Abstract
The efficacy of oral rehydration solution (ORS) enriched with Lactobacillus reuteri DSM 17938 and zinc in infants with acute gastroenteritis, is poorly defined. The aim of this double-blind, randomized, placebo-controlled study, was to assess the efficacy of an ORS enriched with Lactobacillus reuteri DSM 17938 and zinc (ORS+Lr&Z) in well-nourished, non-hospitalized infants with acute diarrhoea. Fifty one infants with acute diarrhoea were randomly assigned to receive either ORS+Lr&Z (28 infants, mean ± SD age 1.7 ± 0.7 years, 21 males), or standard ORS (ORS−Lr&Z; 23 infants, mean ± SD age 1.8 ± 0.7 years, 16 males). Stools volume and consistency were recorded pre- and posttreatment using the Amsterdam Infant Stool Scale and were compared between the two groups, as well as lost work/day care days, drug administration and need for hospitalization. Both groups showed reduction in the severity of diarrhoea on day two (p < 0.001) while, all outcomes showed a trend to be better in the ORS+Lr&Z group, without reaching statistical significance, probably due to the relatively small number of patients. No adverse effects were recorded. In conclusion, both ORS were effective in managing acute diarrhoea in well-nourished, non-hospitalized infants. ORS enriched with L. reuteri DSM 17938 and zinc was well tolerated with no adverse effects.
Highlights
Oral rehydration solution (ORS) is recommended in infants and children with acute diarrhoea for the treatment or the prevention of dehydration [1]
Zinc supplementation is beneficial in infants and children with acute diarrhoea living in developing countries [2], its efficacy in those living in developed countries is poorly defined
The exclusion criteria included the following: diarrhoea lasting more than 48 hours, clinical signs of severe dehydration defined as Bailey scale scores = or > 5, malnutrition defined as weight/height ratio below the 5th percentile, clinical signs of a coexisting severe acute systemic illness, immunodeficiency, severe chronic disease including cystic fibrosis, food allergy diagnosed by physician or other chronic gastrointestinal diseases, use of pre-/probiotics in the previous two weeks, use of antibiotics or any anti-diarrhoeal medication in the previous four weeks
Summary
Oral rehydration solution (ORS) is recommended in infants and children with acute diarrhoea for the treatment or the prevention of dehydration [1]. Zinc supplementation is beneficial in infants and children with acute diarrhoea living in developing countries [2], its efficacy in those living in developed countries is poorly defined. Selected strains of probiotics have been shown to reduce the duration and the severity of diarrhoea in children with acute diarrhoea and the effect is greater if the probiotics are given within 60 hours from the onset of symptoms [3,4,5,6,7,8]. Lactobacillus reuteri (L. reuteri) ATCC 55730 was reported to have a beneficial effect in reducing the duration and severity of acute gastroenteritis of both bacterial and viral (rotavirus) origin in infants and toddlers aged 6–36 months [6,7,8]. The above strain was found to carry transferable resistance traits for tetracycline and lincomycin, and for this reason it was replaced by a new strain—L. reuteri DSM 17938—by removal of two potentially transferable plasmid-borne resistances.
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