Efficacy of synbiotic treatment in children with acute rotavirus diarrhea

Made Ratna Dewi, Yati Soenarto, I Putu Gede Karyana


Background Diarrhea is one of the major causes of morbidity
and mortality in children throughout the world, mostly due to
rotavirus infection. In daily practice, we routinely use the World
Health Organization Five steps for managing acute diarrhea.This
practice has shown great success in diarrhea management, but
concerns remain on reducing the duration of diarrhea to prevent
complications. Synbiotics can reduce the severity of diarrhea.
However, there has been limited data on synbiotic therapy for
treating acute rotavirus diarrhea in children.
Objective To compare the durations of acute rotavirus diarrhea
treated with synbiotics vs. placebo.
Methods This study was a randomized, double-blind, clinical trial,
performed at the Pediatric Gastrohepatology Division, Sanglah
and Wangaya Hospitals in Denpasar. Subjects were children aged
6 to 59 months with acute rotavirus diarrhea. Rotavirus was
diagnosed by immune chromatography assay. The synbiotic group
received probiotic comprised of Lactobacillus sp., Streptococcus sp.,
Bifidobacterium sp. (total viable count 1.00x109 CFU per dose), and
prebiotic consisted of 990.00 mg fructooligosacharide (FOS). The
placebo consisted of lactose monohydrate packaged similarly as the
synbiotics. Subjects orally ingested 1 pack per day for 5 days.
Results Seventy children with acute rotavirus diarrhea was
involved in this study. The median duration of diarrhea in the
synbiotic group was 50.0 (SE 1.1); 95%CI 47.9 to 52.1 hours, while
that of the placebo group was 63.0 (SE 5.9); 95%CI 51.4 to 74.6
hours. Based on Kaplan-Meier survival analysis, the duration of
diarrhea in the synbiotic group was significantly shorter than that
of the placebo group (log-rank test P <0.0001).
Conclusion In children with acute rotaviral diarrhea, synbiotic
reduces the duration of diarrhea compared to placebo.


acute rotavirus diarrhea; synbiotic; randomized clinical trial

Full Text:



Farthing M, Linberg G, Dite P, Khalif I, Lindo ES, Ramakrishna

BS, et al. Acute diarrhea. WGO practice guidelines; 2008. p.


Bengmark S, Gil A. Bioecological and nutritional control

of disease: Prebiotics, probiotics and synbiotics. Nutr Hosp.


Sandhu B, Devadason D. Management of diarrhea. In:

Wyllie R, Hyams JS, editors. Pediatric gastrointestinal & liver

disease. 3rd ed. USA: Saunders Elsevier; 2006. p. 1165-76.

Achmadi UF. Harapan pemerintah mengenai peranan kaum

profesional dalam mendukung program penyakit saluran

cerna anak di era otonomi. In: Kumpulan Makalah Kongres

Nasional II. Badan Koordinasi Gastroenterologi Anak

Indonesia; 2003 Jul 3-5; Bandung. p. 1-16.

Widaya WI, Gandi. Konsistensi pelaksanaan program serta

morbiditas dan mortalitas diare di era otonomi dan krisis, In:

Kumpulan Makalah Kongres Nasional II, Badan Koordinasi

Gastroenterologi Anak Indonesia; 2003 Jul 3-5; Bandung. p.


Direktorat Jendral Pengendalian Penyakit dan Penyehatan

Lingkungan Departemen Kesehatan Republik Indonesia.

Lintas diare. Buku Saku Petugas Kesehatan. 2008. p. 7-18.

Collins MD, Gibson GR. Probiotics, prebiotics and synbiotics:

approaches for modulating the microbial ecology of the gut.

Am J Clin Nutr. 1999;69:1052S-7S.

Dinleyici EC, Dalgic N, Guven S, Ozen M, Kara A, Arica V,

et al. The effect of a multispecies synbiotic mixture on the

duration of diarrhea and length of hospital stay in children

with acute diarrhea in Turkey: single blinded randomized

study. Eur J Pediatr. 2013;172;459-64.

Vandenplas Y, De Hert SG, Probiotical study group.

Randomised clinical trial: the synbiotic food supplement

probiotical vs. placebo for acute gastroenteritis in children.

Aliment Pharmacol Ther. 2011;34:862-7.

Bresee J, Fang ZY, Wang B, Nelson EA, Tam J, Soenarto

Y, et al. First report from the Asian Rotavirus Surveillance

Network. Emerg Infect Dis. 2004;10:988-95.

Soenarto Y, Aman AT, Bakri A, Waluya H, Firmansyah

A, Kadim M, et al. Burden of severe rotavirus diarrhea in

Indonesia. J Infect Dis. 2009;200:S188-94.

Widowati T, Bakrie A, Nirwati H, Soenarto Y. Surveillance

of rotavirus diarrhea, Paediatr Indones. 2012;52:22-7.

Noel RJ, Cohen MB. Infectious diarrhea. In: Wyllie R, Hyams

JS, editors. Pediatric gastrointestinal and liver disease. 3rd ed.

USA: Saunders Elsevier; 2006. p. 557-81.

Kadim M, Soenarto Y, Hegar B, Firmansyah A. Epidemiology

of rotavirus diarrhea in children under five: a hospital-based

surveillance in Jakarta. Paediatr Indones. 2011;51:138-43.

Charrois LT, Sandhu G, Vohra S. Probiotics. Pediatr Rev.


DOI: http://dx.doi.org/10.14238/pi55.2.2015.74-8


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