The use of probiotics for diarrhea in children
According to a meta-analysis published in the journal Digestive Diseases and Sciences, the use of probiotics in conjunction with standard oral rehydration for the treatment of diarrhea of various etiologies in children reduces the duration of the disease.
In connection with the increasing resistance of intestinal pathogens to antibiotics, there is a recent need to research new methods of treating diarrhea in children.
Methods of vaccination against intestinal infections, such as cholera, rotavirus infection, are under development. In addition, pharmaceutical companies are looking for new antimicrobials to treat diarrhea.
Another promising treatment for diarrhea is the use of probiotics or non-pathogenic microorganisms that colonize the intestinal wall and limit the excessive growth of pathogenic bacteria. Competition for mucosal receptors reduces the adhesion and growth of enterotoxic gram-negative anaerobes and enteropathogenic viruses, allowing more "useful" bacteria to multiply on the surface of the mucosa.
Probiotics, such as lactobacilli and bifidobacteria, secrete substances that have antibacterial properties and inhibit the vital activity of intestinal pathogens, and increased production of volatile fatty acids. Decreasing the acidity of the intestinal contents can also inhibit the reproduction of intestinal pathogens. Certain probiotic preparations, such as Lactobacillus GG, have an immunomodulatory effect and can reduce the severity of inflammation of the intestinal wall.
To date, several studies have demonstrated the benefits of using probiotics in pediatric practice when used in both hospital and ambulatory settings. However, the studies had a different design and used different antibiotics, making it difficult to compare the results. Scientists from the Boston Pediatric Clinic and Harvard University, in collaboration with scientists from New York Medical University (USA), have conducted a study that has shown that the use of probiotics in children under the age of 5 reduces the duration of diarrhea.
An article published in the journal Digestive Diseases and Sciences presents the results of a meta-analysis of studies on the use of probiotics to treat diarrhea in children. Recently, many of these studies have been conducted, but most of them were not controlled and were not randomized. In 18 studies with adequate design (control and randomization), a decrease in the duration of diarrhea in treatment with probiotics has been shown in conjunction with standard oral rehydration.
It should be noted that the studies differed not only in design and the probiotic studied, but also in the etiology of diarrhea. The bacterial etiology of diarrhea has only been reported in a few studies, including a small number of patients. Most studies included patients with viral diarrhea, however, the type of virus varied among studies. Thus, rotavirus infection was the cause of diarrhea in 10 to 100% of cases in various studies.
In the 18 studies, the efficacy of lactobacilli was evaluated, and in 9 studies, the effect of the use of Lactobacillus GG, a strain of Lactobacillus rhamnosus, used as a probiotic since 1985, was evaluated for the first time. Bifidobacterium infantis, Bifidobacterium subtilis, Enterococcus spp., Lactobacillus acidophilus, Lactobacillus bulgaricus , Lactobacillus delbruckii, Lactobacillus reuteri, Saccharomyces bouldari and Saccharomyces thermophilus.
Despite differences in study design, patient characteristics, and doses used, a combined analysis found a one-day reduction in disease duration in patients receiving probiotics compared to patients receiving placebo. Most studies showed a decrease in the duration of the disease from 0.6-1.0 days, while 3 studies (which mainly included outpatients) showed a decrease in the duration of diarrhea by 1.5 -3.0 days.
It should be noted that in studies studying the use of lactobacilli, the greatest reduction in the duration of diarrhea was observed - by 1.1 days compared to control, while when using other micro -organisms, the duration of the disease decreased by 0.6 day.