Clinical Efficacy of Probiotics in Children: Nestle
Dr. Ashish Bavdekar, Associate Professor, Paediatric Gastroenterologist, KEM Hospital, Pune In this talk, Dr. Ashish speaks of the possible benefits of probiotics in curing intestinal and other disorders including management of acute diarrhoea. He mentions that not all probiotics work the same way and that certain organisms have a far better result in curing acute diarrhoea. The presentation made details various diseases and the possible outcomes using probiotics including milk. One of the long term effects outlines included fewer respiratory infections in kids. He highlights the need of more in-depth studies and analysis before a conclusion on overall benefits can be arrived. However, he does mention that probiotics do show signs of being useful in the Indian context.In India there are 100+ single and combination brand of probiotics. Single are bacterial/yeast while combinations are prebiotic and probiotic, antibiotic and probiotic, multivitamin and probiotic, zinc and probiotics. Treatment for Acute Gastroenteritis is a dose-dependent with high units is effective. Early use of probiotics is equal to greater benefit. Moderate to severe dehydration and bacterial diarrhoeas see no effect while after onset of severe diarrhoea see no benefit. A note of caution indicates that most studies from developed countries have different breast feeding rates, different gut microflora. Efficacy strain related Lactobacilli GG /S Boulardii.10-20% of all hospitalized patients treated with antibiotics will develop Antibiotic Associated Diarrhoea (AAD). Penicillin, clindarnycin, and cephalosporins are the antibiotics used in most hospitals .Only 15-20% of Antibiotic Associated Diarrhoea (AAD) is due to C. difficile. It alters colonic flora, especially faecal anaerobes which normally metabolize malabsorbed carbohydrates and break down primary bile acids; this can result in osmotic (carbohydrate) or secretory (bile acid) diarrhoea.A study showed that the prevention of atopic dermatitis uses Lactobacillus rhamnosus GG or placebo which is given prenatally to mothers with 1st degree relative with allergy (rhinitis, eczema, asthma) or postnatally for 6 months to infants. The results at 24 months saw 50% less atopic atopic eczema with lactobacillus rhamnosus GG and at 4 years eczema was half of placebo group. Inflammatory Bowel disease like ulcerative colitis has encouraging data in adults with mild-mod disease / ileoaral pouchitis following surgery and limited promising data in children. Crohn’s Disease does not seem to be benefited by probiotics.Long-term effects of probiotics were seen through a study of 223 pregnant mothers in which L. rhamnosus 6G & LC705, B.breve 8b99, P freudenreichíi or placebo were given 4 weeks before delivery. Infants received same probiotic + GoGs or placebo for 6 months. Results were seen after 24 months wherein no difference was seen in neonatal morbidity, colic though fewer respiratory infections were observed.Probiotics are used for manipulation of gut flora and in infancy they prevent infections, promote growth and have other benefits. In later life they reduce allergy and adult lifestyle diseases.