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Paediatrica IndonesianaVOLUME 52 NUMBER 4July

Original Article

Paediatr Indones, Vol. 52, No. 4, July 2012 209

Efficacy of synbiotic and probiotic treatments on acute

watery diarrhea in children

Ani Isti Rokhmawati, Wahyu Damayanti, Madarina Julia

AbstractBackground In developing countries, acute watery diarrhea isDFRPPRQFDXVHRIPRUELGLW\DQGPRUWDOLW\LQFKLOGUHQ*LYLQJ

synbiotics or probiotics may decrease the severity of diarrhea.

Objective To compare the efficacy of synbiotics and probioticsLQGHFUHDVLQJWKHIUHTXHQF\RIGLDUUKHDVKRUWHQLQJWKHGXUDWLRQ

and increasing patient body weight.

Methods This was a double-blind, randomized clinical trial tocompare the effects of synbiotic vs probiotic treatment in children

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twice daily for five days. The measured outcomes were duration

RIGLDUUKHDGDLO\IUHTXHQF\RIGLDUUKHDDQGLQFUHDVHLQERG\weight.

ResultsThere was no significant difference in the mean durationof the diarrhea in the synbiotic and probiotic groups, 3.92 days

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we observe a significant difference in the mean increase in body

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Conclusion:HREVHUYHGQRVLJQLILFDQWGLIIHUHQFHVLQHIILFDF\RIsynbiotic and probiotic treatment for management of acute watery

diarrhea. [Paediatr Indones. 2012;52:209-12].

Keywords: Acute watery diarrhea, synbiotic,

probiotic

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6FKRRO6DUGMLWR+RVSLWDO

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210Paediatr Indones, Vol. 52, No. 4, July 2012

of acute watery diarrhea. Both reported significant

benefits.+RZHYHUWKHUHKDVEHHQOLWWOHGDWD

on which of the two, probiotics or synbiotics, is

more effective for treating acute watery diarrhea in

children.

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V\QELRWLFVDQGSURELRWLFVLQGHFUHDVLQJWKHIUHTXHQF\of diarrhea, shortening the duration of diarrhea, and

increasing body weight during illness.

Methods

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months with acute watery diarrhea admitted at the

two hospitals. Acute watery diarrhea was defined as

watery stools occurring more than three times per

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subjects with bloody diarrhea and diarrhea with severe

complications, such as severe dehydration, metabolic

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written informed consent. This study was approved

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determined by hypothesis test, based on the means

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allocated into the two treatment groups using a

random number table. Only the appointed pharmacist

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information (see study profile inFigure 1).

Before the study, subjects were examined to

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were rehydrated before weighing. The synbiotic and

probiotic sachets were administered twice daily for five

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The physician evaluated the level of dehydration

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first six hours after admission, followed by evaluation

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diarrhea from acute watery diarrhea, as well as the

increase in body weight during illness. Duration of

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If subjects were discharged in less than five days, we

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outpatient clinic on day five after admission.

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Figure 1.6WXG\SUROH

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Ani Isti Rokhmawati et al: 6\QELRWLFDQGSURELRWLFWUHDWPHQWVRQDFXWHZDWHU\GLDUUKHD

Paediatr Indones, Vol. 52, No. 4, July 2012 211

Results

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the study. There were 88 subjects in each of the two

groups. Baseline characteristics of subjects are shown

in Table 1. The results of this study are shown in

Table 2. There was no significant difference in theGXUDWLRQRIWKHGLDUUKHD3WKHGDLO\IUHTXHQF\

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patients suffered from bloating in synbiotic group. No

other gastrointestinal adverse effects were observed

during the study.

Discussion

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V\QELRWLFVDQGSURELRWLFVLQGHFUHDVLQJWKHIUHTXHQF\

of diarrhea, shortening the duration of diarrhea, and

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significant differences between the two groups forPHDQGDLO\IUHTXHQF\RIGLDUUKHDPHDQGXUDWLRQRI

diarrhea or mean increase in body weight.

