Relative Efficacy of Probiotics Compared with Oral Rehydration Solution for Diarrhea Treatment in Children under Five Years Old: a Meta-Analysis from Developing Countries
Abstract
Background: Children under five experience an average of three episodes of diarrhea each year in developing countries. Based on World Health Organization (WHO) guidelines, therapy for acute diarrhea is oral rehydration fluid and zinc to treat fluid and electrolyte loss. But unfortunately, this therapy does not reduce the duration of diarrhea without the intestinal barrier function of pathogenic microorganisms. The ability to inhibit pathogens is one of the three main mechanisms of probiotics. This study aims to examine the efficacy of using probiotics compared to oral rehydration solution (ORS) in the treatment of acute diarrhea in children under five in developing countries.
Subjects and Method: This study is a meta-analysis conducted using PRISMA systematic guidelines. The process of searching for articles was carried out between 2009 and 2019 using a database search engine consisting of PubMed, British Medical Journal (BMJ), CAB Direct, Oxford Academy, Clinical Key, ScienceDirect, and Scopus. Based on a database search, six articles that meet the criteria of the Randomized Controlled Trial (RCT) and research conducted in developing countries were found. The study involved 1234 children who were divided into two groups: 762 probiotic groups and 472 ORS groups. The analysis was performed with the Review Manager (RevMan) software 5.3. The results were assessed using Standardized Mean Difference (SMD).
Results: There was heterogeneity between experiments (I2 = 91%; p <0.001) so Random Effects Model (REM) was used. Probiotics could reduce the duration of acute diarrhea in infants rather than just ORS, with a pooled estimate of 1.13 (SMD = -1.13; 95% CI = -1.54 to -0.72; p <0.001).
Conclusion: Probiotics can reduce the duration of acute diarrhea in infants in developing countries rather than just the administration of ORS.
Keywords: Diarrhea, probiotics, oral rehydration solution, meta-analysis.
Correspondence:
Nurul Aini Suria Saputri. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: ainisuriasaputri@gmail.com. Mobile: 085743401971
Indonesian Journal of Medicine (2019), 4(4): 354-363
https://doi.org/10.26911/theijmed.2019.04.04.08
References
Ahmadi E, Navaei RA, Rezai MS (2015). Efficacy of probiotic use in acute rotavirus diarrhea in children: A systematic review and meta-analysis. Caspian J Intern Med. 6(4): 187-195. Retrieved from https://link.springer.com/reference-workentry/10.1007%2F978-3-319-29489-6234
Barai P, Hossain KM, Gazi MS (2018). Antidiarrheal efficacy of probiotic bacteria in castor oil induced diarrheal mice. Prev Nutr Food Sci. 23(4): 294-300. doi:10.1097/MCG.0b013e31815-a5780.
Basu S, Paul DK, Ganguly S, Chatterjee M, Chandra PK (2009). Efficacy of high dose Lactobacillus rhamnosus GG in controlling acute watery diarrhea in Indian children a randomized controlled trial. J Clin Gastroenterol. 43(3): 208-213. doi: 10.1097/MCG.0b013e31815a5780.
Dinleyici EC, Dalgic N, Guven S, Metin O, Yasa O, Kurugol Z, et al. (2015). Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting. J Pediatr. 91(4): 392-396. doi: 10.1016/j.jped.2014.10.009.
Dinleyici EC, Kara A, Dalgic N, Kurugol Z, Arica V, Metin O, et al. (2015). Saccharomyces boulardii CNCM I745 reduces the duration of diarrhoea, length of emergency care and hospital stay in children with acute diarrhoea. Benef Microbes. 6(4): 415-421. doi: 10.3920/BM2014.0086.
Dinleyici EC, Vandenplas Y, PROBAGE Study Group (2014). Lactobacillus reuteri DSM 17938 effectively reduces the duration of acute diarrhoea in hospitalised children. Acta Paediatr. 103: e300-e305. doi:10.1111/apa.12 617.
Erdogan O, Tanyeri B, Torun E, Gonullu E, Arslan H, Erenberk U, Oktem F (2012). The comparition of the efficacy of two different probiotics in rotavirus gastroenteritis in children. J Trop Med. 2012: 1-5. doi:10.1155/2012/787-240.
Ministry of Health RI (2018). Hasil utama RISKESDAS 2018 (Main results of 2018 RISKESDAS). Kementerian Kesehatan Republik Indonesia: Badan Penelitian dan Pengembangan Kesehatan. Retrieved from https://www.depkes.go.id
Murti B (2018). Prinsip dan metode riset epidemiologi, Edisi IV (Principles and methods of epidemiological research, Fifth Edition). Karanganyar: Bintang Fajar Offset.
Rahmi D, Gayatri P (2015). Laporan kasus berbasis bukti: manfaat pemberian probiotik pada diare akut (Evidence-based case reports: the benefits of giving probiotics in acute diarrhea). Sari Pediatri. 17(1): 76-80. doi: 10.14238/sp17.1.2015.76-80.
Szajewska H, Skorka A, Ruszczynski M Gieruszczak-Białek D (2013). Metaanalysis: Lactobacillus GG for treating acute gastroenteritis in children-updated analysis of randomised controlled trials. Aliment Pharmacol Ther. 38(5): 467-476. doi: 10.1111/apt.12403.
Teran CG, Escalera CNT, Villarroel P (2009). Nitazoxanide vs. probiotics for the treatment of acute rotavirus diarrhea in children: a randomized, single-blind, controlled trial in Bolivian children. Int J Infect Dis. 13: 518-523. doi:10.1016/j.ijid.2008.09.01-4.
UNICEF (2018). Diarrhoea remains a leading killer of young children, despite the availability of a simple treatment solution. Retrieved from https://data.unicef.org/topic/childhealth/diarrhoeal-disease/e32.
WGO (2017). World gastroenterology organisation global guidelines: probiotics and prebiotics. Retrieved from https://www.worldgastroenterology.org/guidelines/globalguidelines/probiotics-and-prebiotics/probiotics-and-prebiotics-english.
WHO (2017). Diarrhoeal disease. Retrieved from https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease.
