Efficacy of Probiotics in the Treatment of Acute Watery Diarrhoea and Their Effects on Serum Immunoglobulin among Children: A Non- randomized Prospective Clinical Study in Tertiary Care Hospital in Bangladesh

Objective: The study aimed to assess the efficacy of probiotics in the context of acute watery Diarrhoea and their effects on serum immunoglobulin in children.

Background: Diarrheal disease is responsible for a substantial health-related burden on human society and remains the second leading cause of death in children below 5 years of age. The use of probiotics has gained increased popularity, even though the concept of using probiotics for the prevention and treatment of some human illnesses has been around for over a century.

Methods: This study was performed as a parallel-group, interventional non-randomized study with enrollment of pediatric patients according to eligibility criteria and being allocated to receive probiotic therapy in Uttara Adhunik Medical College, and allocated to receive probiotics, antibiotics, or probiotics + antibiotics for 30 days in accordance with the standard treatment protocol of Diarrhoea. Clinical outcome measurements included the duration of Diarrhoea and treatment of adverse events. Stool culture and blood immunoglobulin were analyzed on days 0 and 30.

Results: A total of 166 enrolled children were divided into three groups: Group A (probiotics), Group B (antibiotics) and Group C (probiotics + antibiotics) with 98 participants returning for a follow-up visit on day 30. All groups were comparable in their baseline characteristics. Causative organisms of Diarrhoea among final participants (N=98) were Rotavirus (69.4%), E. Coli (67.4%), multiple organisms (2 or more) (45.9%), Campylobacter (34.7%), Vibrio cholerae (20.4%), Salmonella (10.2%), Shigella (9.2%), and Klebsiella (1.0%). The fastest recovery occurred in Group A (3.03 ± 0.76 days; Group C: 3.80 ± 1.10 days; Group B: 4.11 ± 1.48 days; p=0.001). At follow-up, administration of probiotics was associated with the presence of commensal Lactobacillus and Bifidobacterium in stool. Randomized controlled trials that incorporate probiotics in the treatment of Diarrhoeal diseases may potentially lead to improved utilization of the traditional and virtually universally applied antimicrobial chemotherapy in Bangladesh. Probiotics may also provide effective prevention of Diarrhoea, as illustrated by the increased serum levels of immunoglobulins.

Conclusion: The inclusion of probiotics for the treatment of acute watery Diarrhoea in children is effective, and safe and results in a shorter duration of Diarrhoea and faster discharge from the hospital. Probiotics may provide future alternative prevention and treatment strategies for childhood Diarrhoeal diseases in Bangladesh.