Efficacy of synbiotic and probiotic treatments on acute watery diarrhea in children

<jats:p>Background In developing countries, acute watery diarrhea isa common cause of morbidity and mortality in children. Givingsynbiotics or probiotics may decrease the severity of diarrhea.Objective To compare the efficacy of synbiotics and probioticsin decreasing the frequency of diarrhea, shortening the duration,and increasing patient body weight.Methods This was a double􀀷blind, randomized clinical trial tocompare the effects of synbiotic vs probiotic treatment in childrenaged 6􀀷59 months v.ith acute watery diarrhea. This study wasperformed from October to December 2010 in two hospitals inCentral Java. Subjects received either synbiotics or probioticstv.ice daily for five days. The measured outcomes were durationof diarrhea, daily frequency of diarrhea, and increase in bodyweight.Results There was no significant difference in the mean durationof the diarrhea in the synbiotic and probiotic groups, 3.92 days(SD 0.79) vs 3.80 days (SD 0.82) ,(P􀀸0.35), respectively. Nor didwe observe a significant difference in the mean increase in bodyweight in the synbiotic and probiotic groups, 150 g (SD 49.7) vs160 g (SD 48.9), (P􀀸 0.67), respectively.Conclusion We observed no significant differences in efficacy ofsynbiotic and probiotic treatment for management of acute waterydiarrhea. [Paediatr Indones. 2012;52:209,12].</jats:p>

section_content: A cute watery diarrhea is a common cause of morbidity and mortality in children. Dehydration, as its main complication, children in the world annually. The main treatments for managing acute watery diarrhea are rehydration, prevention of further dehydration, and dietetic treatment. The goal of dietetic treatment is to improve the microbial ecosystem of the gut. 2 Effects of probiotics in the gastrointestinal tract are improvement of lactose absorption, normalization of gut microflora, clearance of pathological microorganisms, and improvement of humoral immunity by increasing IgA secretion. 3, 4 f probiotics (living microorganisms), and synbiotics (consisting of a mixture of living microorganisms and oligosaccharides) has been demonstrated to modify the composition of the gut microflora, restore the microbial balance, hence, providing potential health benefits of probiotics compared to placebo, as well as synbiotics compared to placebo, in the management of acute watery diarrhea. Both reported significant benefits. on which of the two, probiotics or synbiotics, is more effective for treating acute watery diarrhea in children. 

of diarrhea, shortening the duration of diarrhea, and increasing body weight during illness.

section_content: months with acute watery diarrhea admitted at the two hospitals. Acute watery diarrhea was defined as watery stools occurring more than three times per subjects with bloody diarrhea and diarrhea with severe complications, such as severe dehydration, metabolic written informed consent. This study was approved determined by hypothesis test, based on the means allocated into the two treatment groups using a random number table. Only the appointed pharmacist while subjects and physicians were blinded to the information (see study profile in Figure 1 ). 

Before the study, subjects were examined to were rehydrated before weighing. The synbiotic and probiotic sachets were administered twice daily for five

The physician evaluated the level of dehydration first six hours after admission, followed by evaluation diarrhea from acute watery diarrhea, as well as the increase in body weight during illness. Duration of If subjects were discharged in less than five days, we outpatient clinic on day five after admission. 

Figure 1.
section_name: Methods

section_content: the study. There were 88 subjects in each of the two groups. Baseline characteristics of subjects are shown in Table 1. The results of this study are shown in Table 2. There was no significant difference in the patients suffered from bloating in synbiotic group. No other gastrointestinal adverse effects were observed during the study.
section_name: Results

section_content: of diarrhea, shortening the duration of diarrhea, and significant differences between the two groups for diarrhea or mean increase in body weight. 

and flatulence, from both synbiotic and probiotic treatment. Three patients in the synbiotic group suffered from bloating. Fermentation of the substrate (prebiotics) produces hydrogen, which may cause duration of diarrhea, and increased body weight better than probiotics. The addition of substrate for bacterial growth to the live microbes increases only beneficial for the administered bacteria, but also for the residing bifidobacteria and lactobacilli in the intestines. Many species of bifidobacteria and lactobacilli other than the administered probiotics were observed in the feces after synbiotic treatment. 

compared to placebo, as well as synbiotics compared to placebo, in the management of acute watery diarrhea, reported significant benefits. This study is the first to compare administered synbiotics and probiotics in the management of acute watery diarrhea in children. prebiotics into the probiotics, i. e the synbiotics, compared to the probiotics alone. If the substrate for bacterial growth was already present in the intestines, adding additional substrate might be useless. 

A limitation of our study was that we did not affect the increase in body weight. Also, we assessed the degree of dehydration based on clinical findings

In conclusion, we found no significant differences in body weight between synbiotic and probiotic treatment in children with acute watery diarrhea.
section_name: Discussion

section_name: References