Efficacy of probiotics in outcome of acute watery diarrhea in children aged 06 months to 12 years admitted to the pediatrics department of Bacha Khan Medical Complex, Swabi

Probiotics, Enteric and Diarrheal Diseases, and Global Health

Background:Probiotic therapies with different strains demonstrated some beneficial effects, although some studies did not show any significant effects. This study assessed systematically the current knowledge on the effect of probiotic bacteria on duration of acute rotavirus diarrhea in children compared with control.Methods:The PubMed, Cochrane Controlled Trial Register (CCTR) and Ovid (Wolters Kluwer Health) were searched between 1980 to June 15, 2013. Randomized controlled trials including the administration of probiotics for treatment of rotavirus diarrhea in infants and children were reviewed.Results:A total number of 1244 articles were found through the aforementioned search. 203 articles were selected after the first screening of title and abstract. The intervention group included subjects who received probiotic strains and dosage in any conditions. Placebo or any similar vehicle without probiotic was used in the controlled trials. Finally, 14 articles were selected. The outcomes from each study were considered in the duration of diarrhea. Statistical analyses were performed with Stata software. The pooled estimate of efficacy of probiotics in prevention or treatment of disease yielded in all studies a mean difference of 0.41 (CI 95%: -0.56 to –0.25; p<0.001). The pooled estimate of efficacy of lactobacillus rhamnosus GG and other probiotics significantly reduced the duration of diarrhea. Among trials, the overall reduction of LGG was 0.47 (CI 95%: -0.80 to -0.14; P= 0.020).Conclusion: In conclusion, probiotics exert positive effect in reducing the duration of acute rotavirus diarrhea compared with control.

The role of zinc and vitamin A in persistent diarrhea among infants and young children.

A Gastroenterologist's Guide to Probiotics

Diarrhea remains a leading cause of morbidity and mortality among children worldwide. Numerous studies have investigated the effects of zinc and probiotics in reducing the duration and severity of acute watery diarrhea. Objective: This study aimed to compare the efficacy of zinc-probiotic combination therapy with zinc-only therapy in managing acute watery diarrhea in pediatric patients. Methodology: Conducted at the Department of Pediatrics, Sughra Shafi Medical Complex, Narowal, from March 10, 2023, to August 10, 2024, the study enrolled 80 children diagnosed with acute watery diarrhea, who were randomly assigned into two groups. Group A received oral zinc, low osmolarity ORS, and continued nutritious feeding, while Group B was given Enflor sachets in addition to zinc and ORS. The duration of diarrhea was recorded, and data analysis was performed using SPSS v25.0. A t-test was used to compare the duration of diarrhea between the two groups, with statistical significance set at p ≤ 0.05. Results: The average age in Group A was 38.3±10.5 months, and in Group B, it was 38.6±10.1 months. The duration of diarrhea in Group A was 31.35±2.338 hours, compared to 24.08±2.495 hours in Group B, with a significant difference (p = 0.0001). Conclusion: The combination of probiotics and zinc was more effective than zinc alone in reducing the duration of acute diarrhea in children, suggesting a significant improvement in treatment outcomes.

Background: Gastroenteritis is a major public health problem worldwide and remains the second leading cause of death among children under five globally. Objective of this study was to investigate and compare the efficacy of commonly available probiotics in the treatment of acute watery diarrhoea (AWD) in children.Methods: This was an open label randomised controlled trial conducted in a tertiary care hospital in Bangalore for 2 years. 120 children aged 6 months to 5 years admitted with AWD of less than or equal to 48 hours duration were randomized into three groups – Group I (control) received oral rehydration therapy and zinc, Group II received Bacillus clausii in a dose of 2 billion spores twice a day and Group III received Saccharomyces boulardii as 250 mg twice a day. The primary outcome measures were total duration of diarrhoea, mean number of stools per day, consistency of stools and secondary outcome measures were duration of vomiting, fever and hospital stay. ANOVA, Student t test, Mann Whitney U test and Chi square test were used for analysis.Results: The duration of diarrhoea and hospital stay significantly reduced (41.68 hrs) in Group III compared to Group I (57.65 hrs) and Group II (53.33 hrs). (p&lt; 0.05). The frequency of stools reduced significantly on Day 4 and the consistency of stools improved significantly on Day 3 in both the probiotic groups (p&lt;0.05). Both the probiotics reduced the duration of fever significantly but had no effect on the duration of vomiting.Conclusions: Saccharomyces boulardii is effective in reducing the duration of diarrhea and hospital stay in children with acute gastroenteritis.

