Pediatr Gastroenterol Hepatol Nutr.  2019 Mar;22(2):162-170. 10.5223/pghn.2019.22.2.162.

Treating Viral Diarrhea in Children by Probiotic and Zinc Supplements

Affiliations
  • 1Department of Pediatrics, Lorestan University of Medical Sciences, Khorramabad, Iran. dr.a.mohsenzadeh@gmail.com
  • 2Pediatric Gastroenterology and Hepatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • 3Children's Medical Center, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.

Abstract

PURPOSE
The aim of this study was to analyze the effects of probiotics and zinc supplements on the mean duration and frequency of acute diarrhea in children aged 6 months to 2 years.
METHODS
In this clinical trial of infants aged between 6 months and 2 years, eligible patients were divided into 3 groups: Zinc Receiving Group (ZRG), Probiotic Receiving Group (PRG), and a control group receiving supportive care alone. The frequency of diarrhea was evaluated in the test groups during the first 24 hours and 48-72 hours, along with the duration of hospitalization and diarrhea persistence for 3-7 days.
RESULTS
Diarrhea persisted for until the third day of admission in 100% of the infants in PRG compared with only 76.1% in ZRG. The relative risk of diarrhea persistence in the PRG was 1.31 times more than in ZRG until the third day. Also, 80% of diarrhea cases in the PRG persisted until the fourth day of admission, compared with 47.8% in the ZRG group, and this value was significant. The relative incidence of diarrhea persistence in the PRG was 36.4 times greater than in the ZRG until the day 4. Also, the percentage of post-treatment complications was 35.5% in the PRG and 2.6% in the ZRG, which was significant.
CONCLUSION
In our study, the effectiveness of zinc at a dose of 20 mg was higher than that of probiotics. The complications associated with zinc supplementation were lower than those of probiotics.

Keyword

Diarrhea; Pediatrics; Probiotics; Viral diarrhea; Zinc

MeSH Terms

Child*
Diarrhea*
Hospitalization
Humans
Incidence
Infant
Pediatrics
Probiotics*
Zinc*
Zinc

Cited by  1 articles

Effect of Synbiotic on the Treatment of Jaundice in Full Term Neonates: A Randomized Clinical Trial
Shokoufeh Ahmadipour, Parastoo Baharvand, Parisa Rahmani, Amin Hasanvand, Azam Mohsenzadeh
Pediatr Gastroenterol Hepatol Nutr. 2019;22(5):453-459.    doi: 10.5223/pghn.2019.22.5.453.