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and flatulence, from both synbiotic and probiotic

treatment. Three patients in the synbiotic group

suffered from bloating. Fermentation of the substrate

(prebiotics) produces hydrogen, which may cause

Table 1.$CUGNKPGEJCTCEVGTKUVKEUQHUWDLGEVU

Characteristics Synbiotic group(n=88)

Probiotic group(n=88)

Mean age, months SD 27.69 13.73 23.69 14.74

Gender

Males, n (%) 51 (58) 41 (47)

Females, n (%) 37 (42) 47 (53)

Socio-economic status1

Low, n (%) 21 (24) 41 (76)

High, n (%) 67 (76) 47 (34)

Nutritional status2

Undernourished, n (%) 31 (35) 34 (38)

Well-nourished, n (%) 57 (65) 54 (62)

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Table 2.4GUWNVUQHVJGUVWF[

Variables Synbiotic group

(n=88)

Probiotic group

(n=88)

/GCP&KHHGTGPEG 95% CI P value

/GCPFWTCVKQPQHFKCTTJGCFC[Uv5& 3.92 0.79 3.80 0.82 - 0.11 -0.35 to 0.12 0.35

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SDday 1 6.871.62 6.671.52 - 0.20 -0.67 to 0.26 0.39

day 2 4.471.82 4.281.78 -0.19 -0.72 to 0.34 0.47

day 3 2.571.52 2.521.56 -0.05 -0.51 to 0.4 0.80

day 4 0.941.09 1.131.50 0.19 -0.19 to 0.58 0.33

day 5 0.230.47 0.200.45 -0.03 -0.17 to 0.10 0.63

Mean increase in body weight, grams

SD

150 49.7 165 48.9 15.0 -1.01 to 29.9 0.67

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Ani Isti Rokhmawati et al:6\QELRWLFDQGSURELRWLFWUHDWPHQWVRQDFXWHZDWHU\GLDUUKHD

212Paediatr Indones, Vol. 52, No. 4, July 2012

bloating, flatulence, and diarrhea. But it is difficult

to differentiate if these effects are due the diarrhea

itself or due to the additional substrates (prebiotics).

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duration of diarrhea, and increased body weight

better than probiotics. The addition of substratefor bacterial growth to the live microbes increases

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only beneficial for the administered bacteria, but

also for the residing bifidobacteria and lactobacilli

in the intestines. Many species of bifidobacteria and

lactobacilli other than the administered probiotics were

observed in the feces after synbiotic treatment.

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compared to placebo, as well as synbiotics compared to

placebo, in the management of acute watery diarrhea,

reported significant benefits.This study is the first

to compare administered synbiotics and probiotics in

the management of acute watery diarrhea in children.

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prebiotics into the probiotics, i.e the synbiotics,

compared to the probiotics alone. If the substrate for

bacterial growth was already present in the intestines,

adding additional substrate might be useless.

A limitation of our study was that we did not

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affect the increase in body weight. Also, we assessed

the degree of dehydration based on clinical findings

DORQHQRWE\FKHFNLQJXULQHVSHFLILFJUDYLW\In conclusion, we found no significant differences

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in body weight between synbiotic and probiotic

treatment in children with acute watery diarrhea.

References

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acute gastroenteritis among children, oral rehydration,

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6HSW@$YDLODEOHIURP KWWSZZZFGFJRYPPZUSUHYLHZ

PPZUKWP

2. %UDQVNL':LOVFKDQVNL0 3URELRWLFVLQ JDVWURLQWHVWLQDO

GLVRUGHUV,Q%HKUPDQ5(.OLHJPDQ50-HQVRQ+%1HOVRQ

WH[WERRNRISHGLDWULFVth HG3KLODGHOSKLD6DXQGHUV

S

3. 6DOD]DU/0LUDQGD/&DPSRV6&KDH:Lactobacillus casei

VWUDLQ**LQWKHWUHDWPHQWRILQIDQWVZLWKDFXWHZDWHU\

GLDUUKHDDUDQGRPL]HGGRXEOHEOLQGSODFHERFRQWUROOHG

FOLQLFDOWULDO%0-3HGLDWU

4. Cohen MB. Evaluation and treatment of the child withDFXWHGLDUUKHD,Q5XGROSK&'5XGROSK$0+RVWHWWHU

0./LVWHU*6LHJHO1-HGLWRUV5XGROSKV3HGLDWULFV st

HG1HZFLWHG6HSW@$YDLODEOHIURPhttp://www.bps.go.id Dughera L, Elia C, Navino M, Cisaro F, the ARMONIA study

group.Effects ofsymbiotic preparations on constipated irritable

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science gastrointestinal physiology and function. Br J Nutr.

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+GXUDWLRQRIGLDUUKHD%HQHILWRIRUDOVXSSOHPHQWDWLRQZLWK

and without synbiotics in young children with acute bacterial

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6LPDNDFKRUQ13LFKDLSDW95LWKLSRUQSDLVDUQ3.RQJNDHZ

&7RQJSUDGLW3 9DUDYLWK\D:&OLQLFDOHYDOXDWLRQRI WKH

DGGLWLRQRIO\RSKLOL]HGKHDWNLOOHGLactobacillus acidophilus LB

to oral rehydration therapy in the treatment of acute diarrhea

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