The use of antibiotics in the treatment of acute and persistent watery diarrhoea has long been a subject of contention. While the advantages of using antimicrobials are acknowledged, concerns remain regarding potential adverse effects and antibiotic resistance. Therefore, we conducted a systematic review and meta-analysis to assess the efficacy of antibiotics compared to placebos for the treatment of diarrhoea. We searched PubMed, CINAHL, the Cochrane Library, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform, and Scopus from inception until 20 July 2023 for studies published after the year 2000 assessing antibiotics vs placebo in acute and persistent diarrhoea and/or blood in stools in children less than 10 years of age. We conducted a meta-analysis for the included studies, assessed them using the Risk of Bias 2 tool, and evaluated their quality of evidence through the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. This review was commissioned by WHO for revision of their guidelines for childhood diarrhoea management. We included five randomised controlled trials (RCTs) for acute watery diarrhoea and no study for bloody diarrhoea. Our findings suggest that there is a significant increase in clinical cure (risk ratio (RR) = 2.28; 95% confidence interval (CI) = 1.52, 3.41; low certainty evidence) and parasitological cure (RR = 2.86; 95% CI = 1.72 to 4.74; low certainty evidence) among children with acute watery diarrhoea in the antibiotic group when compared to the placebo group. The duration of diarrhoea (in hours) was significantly reduced (mean difference = -24.90; 95% CI = -34.09, -15.71; low certainty evidence) in the intervention group, while the effect on all-cause mortality (RR = 0.71; 95% CI = 0.40, 1.27; moderate certainty evidence) and the need for intravenous fluid infusion (RR = 0.50; 95% CI = 0.05, 5.17; very low certainty evidence) were comparable between the two groups. In children under 10 years of age suffering from acute watery or persistent diarrhoea, antibiotics led to an apparent increase in cure rates. However, considering the low certainty of evidence, low number of studies with small sample sizes, and the fact that most studies were conducted in a single country, further investigation and cautious interpretation are warranted, as is a large multi-country RCT that would allow for firmer conclusions. PROSPERO: CRD42023447133.

The aim of this study was to compare the effect of infant formula and the same formula subjected to microbial fermentation (yogurt) on the duration of diarrhea in young children with acute watery diarrhea, with or without reducing substances in stools. One hundred twelve well-nourished children, aged 3 to 24 months, who were admitted to the hospital with acute watery diarrhea were included in a randomized trial. After appropriate rehydration, they were fed either an infant formula (group M, n = 56) or the same formula fermented with Lactobacillus bulgaricus and Streptococcus thermophilus (group Y, n = 56). The two feedings were comparable in lactose concentration (40 to 42 g/L), pH 4.5, flavor, and texture. The groups were subdivided into those with or without reducing sugars in stools at presentation. The presence of reducing sugars in stool was used as a marker of carbohydrate malabsorption. Group M and group Y had comparable clinical characteristics at admission, including the number of patients with reducing sugars in stools (n = 31 in group M and 27 in group Y). The success rate (cessation of diarrhea and appropriate weight gain 7 days after enrollment into the study) was similar in both groups (82% in group M vs. 84% group Y). Clinical failure was 3.6% in both groups. The percentage of patients withdrawn from the study for medical reasons (5.4% in group M vs. 7.1% in group Y) or withdrawn at the parents' request (8.9% in group M vs. 5.4% in group Y) was similar. Duration of diarrhea and number of stools were significantly less in group Y compared with group M. Forty-eight hours after inclusion, diarrhea was still present in 62% of group M versus in 35% of group Y (P < 0.002). In children with reducing sugars in stools, the rate of success (82%) was similar in groups M and Y, but the duration of diarrhea and number of stools per day were significantly decreased in group Y. Forty-height hours after inclusion, diarrhea was still present in 75% of group M patients and in 20% of group Y patients who had reducing substances in the stool. Young children with acute watery diarrhea, without malnutrition or associated disease, can be equally well treated with feeding of either infant formula or yogurt. Yogurt feeding is associated with a clinically relevant decrease in stool frequency and duration of diarrhea in children who have reducing sugars in stools.

