One of the main areas of study of probiotics has been the prevention and/or treatment of diarrhea.
WHO defines diarrhea as the passage of loose or liquid stools three or more times a day. If the bowel movements are frequent, but formed from faces, it is not considered diarrhea. It may be accompanied by fever or vomiting and usually does not last more than 7 days
Diarrhea is usually a symptom of an infection of the digestive tract caused by bacterial microorganisms, viruses, or parasites.
According to WHO, diarrheal diseases are the second leading cause of death among kids under five. They are preventable and treatable diseases. Every year, 525,000 kids under the age of five die from this cause.
Treatment of diarrhea with probiotics
The key treatment is rehydration of the body, although this affects neither the duration of the diarrhea nor the consistency of the stool. This is where the administration of probiotics helps to reduce the duration of the diarrhea and increase the consistency of the faces by means of defense mechanism processes based on the restoration of the microbiota or intestinal flora through the creation of an environment hostile to pathogenic microorganisms. This defense is carried out through a process of competition, a reduction in pH, the synthesis of antimicrobial substances and by stimulating the body’s immune system
In recent years, numerous studies, reviews and meta-analyses have been published that demonstrate the efficacy of probiotics in the treatment of acute diarrhea. In fact, one of the pathologies with the greatest use is made of probiotics.
Beneficial effects in the treatment of diarrhoea with probiotics
The beneficial effects of probiotics on diarrhea are generally manifested by a reduction in the duration of the diarrhea of approximately 1 day, a decrease in the number of bowel movements on the second day, and a decrease in the number of diarrhea episodes lasting more than 4 days.
The positive effect of probiotics in the treatment of diarrhea depends not only on the species but also on the strain used. Furthermore, the effect is directly related to the dose administered, with higher doses being more effective at values of 109 o 1010 cfu/day or higher.
Lactobacillus rhamnosus GG (LGG) y Saccharomyces boulardii.
The WGO World Gastroenterology Organization, and in line with ESPGHAN, in its latest report in 2017 states that the probiotics that have most clearly demonstrated their efficacy in this pathology are Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii. It also mentions Lactobacillus reuteri DSM 17938, although to a lesser extent than the two previous ones.
Likewise, studies carried out with the administration of Lactobacillus rhamnosus GG showed a reduction in the number of diarrheal episodes compared to the control group given a placebo 2.
There are numerous studies that support these data. In 2016, a study of 200 kids, of whom 100 were given Saccharomyces boulardii and 100 placebo, concluded that there was a significant reduction in the duration and number of bowel movements in kids with diarrhea 1
Probiotics for antibiotic-associated diarrhea
A problem resulting from the high use of antibiotics in developed countries is the alteration of the intestinal microbiota which causes a decrease in microbial diversity and leads to a loss of microbial metabolism and as a result, osmotic diarrhea due to excess fluid in the intestine. There is also less resistance to colonization and therefore an increase in infections by pathogenic species. Studies have shown that up to 30% of patients treated with antibiotics experience episodes of diarrhea associated with their administration.
This risk is higher in inpatients than in outpatients. Kids under 2 years of age and adults over 65 years of age are also at greater risk than the rest of the population.
Not all antibiotics are equally predisposing. There are studies that reflect that 20% of diarrhea incidence is produced in treatments with amoxicillin-clavulanic although there are also other antibiotics that are associated with diarrhea such as cephalosporins and clindamycin
Not all antibiotics are equally predisposing. There are studies that reflect more than 20% of incidence of diarrhea in treatments with amoxicillin-clavulanic although there are also other antibiotics that are associated with diarrhea as are also cephalosporins and clindamycin
The benefits of using probiotics depend not only on the strain itself but also on the particular antibiotic that has caused the diarrhea, the age of the patient, and whether or not the patient was hospitalized
Numerous studies have shown that the simultaneous administration of antibiotics together with prebiotics helps to reduce the symptoms of this type of diarrhea. In particular, the most studied probiotics for the prevention of these symptoms are mainly Saccharomyces boulardii and Lactobacillus rhamnosus GG, although the doses should be no less than 1010 cfu/day and the administration of the probiotic should be done from the beginning of the antibiotic treatment, at least within the first two days of the start of the antibiotic and not wait until the diarrhea occurs to start the probiotic treatment.
(1) Sharif MR, Kashani HH, Ardakani AT, Kheirkhah D, Tabatabaei F, Sharif A. The Effect of a Yeast Probiotic on Acute Diarrhea in Children. Probiotics Antimicrob Proteins. 2016;8(4):211‐214. doi:10.1007/s12602-016-9221-2
(2) Oberhelman RA, Gilman RH, Sheen P, et al. A placebo-controlled trial of Lactobacillus GG to prevent diarrhea in undernourished Peruvian children. J Pediatr. 1999;134(1):15‐20. doi:10.1016/s0022-3476(99)70366-5