Reference

1. Kliegman RM, Nelson WE. Nelson textbook of pediatrics. 20th ed. Philadelphia (PA): Elsevier;2016.
2. Black RE. Patterns of Growth in Early Childhood and Infectious Disease and Nutritional Determinants. In : Black RE, Makrides M, Ong KK, editors. Complementary Feeding: Building the Foundations for a Healthy Life. Basel: Karger Publishers;2017. p. 63–72.
3. Ahmed SM, Hall AJ, Robinson AE, Verhoef L, Premkumar P, Parashar UD, et al. Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis. Lancet Infect Dis. 2014; 14:725–730.
Article
4. Andrade FB, Gomes TA, Elias WP. A sensitive and specific molecular tool for detection of both typical and atypical enteroaggregative Escherichia coli . J Microbiol Methods. 2014; 106:16–18.
Article
5. Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet. 2003; 361:2226–2234.
Article
6. Mitra H, Shokoufeh A, Homa B, Azam M. The effect of oral zinc sulfate on hepatitis b vaccine immunogenicity in premature infants. Life Sci J. 2012; 9:3359–3361.
7. Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, et al. Global burden of childhood pneumonia and diarrhoea. Lancet. 2013; 381:1405–1416.
Article
8. Soofi S, Cousens S, Iqbal SP, Akhund T, Khan J, Ahmed I, et al. Effect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: a cluster-randomised trial. Lancet. 2013; 382:29–40.
Article
9. Skrovanek S, DiGuilio K, Bailey R, Huntington W, Urbas R, Mayilvaganan B, et al. Zinc and gastrointestinal disease. World J Gastrointest Pathophysiol. 2014; 5:496–513.
Article
10. Berni Canani R, Buccigrossi V, Passariello A. Mechanisms of action of zinc in acute diarrhea. Curr Opin Gastroenterol. 2011; 27:8–12.
Article
11. Kechagia M, Basoulis D, Konstantopoulou S, Dimitriadi D, Gyftopoulou K, Skarmoutsou N, et al. Health benefits of probiotics: a review. ISRN Nutr. 2013; 2013:481651.
Article
12. Gibson GR, Hutkins R, Sanders ME, Prescott SL, Reimer RA, Salminen SJ, et al. Expert consensus document: the International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nat Rev Gastroenterol Hepatol. 2017; 14:491–502.
Article
13. Gill H, Prasad J. Probiotics, Immunomodulation, and Health Benefits. In : Bösze Z, editor. Bioactive Components of Milk. New York (NY): Springer;2008. p. 423–454.
14. Abraham AA, Amritha SR, Selvin CD. A comparative evaluation on the effect of zinc-probiotic and probiotic therapy in paediatric acute diarrhoea and the impact of counselling of mothers. Int J Pharm Pharm Sci. 2016; 8:241–243.
15. Brooks WA, Santosham M, Roy SK, Faruque AS, Wahed MA, Nahar K, et al. Efficacy of zinc in young infants with acute watery diarrhea. Am J Clin Nutr. 2005; 82:605–610.
Article
16. Sachdev HP, Mittal NK, Mittal SK, Yadav HS. A controlled trial on utility of oral zinc supplementation in acute dehydrating diarrhea in infants. J Pediatr Gastroenterol Nutr. 1988; 7:877–881.
Article
17. Qadir MI, Arshad A, Ahmad B. Zinc: role in the management of diarrhea and cholera. World J Clin Cases. 2013; 1:140–142.
Article
18. Bhatnagar S, Bahl R, Sharma PK, Kumar GT, Saxena SK, Bhan MK. Zinc with oral rehydration therapy reduces stool output and duration of diarrhea in hospitalized children: a randomized controlled trial. J Pediatr Gastroenterol Nutr. 2004; 38:34–40.
Article
19. Bhandari N, Bahl R, Taneja S, Strand T, Mølbak K, Ulvik RJ, et al. Substantial reduction in severe diarrheal morbidity by daily zinc supplementation in young north Indian children. Pediatrics. 2002; 109:e86.
Article
20. Boran P, Tokuc G, Vagas E, Oktem S, Gokduman MK. Impact of zinc supplementation in children with acute diarrhoea in Turkey. Arch Dis Child. 2006; 91:296–299.
Article
21. Torabi SZ, Abbaszadeh A, Ahmadiafshar A. The effect of oral zinc sulfate on the management of acute gastroenteritis in children. ZUMS J. 2011; 19:58–65.
22. Mazumder S, Taneja S, Bhandari N, Dube B, Agarwal RC, Mahalanabis D, et al. Effectiveness of zinc supplementation plus oral rehydration salts for diarrhoea in infants aged less than 6 months in Haryana state, India. Bull World Health Organ. 2010; 88:754–760.
Article
23. Freedman SB, Sherman PM, Willan A, Johnson D, Gouin S, Schuh S, et al. Emergency department treatment of children with diarrhea who attend day care: a randomized multidose trial of a Lactobacillus helveticus and Lactobacillus rhamnosus combination probiotic. Clin Pediatr (Phila). 2015; 54:1158–1166.
Article
24. Goldenberg JZ, Ma SS, Saxton JD, Martzen MR, Vandvik PO, Thorlund K, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev. 2013; CD006095.
Article
25. Takagi A, Yanagi H, Ozawa H, Uemura N, Nakajima S, Inoue K, et al. Effects of Lactobacillus gasseri OLL2716 on Helicobacter pylori-associated dyspepsia: a multicenter randomized double-blind controlled trial. Gastroenterol Res Pract. 2016; 2016:7490452.
26. Brown AC, Valiere A. Probiotics and medical nutrition therapy. Nutr Clin care. 2004; 7:56.
27. Dinleyici EC, Vandenplas Y. PROBAGE Study Group. Lactobacillus reuteri DSM 17938 effectively reduces the duration of acute diarrhoea in hospitalised children. Acta Paediatr. 2014; 103:e300–e305.
28. Szajewska H, Mrukowicz JZ. Probiotics in the treatment and prevention of acute infectious diarrhea in infants and children: a systematic review of published randomized, double-blind, placebo-controlled trials. J Pediatr Gastroenterol Nutr. 2001; 33:Suppl 2. S17–S25.
Article
29. Thibault H, Aubert-Jacquin C, Goulet O. Effects of long-term consumption of a fermented infant formula (with Bifidobacterium breve c50 and Streptococcus thermophilus 065) on acute diarrhea in healthy infants. J Pediatr Gastroenterol Nutr. 2004; 39:147–152.
Article
30. Cimperman L, Bayless G, Best K, Diligente A, Mordarski B, Oster M, et al. A randomized, double-blind, placebo-controlled pilot study of Lactobacillus reuteri ATCC 55730 for the prevention of antibiotic-associated diarrhea in hospitalized adults. J Clin Gastroenterol. 2011; 45:785–789.
Article
31. Riddle DJ, Dubberke ER. Clostridium difficile infection in the intensive care unit. Infect Dis Clin North Am. 2009; 23:727–743.
32. Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis. 2013; 13:1057–1098.
Article
33. Urbańska M, Szajewska H. The efficacy of Lactobacillus reuteri DSM 17938 in infants and children: a review of the current evidence. Eur J Pediatr. 2014; 173:1327–1337.
Article
Full Text Links
  • PGHN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr