PROBIOTICS SHORTEN ACUTE DIARRHOEA

From Medscape Medical News  

Probiotics May Shorten Acute Diarrheal Episodes; Laurie Barclay, MD

November 12, 2010 — Probiotics shorten diarrheal episodes, according to the results of a systematic review reported online in the November 10 issue of the Cochrane Database of Systematic Reviews.
"A striking finding of this review is that most trials reported that probiotics reduced diarrhoea," said lead author Stephen J. Allen, from the School of Medicine at Swansea University, Swansea, United Kingdom, in a news release. "The beneficial effect was consistent and significant across many different types of trials."
To evaluate the impact of probiotics in proven or presumed acute infectious diarrhea, the investigators searched the Cochrane Infectious Diseases Group's trials register through July 2010, the Cochrane Controlled Trials Register (The Cochrane Library Issue 2, 2010), MEDLINE (1966 - July 2010), EMBASE (1988 - July 2010), and bibliographies of retrieved studies and reviews. They also contacted relevant organizations and experts, as well as pharmaceutical companies manufacturing probiotic agents.
Inclusion criteria were randomized and quasirandomized controlled trials in which a specified probiotic was compared vs a placebo or no probiotic in persons with acute diarrhea proven or presumed to be caused by an infectious agent. Two reviewers independently evaluated the methodologic quality of and extracted data from included trials. The main study endpoints, which were analyzed with use of a random-effects model, were mean duration of diarrhea, stool frequency on day 2 after treatment, and ongoing diarrhea on day 4.
Of 63 studies meeting inclusion criteria and enrolling a total of 8014 participants, 56 trials enrolled infants and young children. There was some heterogeneity among trials in the risk for bias in definitions used for acute diarrhea and for the end of the diarrheal illness, settings, organisms tested, dosage, and participants' characteristics.
Although the magnitude of the effect varied considerably among studies, probiotics significantly reduced the mean duration of diarrhea (mean difference, 24.76 hours; 95% confidence interval [CI], 15.9 - 33.6 hours; n = 4555; trials = 35). Probiotics also reduced diarrhea lasting at least 4 days (risk ratio, 0.41; 95% CI, 0.32 - 0.53; n = 2853; trials = 29) and stool frequency on day 2 (mean difference, 0.80; 95% CI, 0.45 - 1.14; n = 2751; trials = 20). In the trials reviewed, probiotics were not associated with any significant adverse effects.
Limitations of this review include great variability in the methodologic quality of the trials, persistence of statistical heterogeneity in subgroup analyses, marked clinical variability among studies, and lack of cost-effect analyses.
"The differences in effect size between studies was not explained by study quality, probiotic strain, the number of different strains, the viability of the organisms, dosage of organisms, the causes of diarrhoea, or the severity of the diarrhoea, or whether the studies were done in developed or developing countries," the study authors write. "Used alongside rehydration therapy, probiotics appear to be safe and have clear beneficial effects in shortening the duration and reducing stool frequency in acute infectious diarrhoea. However, more research is needed to guide the use of particular probiotic regimens in specific patient groups." The study authors also suggest that future research include evaluation of different probiotic strains to treat diarrhea and prevent the progression from acute to persistent diarrhea.
Swansea School of Medicine, United Kingdom, and Cochrane Infectious Disease Group, Liverpool School of Tropical Medicine, United Kingdom, supported this study. Some of the study authors have disclosed various financial relationships with Cultech Ltd, United Kingdo; Scientific Hospital Supplies, United Kingdom; Valio Ltd, Finland; and United Laboratories Inc, Philippines.
Cochrane Database Syst Rev. Published online November 10, 2010.

Comments :It is a common practice to prescribe Metronodazole or Quinolone based antibiotics to treat acute diarrhea. Instead of prescribing antibiotics, we, healthcare providers should advocate and educate our patients on the usage of probiotics in treating acute diarrhea cases. Not only it balances and replenishes the normal flora in a patient’s gut, it is also safe and we don’t have to worry about resistance towards abuse of antibiotics.