Article Type : Research Article
Authors : Hawal AIM, Hegab WSM, El Deib SMM, Mohamed GI, Alia MA and Osman YKG
Keywords : Probiotic strains; A. Diarrhea; Intestinal colonization; GUT microbiome; Dehydration; LrGG
Acute Diarrheal Diseases
considered as the most common leading causes of children mortality all over the
globe. Today, only 39 per cent of children with Diarrhea in developing countries
receive the recommended treatment, and limited trend data suggest that there
has been little progress since 2000, more than
386000 children dies in India only due to A. Diarrhea every
year.
An international
commitment to tackle childhood Diarrhea in the 1970s and 1980s resulted in a
major reduction in child deaths. This came about largely through the scaling up
of oral rehydration therapy, coupled with programs to educate caregivers on its
appropriate use. But these efforts lost momentum as the world turned its
attention to other global emergencies.
Our review aims to search
& updates the Evidence-Based Review Articles that study the use of specific
probiotic strains, namely Lactobacillus rhamnosus GG (LGG) and Saccharomyces
boulardii, for the management of children with acute gastroenteritis (AGE)
as an adjunct to rehydration therapy [1-10].
This Literature Review
also aim to show us the role of different probiotics in the treatment of acute
diarrhea in children.
‘‘Probiotics
may be an effective adjunct to the management of diarrhea".
L.
rhamnosus GG (LGG) significantly reduced duration of diarrhea, daily stool
outputs, improved stool consistency and
reduced no. of hospitalization and fever in children compared to other
probiotics (B. clausii and S. boulardii) & ORS group as we will discuss
now.
The guidelines recommend the
use of the specific probiotic strains, namely Lactobacillus rhamnosus GG (LGG)
and Saccharomyces boulardii, for the management of children with acute
gastroenteritis (AGE) as an adjunct to rehydration therapy.
The Efficacy of any probiotic is strain-dependent
1.
Lactobacillus acidophilus strain is effective
in IBS but not in AAD.
2.
Bifidobacterium bifidum reported that one
strain (CIDCA5310) inhibited enterocyte invasion by Salmonella arizonae,
whereas the other (CIDCA 537) had no effect.
3.
Lactobacillus rhamnosus GG (ATCC) help in
treatment of Acute diarrhea, Persistent diarrhea, Rotavirus diarrhea,
Gastroenteritis, AAD (Antibiotic Associated Diarrhea) Prevention & Treatment,
Traveller’s diarrhea, Nosocomial diarrhea, Irritable Bowel Syndrome (IBS),
Abdominal pain, Crying etc. , Ulcerative colitis, Necrotizing Enterocolitis
(NEC) in pre-term infants, As an adjuvant to vaccines to stimulate immunity,
Gastrointestinal infections & Respiratory Infections.
4.
L. Rhamnosus GG – Age group help in treatment
of Acute infectious diarrhea, Antibiotic-associated diarrhea (AAD), Nosocomial
diarrhea, Acute Gastroenteritis (AGE), Irritable bowel syndrome (IBS),
Preventing infections, Allergic diseases, C. difficile diarrhea Pouchitis,
Adjuvant therapy for H. pylori Eradication [11-16].
Proved advantages &
clinical benefits of lGG probiotic strains use
·
Lactobacillus rhamnosus GG (ATCC 53103) has a safe
history of use in since1990
·
Can even be given to a 24 hrs old neonate..!
·
Clinically studied in various age group population
starting from new born preterm infants to elderly population
·
Clinically studied at various dosage range starting
(120mn CFU to 2000bn CFU/d)
Do probiotics
work in acute infectious diarrhea?
63
trial, 8014 subjects
That
study concluded that:
·
Its
use reduced the duration of diarrhea by around 25 hours,
·
Risk
of diarrhea be > 4 days by 59%,
·
&
One fewer diarrheal stool on day 2 after the intervention.
Comparative clinical study; L. rhamnosus GG vs. B. clausii vs. S. boulardii
Group |
Treatment |
Dosage (twice daily) |
1 |
Control: Oral rehydration solution (ORS) (N=92) |
- |
2 |
Saccharomyces boulardii (N=91) |
5 billion CFU/dose |
3 |
Bacillus clausii (N=100) |
1 billion CFU/dose |
4 |
Enterococcus faecium (N=91) |
0.075 CFU/dose |
5 |
Lactobacillus rhamnosus GG (ATCC 53103) (N=100) (uncoated) |
6 billion CFU/dose |
Study design
This Study designed to
compare the efficacy of 5 different preparations recommended to parents in the
treatment of acute diarrhea in children.
·
Design:
Prospective randomized controlled clinical trial.
·
Study
Arm: N=571 children (age 3-36 months).
·
Duration:
5 days.
That study concluded
that … The use of LrGG P. Strains;
Reduce in duration of diarrhea: LrGG group has shown highest &
significant efficacy in terms of reducing duration of diarrhea compared to
other probiotics & ORS group.
Reduce in daily stool outputs: LrGG group has shown significant
reduction in terms of no. of stools per day on Day-2 compared to other
probiotics & ORS group.
Improve in stool consistency: LrGG group has shown significant
improvement in terms of stool consistency on
Day-2 compared to other
probiotics & ORS group.
Recent Content Analysis Report of
Various Probiotic Brands
Comparative Study of 3
Brands … Enterogermina vs. Tufpro vs. Darolac Aqua; These figure that show us the study [17-21];
That comparative review stated only product 1
was found to contain a homogenous population of bacillus clausii whereas
product 2 and product 3 showed growth of bacillus subiilis species in the
samples.
Our mini review aims to
use of the specific probiotic strains, namely Lactobacillus rhamnosus GG (LGG)
and Saccharomyces boulardii, for
the management of children with acute gastroenteritis (AGE) as an adjunct to
rehydration therapy [2]. The aim of this Mini Review also is to show us the
role of probiotic in the treatment of acute diarrhea in children. We review the
evidence of several Probiotics modalities for AD treatment. We describe the
Clinical Impact & prevalence of Acute Diarrhea in children and its
complications, provide an overview of current treatments, and finally, discuss
recent emergent Gut approaches to AD management. Specifically, we will describe
- in a Comparative study - on the utility of different kinds of Probiotics
known & used and common natural products in the treatment of Acute cases of
AD and focus on recent, high-quality studies. Adverse effects and potential interactions
of each therapy will be highlighted where applicable. Some probiotics agents
have a Benifitiary effects on the onset, course of acute Diarrheal illnesses
but still in need for further reviews on the side effects & safety of such
agents.