Effectiveness of Zinc Supplementation with ORS and Bacillus clausii versus zinc with ORS and Saccharomyces boulardii in Acute Watery Diarrhea in Pediatric Patients
DOI:
https://doi.org/10.47489/szmc.v39i3.790Keywords:
Bacillus clausii, diarrhea, probiotic, saccharomyces boulardii, stoolAbstract
Background: Acute watery diarrhea (AWD) remains a leading cause of death in children. Probiotics, when used alongside standard therapy, can improve clinical outcomes.
Objective: To compare the effectiveness of Bacillus clausii versus Saccharomyces boulardii, each combined with zinc and oral rehydration solution (ORS), in the management of AWD in children.
Method: This randomized controlled trial was conducted in the Department of Pediatric Medicine, Children’s Hospital Lahore, from April to September 2023. Sixty children aged 3 months to 5 years with AWD and mild to moderate dehydration were randomly assigned to Group A (Bacillus clausii + Zinc + ORS) or Group B (Saccharomyces boulardii + Zinc + ORS). Primary outcomes were stool frequency and consistency; secondary outcome was hospital stay duration.
Results: In a total of 60 children, 30 each group, 28 (46.7%) were male. Both groups showed decreased stool frequency from day 1 to day 5. Group A reduced from 4.43 ± 1.72 to 1.56 ± 0.57 stools per day, while Group B decreased from 4.96
± 1.56 to 1.76 ± 0.63 stools per day. Group A had a higher efficacy rate (96.7%) compared to Group B (90%) and faster symptom improvement (2.48 ± 0.74 days vs. 3.14 ± 1.06 days, p = 0.007). Group A had a shorter mean hospital stay (34.86 hours vs. 48.40 hours, p=0.014).
Conclusion: Bacillus clausii in comparison to Saccharomyces boulardii is more effective in reducing the duration as well as frequency of diarrhea in children.
References
Mulatya DM, Mutuku FW. Assessing comorbidity of diarrhea and acute respiratory infections in children under 5 years: evidence from Kenya’s demographic health survey 2014. J. Prim. Care Community Health. 2020 May;11:2150132720925190. https://doi.org/10.1177/2150132720925190
Hartman RM, Cohen AL, Antoni S, Mwenda J, Weldegebriel G, Biey J, et al. Risk factors for mortality among children younger than age 5 years with severe diarrhea in low-and middle-income countries: Findings from the world health organization-coordinated global rotavirus and pediatric diarrhea surveillance networks. Clin. Infect. Dis. 2023 Feb 1;76(3):e1047-53. https://doi.org/10.1093/cid/ciac561
Valencia-Rodríguez A, Aquino-Matus J, Vera-Barajas A, Qi X, Méndez-Sánchez N. New therapeutic options for bile acid malabsorption diarrhea. Ann. Transl. Med. 2019 Nov;7(22). https://doi.org/10.21037/atm.2019.09.112
Mosaddek AS, Rizvi M, Akter R, Islam S, Hossain N, Iqbal H. Effect of probiotics in the treatment of acute watery diarrhoea in children admitted to a tertiary care hospital in Bangladesh: a non-randomized prospective clinical trial. IJCRIMPH. 2022;14(2):1-7. https://doi.org/10.35248/1840-4529.22.14.341
Sharma H, Bajwa J. Potential role and mechanism of probiotics. Ann. Rom. Soc. Cell Biol. 2021 Feb 1:3616-24. http://www.annalsofrscb.ro/index.php/journal/article/view/472
Collinson S, Deans A, Padua-Zamora A, Gregorio GV, Li C, Dans LF, Allen SJ. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 2020(12). https://doi.org/10.1002/14651858.CD003048.pub4
Depoorter L, Vandenplas Y. Probiotics in pediatrics. A review and practical guide. Nutrients. 2021 Jun 24;13(7):2176. https://doi.org/10.3390/nu13072176
Li Z, Zhu G, Li C, Lai H, Liu X, Zhang L. Which probiotic is the most effective for treating acute diarrhea in children? A Bayesian network meta-analysis of randomized controlled trials. Nutrients. 2021 Nov 29;13(12):4319. https://doi.org/10.3390/nu13124319
Szajewska H, Guarino A, Hojsak I, Indrio F, Kolacek S, Salvatore S, et al. Use of probiotics for the management of acute gastroenteritis in children: an update. J. Pediatr. Gastroenterol. Nutr. 2020 Aug 1;71(2):261-9. https://doi.org/10.1097/MPG.0000000000002751
Sniffen JC, McFarland LV, Evans CT, Goldstein EJ. Choosing an appropriate probiotic product for your patient: An evidence-based practical guide. PLoS One. 2018 Dec 26;13(12):e0209205. https://doi.org/10.1371/journal.pone.0209205
Acosta-Rodríguez-Bueno CP, Abreu y Abreu AT, Guarner F, Guno MJ, Pehlivano?lu E, Perez III M. Bacillus clausii for gastrointestinal disorders: a narrative literature review. Adv Ther. 2022 Nov;39(11):4854-74. https://doi.org/10.1007/s12325-022-02285-0
Ianiro G, Rizzatti G, Plomer M, Lopetuso L, Scaldaferri F, Franceschi F, et al. Bacillus clausii for the treatment of acute diarrhea in children: a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2018 Aug 12;10(8):1074. https://doi.org/10.3390/nu10081074
Mahyar A, Ayazi P, Pashaei H, Arad B, Oveisi S, Esmaeili S. The effect of the yeast probiotic Saccharomyces boulardii on acute diarrhea in children. J. Compr. Ped. 2021;12(4). https://doi.org/10.5812/compreped.117391
Fatima M, Kauser S, Fatima B, Mudassir K, Siddiqua S, Reddy UN, et al. Comparison of effectiveness of zinc supplementation with ORS and Bacillus clausii vs zinc supplementation with ORS and Saccharomyces boulardii in acute watery diarrhoea in paediatric patients. IJAM. 2018;2(4):3–5. https://journals.indexcopernicus.com/publication/2210565
Altcheh J, Carosella MV, Ceballos A, D’Andrea U, Jofre SM, Marotta C, et al. Randomized, direct comparison study of Saccharomyces boulardii CNCM I-745 versus multi-strained Bacillus clausii probiotics for the treatment of pediatric acute gastroenteritis. Medicine. 2022 Sep 9;101(36):e30500. https://doi.org/10.1097/MD.0000000000030500
Asmat S, Shaukat F, Asmat R, Bakhat HF, Asmat TM. Clinical efficacy comparison of Saccharomyces boulardii and lactic acid as probiotics in acute pediatric diarrhea. J. Coll. Physicians Surg. Pak. 2018 Mar 1;28(3):214-7. https://doi.org/10.29271/jcpsp.2018.03.214
Sudha MR, Jayanthi N, Pandey DC, Verma AK. Bacillus clausii UBBC-07 reduces severity of diarrhoea in children under 5 years of age: a double blind placebo controlled study. Benef. Microbes. 2019 Mar 13;10(2):149-54. https://doi.org/10.3920/BM2018.0094
Szajewska H, Ko?odziej M, Zalewski BM. Systematic review with meta?analysis: Saccharomyces boulardii for treating acute gastroenteritis in children—a 2020 update. Aliment. Pharmacol. Ther. 2020 Apr;51(7):678-88. https://doi.org/10.1111/apt.15659
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