Probiotics have Clinical, Microbiologic, and Immunologic Efficacy in Acute Infectious Diarrhea

From The Pediatric Infectious Disease Journal®

Chien-Chang Chen, MD; Man-Shan Kong, MD; Ming-Wei Lai, MD; Hsun-Chin Chao, MD; Kuei-Wen Chang, MD; Shih-Yen Chen, MD; Yhu-Chering Huang, MD, PhD; Cheng-Hsun Chiu, MD, PhD; Wen-Chen Li, MD; Pen-Yi Lin, MD; Chih-Jung Chen, MD; Tzou-Yien Lin, MD

Posted: 03/04/2010; Pediatr Infect Dis J. 2010;29(2):135-138. © 2010 Lippincott Williams & Wilkins

Abstract
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.

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-α values were down-regulated. Interferon-γ 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.

Introduction
Probiotics may be beneficial in the management of acute diarrhea. Some studies reported that probiotics can reduce the severity of viral diarrhea and rotavirus shedding.
Few trials have investigated the effect of probiotics in bacterial diarrhea. Guandalini et al[3] and Shornikova et al[4] reported that diarrhea was not reduced in the probiotic group compared with the control group.

A probiotics preparation (Bio-three, TOA Pharmaceutical Ltd, Japan; containing Bacillus mesentericus TO-A, Enterococcus faecalis T-110, Clostridium butyricum TO-A) had an effect on normalization of enterobacterial flora, inhibition of pathogenic bacteria, and promotion of the growth of beneficial bacteria.

This probiotics preparation may prevent growth of enterohemorrhagic E. coli in the intestine and associated diarrhea in a rabbit model.

The mechanism by which probiotics bacteria inhabit the gastrointestinal tracts of host and exert their beneficial effects is unclear. Our study sought to determine whether probiotics (Bio-three) inhibited infectious diarrhea and reduced the associated inflammatory response. Bacterial counts (microbiology) and subsequent immune reaction were investigated. No previous human studies have explored clinical, microbiologic, and immunologic effects of probiotics in acute diarrhea simultaneously.