Comparison of zinc-probiotic combination therapy to zinc therapy alone in reducing the severity of acute diarrhea

Muhammad Hatta; Supriatmo Supriatmo; Muhammad Ali; Atan Baas Sinuhaji; Berlian Hasibuan; Fera Luna Nasution

doi:10.14238/pi51.1.2011.1-6

Muhammad Hatta Department of Child Health, Univetsity of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera
Supriatmo Supriatmo Department of Child Health, Univetsity of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera
Muhammad Ali Department of Child Health, Univetsity of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera
Atan Baas Sinuhaji Department of Child Health, Univetsity of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera
Berlian Hasibuan Department of Child Health, Pirngadi Hospital, Medan, North Sumatera
Fera Luna Nasution Department of Child Health, Pirngadi Hospital, Medan, North Sumatera

DOI: https://doi.org/10.14238/pi51.1.2011.1-6

Keywords: acute diarrhea, zinc, probiotic, Lactobacillus acidophilus

Abstract

Background Although the incidence of diarrhea in Indonesia has declined in the last five years, the mortality rate in children under five years old is still high. Therefore, appropriate and comprehensive management of diarrhea is essential. There have been many studies on the role of zinc therapy and probiotic therapy in reducing the severity of acute diarrhea, but not many studies have compared the use of a combination of the two therapies to

zinc therapy alone.

Objective To compare the efficacy of zinc-probiotic combination therapy to zinc alone in reducing the severity of acute diarrhea.

Methods We conducted a randomized, open-label, controlled trial from July 2009 to January 2010 in Adam Malik Hospital and Pirngadi Hospital, Medan. Children aged between 1 month and 5 years who met the criteria were divided into two groups. Group I received zinc sulphate (aged <6 months: 10 mg/day; aged 2:6 months: 20 mg/day) combined with heat-killed Lactobacillus acidophilus (3x101O CFU/day) for 10 days. Group II received only zinc sulphate at the same dosage as group I. Measurement of disease severity was based on the frequency of diarrhea (times/day) and the duration of diarrhea (hours) after initial drug consumption.

Results Eighty subjects were enrolled, randomised, and divided equally into two groups. 40 children received zinc-probiotic in combination (group I) and the remainder (group II) received zinc alone. We observed significant differences in frequency of diarrhea (2.1 vs 3.1 times/day, P=0.001, 95%CI -1.62 to -0.49), and duration of diarrhea (52.1 vs. 72.6 hours, P=0.00l, 95%CI -30.91 to -10.18) in the two groups.

Conclusion Combination of zinc-probiotic therapy was more effective in reducing the severity of acute diarrhea than zinc therapy alone in children under five years of age.

