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Probiotics show anti-diarrhea potential in kids: RCT data

By Stephen Daniells , 02-Aug-2012

Daily supplements of probiotic bacterial strain Lactobacillus reuteri DSM 17938 may reduce the frequency and duration of diarrhea for children, says new data from Italy.

The probiotic supplements were also associated with a significantly lower rate of relapse of diarrhea of only 15%, compared to 42% in the placebo group, according to findings published in Alimentary Pharmacology & Therapeutics .

“Viewed from a global perspective, gastroenteritis in children is of enormous public health importance,” wrote researchers from the University of Bari. “In the 1970s, there were almost 5 million childhood deaths worldwide from gastroenteritis each year.

“The present study demonstrates that children receiving L. reuteri DSM 17938 on days 2 and 3 were statistically significantly more likely to be diarrhea-free and passed significantly fewer stools compared with those receiving placebo.”

Probiotics

Probiotics are defined by FAO/WHO as ‘Live microorganisms which when administered in adequate amounts confer a health benefit on the host’.

The new study used Lactobacillus reuteri DSM 17938, which is derived from L. reuteri ATCC 55730. Two previous clinical trials found that the parent strain ATCC 55730 could significant reduce the duration of diarrhea, but subsequent data indicated that ATCC 55730 could transfer highly-undesirable antibiotic resistance traits. As a result, DSM 17938 was developed which did not have these resistance traits.

The Bari-based scientists then tested the efficacy and safety of L. reuteri DSM 17938 in combination with rehydration therapy in children with diarrhea. They recruited 74 children aged between 6 and 36 months and randomly assigned them to receive either placebo or L. reuteri DSM 17938. 

Results showed that the duration of watery diarrhea was 2.1 days in the probiotic group, compared to 3.3 days in the placebo group.

In addition, on the second and third day of intervention, watery diarrhea was still observed in 82% and 74% of the children in the placebo group, and 55% and 45% of the children in the probiotic group.

Importantly, no adverse events were recorded in either groups, said the researchers.

Commenting on the potential mechanism, the researchers said that there were several possibilities, including “(i) the production of a broad-spectrum antimicrobial substance, called reuterin, (which may be responsible for the inhibition of pathogenic microorganisms in the gastrointestinal tract); (ii) competition with pathogens for binding sites and substrates; (iii) stabilisation of the mucosal barrier with a decrease in intestinal permeability and (iv) stimulation of intestinal immune responses.”

Source: Alimentary Pharmacology & Therapeutics
August 2012, Volume 36, Issue 4, pages 363–369, doi: 10.1111/j.1365-2036.2012.05180.x
“Randomised clinical trial: Lactobacillus reuteri DSM 17938 vs. placebo in children with acute diarrhoea - a double-blind study”
Authors: Francavilla R, Lionetti E, Castellaneta S, Ciruzzi F, Indrio F, Masciale A, Fontana C, La Rosa MM, Cavallo L, Francavilla A.

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