To compare the efficacy of two probiotics in acute non bloody diarrhea


  • Mohitesh Kumar Department of Pediatrics, Sarvodaya Hospital, Faridabad, Haryana, India
  • Minhajuddin Ahmed Department of Pediatrics, Chirayu Medical College, Bhopal, Madhya Pradesh, India
  • Pankaj Vohra Department of Gastroenterology, Max Hospital, Saket, New Delhi, India
  • Sumbul Warsi Department of Pediatrics, Holy Family Hospital, New Delhi, India



Diarrhea, Rotavirus


Background: According to WHO watery diarrhea is defined as passage of 3 or more loose stools without blood during preceding 24 hrs. End point of diarrhea was defined as passage of 3 stools of formed consistency. The objective of this study was tocompare the efficacy of two groups of commercially available probiotics in treating children hospitalized with acute non-bloody diarrhea on the basis of duration of stay in hospital, frequency of stool per day and duration of requirement for intravenous fluid. And to compare the results of probiotics in Rotavirus antigen positive children.

Methods: A prospective interventional study was conducted in Holy Family Hospital, New Delhi in children aged between 6 months - 5 years hospitalized with acute non bloody diarrhea with 30 children in each group.

Results: Total 123 children (6 months - 5 years) admitted in hospital with acute diarrhea, out of which 6 turned out to be bloody, 5 could not be followed up and 3 went LAMA. Finally 109 children with 68 males (62%) with male:female ratio of 1.65. Total 109 children (68 males) were included - Group A (33), 48 in Group B (48) and 28 in Group C (28). In a lateral study, Group A (11), Group B (23) and Group C (10) were Rotavirus positive. 49 children (45%) admitted with stool frequency of 5-10 times per day. Majority of children presented with symptoms like vomiting (68%), fever (55%), decrease oral intake (45%), decrease urine output (25%). Majority of patients 92 children (84%) were between 6 months to 2 years. 44 children (40%) were Rotavirus antigen positive.

Conclusions: There is no statistical significant advantage of adding probiotics for treating acute non bloody diarrhea including Rotaviral.


Nelson textbook of pediatrics: acute gastroenteritis in children: e18th: Elsevier Saunders publisher, Philadelphia; 2015:1605.

Denno DM, Stapp JR, Boster KR, Qin X, Clausen CR, Del Beccaro KH, et al. Etiology of diarrhea in pediatric outpatient settings. Pediatr Infect Dis J. 2005;24(2):142-8.

Eddliott EJ. Acute gastroenteritis in children. British Med J. 2007;334:35-40.

Bhatnagar S, Bahl R, Sharma PK, Kumar GT, Saxena SK, Bhan MK. Zinc with oral rehydration therapy reduces stool ouptut and duration of diarrhea in hospitalized children: a randomized controlled study. J Pediatr Gastro Nutri. 2004:38(1):34-40.

Gill HS, Guarner F. Probiotics and human health: a clinical perspective. Postg Med J. 2004;80(947):516-26.

Hammerman C, Bin-Nun A, Kaplan M. Safety of probiotics: comparison of two popular strains. BMJ. 2006;333(7576):1006-8.

Huebner ES, Surawicz CM. Probiotics in the prevention and treatment of gastrointestinal infections. Gastro Clin North America. 2006;35(2):355-65.

Food and Agriculture Organization (FAO) of the United Nations and World Health Organization (WHO). Guidelines for the Evaluation of Probiotics in Food. Report of a Joint FAO/WHO Working Group on Drafting Guidelines for the Evaluation of Probiotics in Food; 2006.

Salminen S, Bouley C, Ruault MC, Cummings JH, Franck A, Gibson GR, et al. Functional food science and gastrointestinal physiology and function. British J Nutr. 1998;80(supplement):147-71.

Chen JM, Ni Yh, Chen Hl, Chary MH. Microbiology etiology of acute gastroenteritis in hospitalised children in Taiwan. J Formos Med Assoc. 2006;105(12):964-70.

Heulian, Hermann J, Blackflow N. Enteric adenoviruses in children: Infection of the gastrointestinal tract, New York, Raven press; 1995:1047-1053.