References

1. Sinuhaji AB, Sutanto AH. Mekanisme diare infeksius akut. Cermin Dunia Kedokteran. 1992;80:44-6.
2. Noerasid H, Suraatmadja S, Asnil PO . Gastroenteritis (diare) akut. In: Suharyono, Boediarso A, Halimun EM, editors. Gastroenterologi anak praktis. 4th ed. Jakarta: Balai Penerbit FKUI; 2003. p.51,76.
3. Afifah T, Djaja S, Irianto J. Kecenderungan penyakit penyebab kematian bayi dan anak balita di indonesia: 1992-2001. Bul Pene! Kesehatan. 2003;31.48,59.
4. Anggarwal R, Sentz J, Miller MA. Role of nnc administration in prevention of childhood diarrhea and respiratory illness: a meta-analysis. Pediatrics. 2007;119:1120-30.
5. Roy SK, Hossain Mj, Khatun W, Chakraborthy B, Chowdhury S, Begum A, et al. Zinc supplementation in children with cholera in Bangladesh: randomised controlled trial. BMJ. 2008;336.266.
6. Sur D, Gupta DN, Mondal SK, Ghosh S, Manna B, Rajendran K, et al. Impact of nnc supplementation on diarrheal morbidity and growth paterrn of low birth weight infants in Kolkata, India: a randomized, double-blind, placebo-controlled, community-based study. Pediatrics. 2003; 112: 1327-32.
7. WHO. The treatment of diarrhea, a manual for physicians and other senior health workers, 4th revision. Geneva: WHO Press; 2005. page#???
8. Van Niel Cw, Feudtner C, Garrison MM, Christakis DA. Lactobacillus therapy for acute infectious diarrhea in children: a metaô€ analysis. Pediatrics. 2002;109:678-84.
9. Shamir R, Makhoul IR, Etzioni A, Shehadeh N. Evaluation of a diet containing probiotics and zinc for the treatment of mild diarrheal illness in children younger than one year of age. j Am Coli Nutr. 2005;24:370-5.
10. Annin SA. Zat gizi mikro zink, dari aspek molekuler sampai pada program kesehatan masyarakat. Suplement. 2005:26;29-35.
11. Wapnir RA. Zinc deficiency, malnutrition and the gastrointestinal tract. J Nutr. 2000: 130; 1388S-92S.
12. AltafW, Perveen S, Rehman KU, Teicberg S, Vancurova I, Harper RG, et al. Zinc supplementation in oral rehydration solutions: experimental assessment and mechanisms of action. j Am Coli Nutr. 2002.21;26-32.
13. Hoque KM, Rajendran VM, Binder HJ. Zinc inhibits cAMPô€ stimulated Cl secretion via basolateral K-channel blockade in rat ileum. Am J Physiol G astrointest Liver Physiol. 2005;288:G956-63.
14. Isolauri E, Kirjavainen PY, Salminen S. Probiotics: a role in the treatment of intestinal infection and inflammation? Gut. 2002;50:iii54-9.
15. Nguyen Tv, Le Van P, Le Huy C, Weintraub A. Diarrhea caused by rotavirus in children less than 5 years of age in Hanoi, Vietnam. j Clin Microbiol. 2004;42.5745-50.
16. Khan SA, Ahmed A, Khalid SM. Diarrhea due to rotavirus and probability of sewage contamination. J Islamic Acad Sci. 1992;5:142-4.
17. Hussein AM, Hassan MK. Rot avirus infection among hospitalized children \\lith acute watery diarrhea in Basrah - Iraq. Bahrain Med Bull. 2000;22:170-3.
18. Albert MJ, Faruque ASG, Faruque SM, Sack RB, Mahalanis B. Case control study of enteropathogens associated with childhood diarrhea in Dhaka, Bangladesh. J Clin Microbiol. 1999;37:3458-64.
19. Supriatmo. Effectivity of live versus heat killed probiotic in children with acute diarrhoea . Maj Kedokt Nus. 2006;39:391-5.
20. Rodrigues MAM, Oliveira DA, Taketomi EA, Hernandez FJ. IgA production, coliforms analysis and intestinal mucosa morphology of piglets that received probiotics with viable or inactivated cells. Pesq Vet Bras. 2007;27:241-5.
21. Zhang L, Li N, Caicedo R, Neu J. Alive and dead Lactobacillus rhamnosus GG decrease tumor necrosis factor-D-induced interleukin-8 production in cacoô€2 cells. J Nutr. 2005,05; 1752-6.
22. Shu-Dong X, De Zhong Z, Hong L, Shi Hj, Hou YL, Geng Sw, dkk. Multicenter, randomized, controlled trial of heat- killed Lactobacillus acidophilus LB in patients \\lith chronic diarrhea. Adv T her. 2003,20;253-60.
23. Almatsier S. Zink mineral. In: Almatsier S. Prinsip dasarilmu gizi. Jakarta: Gramedia Pustaka Utama, 2003; p. 247-50.
24. Pudjiadi S. Kekurangan dan keracunan mineral. In: Pudjiadi S. Hmu gizi klinis pada anak. 4th ed. Jakarta: Balai Penerbit 6â€¢ Paediatr Indones, Vol. 51, No.1, January 2011 FKUI; 2005. p.205-6.
25. Boyle RJ, Robinsô€Browne RM, Tang MLK. Probiotic use in clinical practice: what are the risks? Am J Clin Nutr. 2006,83 ;1256-64.
26. Borthakur A, Gill RK, Tyagi S, Koutsouris A, Alrefai WA, Hecht GA, dkk. T he probiotic Lactobacillus acidophilus stimulates chloride/hydroxyl exchange activity in human intestinal epithelial cells. J Nutr. 2008:138;1355-9.
27. Leô€Moal V L , Sarrazin-Davilla LE, Servin AL. An experimental study and a randomized, double-blind, placeoo-controlled clinical trial to evaluate the antisecretory activity of Lactobacillus acidophilus strain LB against nonrotavirus diarrhea. Pediatrics. 2007:120;e795-803.
28. Subagyo B, Santoso N. Diare akut. In: Juffrie M, Soenarto SS, Oswari H, Arief S, Rosalina I, Sri Mulyani N, editors. Buku ajar gastroenterology-hepatologi. Jakarta: Badan Penerbit IDAI; 2010. p.87-l20.