ABSTRACTBackgroundThe aim of this study was to compare the effect of infant formula and the same formula subjected to microbial fermentation (yogurt) on the duration of diarrhea in young children with acute watery diarrhea, with or without reducing substances in stools.MethodsOne hundred twelve well‐nourished children, aged 3 to 24 months, who were admitted to the hospital with acute watery diarrhea were included in a randomized trial. After appropriate rehydration, they were fed either an infant formula (group M, n = 56) or the same formula fermented with Lactobacillus bulgaricus and Streptococcus thermophilus (group Y, n = 56). The two feedings were comparable in lactose concentration (40 to 42 g/L), pH 4.5, flavor, and texture. The groups were subdivided into those with or without reducing sugars in stools at presentation. The presence of reducing sugars in stool was used as a marker of carbohydrate malabsorption.ResultsGroup M and group Y had comparable clinical characteristics at admission, including the number of patients with reducing sugars in stools (n = 31 in group M and 27 in group Y). The success rate (cessation of diarrhea and appropriate weight gain 7 days after enrollment into the study) was similar in both groups (82% in group M vs. 84% group Y). Clinical failure was 3.6% in both groups. The percentage of patients withdrawn from the study for medical reasons (5.4% in group M vs. 7.1% in group Y) or withdrawn at the parents’ request (8.9% in group M vs. 5.4% in group Y) was similar. Duration of diarrhea and number of stools were significantly less in group Y compared with group M. Forty‐eight hours after inclusion, diarrhea was still present in 62% of group M versus in 35% of group Y (P &lt; 0.002). In children with reducing sugars in stools, the rate of success (82%) was similar in groups M and Y, but the duration of diarrhea and number of stools per day were significantly decreased in group Y. Forty‐height hours after inclusion, diarrhea was still present in 75% of group M patients and in 20% of group Y patients who had reducing substances in the stool.ConclusionYoung children with acute watery diarrhea, without malnutrition or associated disease, can be equally well treated with feeding of either infant formula or yogurt. Yogurt feeding is associated with a clinically relevant decrease in stool frequency and duration of diarrhea in children who have reducing sugars in stools.

Background Acute watery diarrhea remains a major health problem affecting infants and children in developing countries. Selenium deficiency may be a risk factor for diarrhea and vice versa. Few studies have been conducted on the effectiveness of selenium for the treatment of diarrhea in children.Objective To determine the effectiveness of selenium in reducing the severity of acute watery diarrhea in children.Methods A single-blind, randomized clinical trial was done in children with acute watery diarrhea, aged six months to two years, and who visited the community health center in Simalungun from May to August 2012. Children were randomized into either the selenium or placebo (maltodextrin) group. We monitored diarrheal frequency, stool consistency, and duration of diarrhea. Mann-Whitney, Fisher’s, and Kolmogorov-Smirnov tests were used to compare the two groups.Results Sixty-five children were recruited into the study, of whom 36 children received selenium and 29 children received a placebo. The selenium group had significantly lower frequency of diarrhea (bouts per day) than the placebo group on days 2, 3, and 4 after treatment onset [day 2: 3.5 vs. 4.1, respectively (P=0.016); day 3: 2.7 vs. 3.4, respectively (P=0.002); day 4: 2.1 vs. 2.8, respectively (P&lt;0.001)]. On day 2, stool consistency had significantly improved in the selenium group compared to the placebo group (P=0.034). In addition, the median duration of diarrhea was significantly lower in the selenium group than in the placebo group (60 vs. 72 hours, respectively; P=0.001). Median recovery time from the the first day of diarrhea was also significantly lower in the selenium group than in the placebo group (108 vs. 120 hours, respectively; P=0.009).Conclusion In children with acute watery diarrhea, those treated with selenium have decreased frequency of diarrhea, improved stool consistency, as well as shorter duration of diarrhea and recovery time than those treated with a placebo. [Paediatr Indones. 2016;56:139-43.].