Reither K, Ignatius R, Weitzel T, Seidu Korkar A, Anyidoho L, Saad E, Djie-Maletz A, et al. Acute childhood diarrhea in Northern Ghana: epidemiological, clinical and microbiolgical characteristics. BMC Infect Dis. 2007;7:104-12.

Stanly AM, Sathiyasekaran BWC, Palani G. A population based study of acute diarrhea among children under 5 years in rural community in South India. Sri Ramachandra J Med. 2009:28-36.

Erdogem O, Turkey. The comparison of the efficacy of two different probiotics in Rotavius gastroenteritis in children. J Trop Med. 2012:787-783.

Samantray JC, Mahapatra LN, Bhan MK, Ghai OP. Study of Rotavirus diarrhea in North Indian community. Indian Pediatrics. 1982;19:761-4.

Steinhoff MC, John TJ. Non-bacterial gastroenteritis; Indian J Pediatr. 1980;47:317-20.

Maya PP, Periera SM, Mathan M, Bhat P, Albert MK, Baker ST. Etiology of acute gastroenteritis in infancy and early childhood in Southern India. Arch Dis Childhood. 1997;52:482-5.

Anand T, Lakhshmi N, Kumar AG. Rotavirus diarrhea among infants and children at Tirupati. Indian Pediatr. 1994;31(1):46-8.

Nerurkar V. Pediatric Rotavirus gastroenteritis a: a 2 years analysis to understand prevalence in Mumbai. OJHA. 2011;10(1).

Van Niel CW, Feudtner C, Garrison MM, Christakis DA. Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics. 2002;109(4):678-84.

Raza S, Graham SM, Allen SJ, Sultana S, Cuevas L, Hart CA. Lactobacillus GG promotes recovery from acute non bloody diarrhea in Pakistan. Pediatr Infect Dis J. 1995;14(2):107-11.

Sarker SA, Sutana S, Fuchs GJ Alam NH, Azim T, Brüssow H, Hammarström L. Lactobacillus paracasei srain ST 11 has no effect on rotavirus but ameliorates the outcome of nonrotavirus diarrhea in children from Bangladesh: Pediatrics. 2005;116(2):e221-8.

Billo AG, Menon MA, Khaskheli SA, Murtaza G, Iqbal K, Saeed Shekhani M, et al. Role of a probiotic (Saccharomyces boulardii) in management and prevention of diarrhea. World J Gastroenterol. 2006;12(28):4557-60.

Kurugol Z, Koturoglu G. Effects of Saccharomyces boulardii in children with acute diarrhea. Acta Paediatr. 2005;94(1):44-7.

Guarino A, Canani RB, Spagnuolo MI, Albano F, Di Benedetto L. Oral bacterial therapy reduces the duration of symptoms and of viral execretion in children in mild diarrhea. J Pediatr Gastroenterol Nutr. 1997;25(5):516-9.

Guandalini S, Pensabene L, Zikri MA, Dias JA, Casali LG, Hoekstra H, et al: Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. J Pediatr Gastroenterol Nutr. 2000;30(1):54-60.

Majamaah H, Isolauri E, Saxelin M, Vesikari T. Lactic acid bacteria in the treatment of acute rotavirus gastroenteritis. J Pediatr Gastroenterol Nutr. 1995;20(3):333-8.

Szymasnski H, Pejcz J, Jawien M, Chmielarczyk A, Strus M, Heczko PB. Treatment of acute infectious diarrhea in infants in infants and children with a mixture of three lactobacillus rhamnosus strains- a randomised, double blind, placebo- controlled trial. Aliment Pharmacol Ther. 2006;23(2):247-53.

Allen SJ, Okoko B, Martinez E, Gregorio GV, Dans LF. Probiotics for treating infectious diarrhea. Cochrane Database Syst Rev. 2010;(11):CD003048.

Salazar- Lindo E, Miranda- Langschwager P, Campos- Sanchez M. Lactobacillus casei strain GG in the treatment of infants with acute watery diarrhea: a randomized, double blind, placebo controlled clinical trial. British Med Centre Pediatr. 2004;2:4-18.

Grandy G. Probiotics for children; use in diarrhea. J Clin Gastro. 2006;40:224-8.

Ezendam J, van Loveren H. Probiotics: immunomodulation and evaluation of safety and efficacy. Nutr Reviews. 2006;64(1):1-14.






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