DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20191317

Comparative study of Bacillus clausii and multistrain probiotics in the management of acute diarrhoea in children

Farzana Hamid, Syed Moosa M. A. Quaium, Azizur Rahman

Abstract


Background: Diarrhoea is the second most common cause of under-five mortality especially in developing world. Many studies have been conducted so far using different probiotic strains with variable outcome. So, the aim of the present study was to compare the clinical efficacy of Bacillus clausii and multi strain probiotic formulation as adjunct treatment of acute diarrhoea.

Methods: This prospective single blind randomized controlled clinical trial included 300 infants and children between 6 months to 6 years of age admitted in a tertiary care hospital Sylhet, Bangladesh with acute watery diarrhoea having varied dehydration status ranging from no to severe dehydration excluding shocked state. Cases were randomly assigned to three groups which were group I (n=100) comprised of children who were treated with standard treatment (according to WHO guideline) only as control group, group II (n=100) who received standard treatment plus Bacillus clausii and group III (n=100) who received standard treatment plus multi strain probiotic formulation (Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus acidophilus, Lactobacillus bulgaricus, Bifidobacterium breve, Bifidobacterium infantis, Streptococcus thermophilus). Primary outcome variables were duration, frequency of diarrhoea and consistency of stool. Secondary outcome variable was duration of hospital stay.

Results: Mean duration of diarrhoea was significantly shorter (p=0.001) in group III (2.62 days) compared to group I (3.26 days) and group II (3.22 days). Frequency of diarrhoea was significantly lower on day 3 of probiotic administration in group III (p <0.05) and on day 5 of treatment in group II (p <0.05). Stool consistency significantly improved on day 3 in group III (p <0.05) while it was on day 4 in group II. The duration of diarrhoea, hospital stay, stool consistency and frequency of stool on day 3 were not statistically significant (p >0.05) in group II in comparison to group I and group III.

Conclusions: Multistrain probiotic formulation is effective in reducing the duration, frequency of diarrhoea and duration of hospital stay.


Keywords


Bifidobacterium breve, Bifidobacrerium infantis, Bacillus Clausii, Diarrhoea, Lactobacilli casei, Lactobacillus rhamnosus, Lactobacillus acidophilus, Lactobacillus bulgaricus, Probiotic, Streptococcus thermophilus

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References


Wardlaw T, Salama P, Brocklehurst C, Chopra M, Mason E. Diarrhoea: why children are still dying and what can be done. Lancet. 2010;375:870-872.

WHO/UNICEF. Joint statement: clinical management of acute diarrhoea (WHO/FCH/CAH/04.07). Geneva and New York: World Health Organization, Department of Child and Adolescent Health and Development, and the United Nations Children's Fund, Programme Division, 2004. Available at: https://www.unicef.org/publications/files/ENAcute_Diarrhoea_reprint.pdf.

Guandalini S. Probiotics for prevention and treatment of diarrhea. J Clin Gastroenterol. 2011;45:S149-53.

Vandenplas Y, Salvatore S, Viera M, Devreker T, Hauser B. Probiotics in infectious diarrhoea in children: are they indicated?. Euro J Ped. 2007;166(12):1211-8.

Rosenfeldt V, Michaelsen KF, Jakobsen M, Larsen CN, Møller PL, Pedersen P, et al. Effect of probiotic Lactobacillus strains in young children hospitalized with acute diarrhoea. Pediatric Inf Dis J. 2002;21(5):411-6.

Canani RB, Cirillo P, Terrin G, Cesarano L, Spagnuolo MI, De Vincenzo A, et al. Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations. BMJ. 2007;335(7615):340.

McFarland LV, Evans CT, Goldstein EJ. Strain-specificity and disease-specificity of probiotic efficacy: a systematic review and meta-analysis. Frontiers Med. 2018;5.

Szajewska H, Guarino A, Hojsak I, Indrio F, Kolacek S, Shamir R, et al. Use of probiotics for management of acute gastroenteritis: a position paper by the ESPGHAN Working Group for Probiotics and Prebiotics. J Pediatr Gastroenterol Nutr. 2014;58(4):531-9.

Szajewska H, Mrukowicz JZ. Probiotics in the treatment and prevention of acute infectious diarrhea in infants and children: a systematic review of published randomized, double-blind, placebo-controlled trials. J Pediatr Gastroenterol Nutr. 2001;33:S17-25.

Allen SJ, Okoko B, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating infectious diarrhoea. Cochrane Database Sys Rev. 2003(4).

Applegate JA, Walker CL, Ambikapathi R, Black RE. Systematic review of probiotics for the treatment of community-acquired acute diarrhea in children. BMC Pub Heal. 2013;13(3):S16.

Vivatvakin B, Kowitdamrong E. Randomized control trial of live Lactobacillus acidophilus plus Bifidobacterium infantis in treatment of infantile acute watery diarrhea. J Med Assoc Thailand Chotmaihet Thangphaet. 2006;89:S126-33.

Bhat S, Shreekrishna GN, Savio CD. Efficacy of probiotics in acute diarrhoea in children. Int J Contemp Pediatr. 2018;5(4):1646-1650.

Maugo BM. Effectiveness of Bacillus clausii in reducing duration of illness in acute diarrhoea in children 6-59 months of age admitted with severe dehydration. Available at: http://erepository.uonbi.ac.ke/bitstream/handle/11295/8325/DR._MAUGO_BRIAN_MAUGO_M.MED_PAEDS_2012.pdf?sequence=1. Accessed 19 April 2018.

Ianiro G, Rizzatti G, Plomer M, Lopetuso L, Scaldaferri F, Franceschi F, et al. Bacillus clausii for the treatment of acute diarrhoea in children: a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2018;10(8):1074.

Jayanthi N, Sudha RM. Bacillus clausii-the probiotic of choice in the treatment of diarrhoea. J Yoga Physical Therapy. 2015;5(4):1.

Lahiri K, Jadhav K, Gahlowt P, Najmuddin F, Padmashree Y. Bacillus clausii as an adjuvant therapy in acute childhood diarrhoea. IOSR-JDMS. 2015;14:74-6.

Freedman SB, Williamson-Urquhart S, Farion KJ, Gouin S, Willan AR, Poonai N, et al. Multicenter trial of a combination probiotic for children with gastroenteritis. New Eng J Med. 2018;379(21):2015-26.

Schnadower D, Tarr PI, Casper TC, Gorelick MH, Dean JM, O’connell KJ, et al. Lactobacillus rhamnosus GG versus placebo for acute gastroenteritis in children. New Eng J Med. 2018;379(21):2002-14.