Evidence from the literature has shown that Saccharomyces boulardii provides a clinically significant benefit in the treatment of acute infectious diarrhoea in children. In this multicentre, randomised, prospective, controlled, single blind clinical trial performed in children with acute watery diarrhoea, we aimed to evaluate the impact of S. boulardii CNCM I-745 in hospitalised children, in children requiring emergency care unit (ECU) stay and in outpatient settings. The primary endpoint was the duration of diarrhoea (in hours). Secondary outcome measures were duration of hospitalisation and diarrhoea at the 3(rd) day of intervention. In the whole study group (363 children), the duration of diarrhoea was approximately 24 h shorter in the S. boulardii group (75.4±33.1 vs 99.8±32.5 h, P<0.001). The effect of S. boulardii (diarrhoea-free children) was observed starting at 48 h. After 72 h, only 27.3% of the children receiving probiotic still had watery diarrhoea, in contrast to 48.5% in the control group (P<0.001). The duration of diarrhoea was significantly reduced in the probiotic group in hospital, ECU and outpatient settings (P<0.001, P<0.01 and P<0.001, respectively). The percentage of diarrhoea-free children was significantly larger after 48 and 72 h in all settings. The mean length of hospital stay was shorter with more than 36 h difference in the S. boulardii group (4.60±1.72 vs 6.12±1.71 days, P<0.001). The mean length of ECU stay was shorter with more than 19 h difference in the probiotic group (1.20±0.4 vs 2.0±0.3 days, P<0.001). No adverse effects related to the probiotic were noted. Because treatment can shorten the duration of diarrhoea and reduce the length of ECU and hospital stay, there is likely a social and economic benefit of S. boulardii CNCM I-745 in adjunction to oral rehydration solution in acute infectious gastroenteritis in children.

Objective: To compare the efficacy of zinc-probiotic combination therapy and probiotic therapy alone in the treatment of acute pediatric watery diarrhea. Study Design: Randomized Clinical Controlled trial. Setting: The study was completed at The Department of Pediatrics, Unit I, Bolan Medical Complex Hospital, Quetta, Pakistan from July 2021 to January 2022. Methodology: A total number of 144 children of either gender aged 3 months to 5 years presented with acute watery diarrhea were included. Patients were randomly allocated into either Group-A (zinc supplementation with probiotics) or Group-B (only probiotics) for the treatment of acute diarrhea. Relief from diarrhea and duration of diarrhea were the main study end-points. Results: In a total of 144 children, the mean age was 27.04+14.43 months while the mean duration of diarrhea was 8.05+5.18 hours. On comparison of recovery from diarrhea, all the 72 children who received combination of probiotics and zinc were recovered from diarrhea, while 4 children (5.6%) children did not recovered from diarrhea within 5 days after starting the treatment in probiotics alone group (p=0.04). Duration of diarrhea was 27.63±14.22 hours in probiotics plus zinc group and 38.86±20.70 hours in probiotics only group (p&lt;0.001). Practical Implications: Combination of probiotics with zinc resulted in early recovery among children with acute diarrhea but further randomized controlled trial enrolling large sample size from local population are necessary to verify the findings of this study. Conclusion: Combination of probiotics and zinc was superior as compared to the probiotics alone in the treatment of acute diarrhea in children. Keywords: Diarrhea, probiotics, recovery, stool, treatment, zinc.

