Probiotics have clinical, microbiologic, and immunologic efficacy in acute infectious diarrhea.
BACKGROUND
Acute infectious diarrhea is a major cause of childhood morbidity and economic burden for families. We evaluate the clinical, microbiologic, and immunologic effects of probiotics in acute infectious diarrhea.


METHODS
Children (n = 304) aged 3 months to 6 years hospitalized for acute diarrhea were randomized to receive Bio-three (a mixture of Bacillus mesentericus, Enterococcus faecalis, and Clostridium butyricum) or placebo orally 3 times daily for 7 days. Fecal samples were homogenized for bacterial culture and blood cells were isolated for cell culture and cytokine analysis. This study is registered (NCT00463190).


RESULTS
The mean duration of diarrhea after start of therapy was 60.1 hours in the probiotics group versus 86.3 hours in the placebo group (P = 0.003). Hospital stay was shorter in the probiotics group than in the placebo group (P = 0.009). Counts of Bifidobacteria and Lactobacillus species were elevated in stool culture of the probiotics (Bio-three) group. IL-10 was increased in the serum and supernatants of cell culture in the probiotics group, and tumor necrosis factor-alpha values were down-regulated. Interferon- gamma and IL-12 were mildly elevated in the probiotics group, compared with the placebo group.


CONCLUSIONS
This probiotics mixture reduced the severity of diarrhea and length of hospital stay in children with acute diarrhea. In addition to restoring beneficial intestinal flora, probiotics may enhance host protective immunity such as down-regulation of pro-inflammatory cytokines and up-regulation of anti-inflammatory cytokines.
Chen
Chien-Chang
CC
Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Taiwan.
Kong
Man-Shan
MS
Lai
Ming-Wei
MW
Chao
Hsun-Chin
HC
Chang
Kuei-Wen
KW
Chen
Shih-Yen
SY
Huang
Yhu-Chering
YC
Chiu
Cheng-Hsun
CH
Li
Wen-Chen
WC
Lin
Pen-Yi
PY
Chen
Chih-Jung
CJ
Li
Tzou-Yien
TY
D000898:Antibiosis; D002648:Child; D002675:Child, Preschool; D046972:Clostridium butyricum / Q000254:growth & development / Q000276:immunology; D016207:Cytokines / Q000032:analysis; D003967:Diarrhea / Q000628:therapy*; D013293:Enterococcus faecalis / Q000254:growth & development / Q000276:immunology; D005243:Feces / Q000737:chemistry / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007778:Lactobacillus / Q000254:growth & development / Q000276:immunology; D007902:Length of Stay; D008297:Male; D010919:Placebos / Q000008:administration & dosage; D019936:Probiotics / Q000494:pharmacology / Q000627:therapeutic use*
D016207:Cytokines; D010919:Placebos