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Prebiotics for acute diarrhea in adults and children

Prebiotics for acute diarrhea in adults and children. Rüdiger Schultz, MD, PhD Pediatrician Ilembula Hospital. Probiotics. The definition of Probiotics: -Living micro-organisms that, upon ingestion in certain numbers, exert health benefiting effects beyond inherent general nutrition

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Prebiotics for acute diarrhea in adults and children

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  1. Prebiotics for acute diarrhea in adults and children Rüdiger Schultz, MD, PhD Pediatrician Ilembula Hospital

  2. Probiotics The definition of Probiotics: -Living micro-organisms that, upon ingestion in certain numbers, exert health benefiting effects beyond inherent general nutrition -The most commonly used probiotics are lactic acid bacteria such as bifidus or lactobacilla -Probiotics are believed to improve the immune response in allergic or infectional conditions

  3. Precosa • The drug Precosa consists of a strain of probiotic yeast, called Saccharomyces boulardii. • It has been shown to be useful against enteropathogens • Most of the proposed mechanisms by which this yeast exerts its beneficial effects on the gut are derived from animal studies and are of theoretical nature.

  4. Possible mechanisms of Precosa • Inhibition of if pathogen adhesion to gut mucosa • Strengthening of enterocyte tight junctions • Neutralization of bacterial virulence factors • Enhancement of IgA on the surface of the gut mucosa

  5. Meta-analysis: Saccharomyces boulardii for treating acute diarrhoea in children • In fiverandomised-controlledtrials (619 participants) S. boulardiisignificantlyreducedtheduration of diarrhoeacomparedwithcontrols. • Thepooledmeandifference of diarrhoeacompardwithcontrolswas -1.1 to 1.3 days. • Saccharomycesboulardiisignificantlyreducedtherisk for diarrhea on days 3, 6 and 7 and reducedsignificantlytherisk for diarrhoealastingmorethan 7 days. Szajewska H, Skórka A and Dylag M 2007. AlimentPharmacolTher 25:257-264

  6. Indications for Precosa • All kind of diarrhea, from watery to mucoid of viral origin • So called tourist diarrhea, caused by E.coli • Diarrhoea caused by entamebae • In prevention of diarrhea, caused by antibiotics • Prevention of diarrhoea caused by Clostridium difficile • Precosa can be used together with metronidazole and vancomysin to prevent sequelae caused by this drugs • Precosa can be preventivley used when travelling

  7. Precosa should not be used • In thesevereimmunecompromisedpatient • Whenthepatient is unconscious • Togetherwithindwelling iv-catheters • If thepatient is intolerant to onemore of theingredients of the drug • In combinationwithalcohol • In hotdringsor food

  8. Unless new evidence for other use is established be careful if: • the patient is moderately immune compromised • When stools are bloody • When the patient is in addition to diarrhoea also heavily vomiting • The patient is under three month of age

  9. How to use Precosa • Thenormaldosage in children is 250 mg (1 package) x2/day. In cases of diarrheathenormaltime of use is oneweek • Thenormaldosage in adults is 500 mg ( 2 packages) x2/day. In cases of diarrheathenormaltime of use is oneweek • To preventreoccurence of clostridiumdifficile, Precosa is used as soon as possibleafterstartingan antibiotic thatcancauseinfection of clostridiumdifficileor as an adjuvant to metronidazole in thedosagesusedabove for 4 weeks • To preventanyotherdiarrheacausedbyantibioticsusePrecosa at thelatest 48-72 hoursafterstartingthe antibiotic and continue as long as the antibiotic is prescribed(usually for oneweek) • To preventtouristdiarrhea, Precosa is started in thedosagesabove 2 daysbeforetravelling and is continuedoverthewholetravelperiod

  10. How to use Precosa • Precosa is available in capsules, 250 mg each which are taken with a lot of clean water or juice. • For children Precosa is available in form of granulate, 250 mg/package which is poured into clean water or juice. • Because Precosa consists of living, dried yeast cells, don´t use Precosa in combination with hot foods or drings or in combination with alcoholic drinks • Precosa, when used during pregnancy will have no impact on the fetus. It can also be used while nursing, Precosa is not excreted into breast milk

  11. Donators of Precosa for Ilembula Hospital • IlembulaHospitalhas got untilnowover 1000 packages of Precosa in form of granulatfromdonations of a single private person in Finland and the Rotary Club Tampere-Hervanta • Thevalue of thedonation is around 2 millionTzh-shillings • Thedrug is available at thedispensary of thehospital • Furtherdonationswillhopefullyfollow, one is allreadywaiting to berealized (EvangelicalFree-Church of Tampere)

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