To determine the effectiveness of green banana in the home management of acute (<7 days) or prolonged (≥ 7 days) diarrhoea at the community level. A cluster randomized field trial was conducted among 2968 Bangladeshi rural children 6-36 months old. Wards (villages) were randomly assigned to either a standard care group or a standard care plus green banana group where mothers were instructed to add cooked green banana to the diets of diarrhoeal children. Through a village-based surveillance system, diarrhoeal morbidity data (severity, duration, compliance) were collected for 14 days. Treatment effects were determined by analysing cumulative probability of cure by testing Cox proportional hazards models and relative risk (RR). The cumulative probability of cure was significantly (P < 0.001) different in children receiving GB for both acute [hazard ratio (HR) = 0.63 (95% CI: 0.56-0.67)] and prolonged diarrhoea [HR = 0.38 (95% CI: 0.26-0.59)]. The recovery rates of children with acute diarrhoea receiving GB (vs. control) were significantly more by day 3: 79.9%vs. 53.3% [(RR) = 0.47, 95% CI: 0.41-0.55], (P < 0.001) and day 7: 96.6%vs. 89.1% (RR = 0.32; 0.22-0.46), (P < 0.001). Children with prolonged diarrhoea receiving green banana had significantly higher recovery rates by day 10: 79.8%vs. 51.9% (RR = 0.42; 0.23-0.73), (P < 0.001) and day 14: 93.6%vs. 67.2% (RR = 0.22; 0.08-0.54), (P < 0.001). A green banana-supplemented diet hastened recovery of acute and prolonged childhood diarrhoea managed at home in rural Bangladesh.

Background & objectives:Randomized controlled trials in developed countries have reported benefits of Lactobacillus GG (LGG) in the treatment of acute watery diarrhoea, but there is paucity of such data from India. The study was aimed to evaluate the efficacy and safety of Lactobacillus GG in the treatment of acute diarrhoea in children from a semi-urban city in north India.Methods:In this open labelled, randomized controlled trial 200 children with acute watery diarrhoea, aged between 6 months to 5 years visiting outpatient department and emergency room of a teaching hospital in north India were enrolled. The children were randomized into receiving either Lactobacillus GG in dose of 10 billion cfu/day for five days or no probiotic medication in addition to standard WHO management of diarrhoea. Primary outcomes were duration of diarrhoea and time to change in consistency of stools.Results:Median (inter quartile range) duration of diarrhoea was significantly shorter in children in LGG group [60 (54-72) h vs. 78 (72-90) h; P<0.001]. Also, there was faster improvement in stool consistency in children receiving Lactobacillus GG than control group [36 (30-36) h vs. 42 (36-48) h; P<0.001]. There was significant reduction in average number of stools per day in LGG group (P<0.001) compared to the control group. These benefits were seen irrespective of rotavirus positivity in stool tests.Interpretation & conclusions:Our results showed that the use of Lactobacillus GG in children with acute diarrhoea resulted in shorter duration and faster improvement in stool consistency as compared to the control group.

Diarrhea is a leading killer of children, accounting for 9% of all deaths among under-five children worldwide. WHO protocol deviation in management of diarrheas in children is likely due to various reasons. To study the prescription practices, regarding adherence to WHO protocol and deviations, in the management of acute diarrhea in children presenting at a tertiary care hospital and its impact on the outcome. This was a prospective observational hospital based study at a tertiary care carried out over a 12-month period including all cases of acute diarrhea (defined as 3 or more loose stools in last 24 hours) in children belonging to the age group of 6 months to 5 years. Patients were followed up on day 3,7,14 and 28 from the day of presentation. Software SPSS Version 17.0 was used for analysis. Correlation regression analysis was used to study predictiveness of different variables affecting outcome. In this study, 447 children aged between 6 months and 5 years were enrolled, of which 45 cases were lost in follow-up and excluded. The median age was 14 months. Some deviation from WHO protocol was noted in 78.4% of the cases. Most common deviations from WHO protocol were addition of probiotics (78.1% of cases) and addition of race cadotril (15.9% of cases). Inadvertent use of antibiotics in diarrhea was noted in 12.2% of cases. Presence of fever was strong predictor for use of antibiotics. Cases of early recovery within 3 days of presentation were higher in WHO protocol deviation group. Use of probiotics had statistically significant association with early recovery. In diarrhea management, WHO protocol deviation is common. Probiotics are likely to help in early recovery.