087. PMID: 18520336. https://pubmed.ncbi.nlm.nih.gov/18520336/
Clinical management of acute diarrhoea: WHO/UNICEF joint statement
Overview
Diarrhoeal diseases are a leading cause of sickness and death among children in developing countries.
This Joint Statement focuses on two recent advances in managing diarrhoeal disease – newly formulated oral rehydration salts (ORS) containing lower concentrations of glucose and salt, and success in using zinc supplementation – which can drastically reduce the number of child deaths.
The new methods, used in addition to prevention and treatment of dehydration with appropriate fluids, breastfeeding, continued feeding and selective use of antibiotics, will reduce the duration and severity of diarrhoeal episodes and lower their incidence. Families and communities are key to achieving the goals set for managing the disease by making the new recommendations routine practice in the home and health facility.