Epidemiology and Infection

Gastrointestinal infections

Role of probiotic in preventing acute diarrhoea in children: a community-based, randomized, double-blind placebo-controlled field trial in an urban slum

D. SURa1 c1, B. MANNAa1, S. K. NIYOGIa1, T. RAMAMURTHYa1, A. PALITa1, K. NOMOTOa2, T. TAKAHASHIa2, T. SHIMAa2, H. TSUJIa2, T. KURAKAWAa2, Y. TAKEDAa3, G. B. NAIRa1 and S. K. BHATTACHARYAa4

a1 National Institute of Cholera and Enteric Diseases, Kolkata, India

a2 Basic Research Department II, Yakult Central Institute for Microbiological Research, Yaho, Kunitachi, Japan

a3 Collaborative Research Center of Okayama University for Infectious Diseases in India, Kolkata, India

a4 Indian Council of Medical Research, New Delhi, India

SUMMARY

Acute diarrhoea remains a major public health challenge in developing countries. We examined the role of a probiotic in the prevention of acute diarrhoea to discover if there was an effect directed towards a specific aetiology. A double-blind, randomized, controlled field trial involving 3758 children aged 1–5 years was conducted in an urban slum community in Kolkata, India. Participants were given either a probiotic drink containing Lactobacillus casei strain Shirota or a nutrient drink daily for 12 weeks. They were followed up for another 12 weeks. The primary outcome of this study was the occurrence of first episodes of diarrhoea. We assessed this during 12 weeks of intake of study agent and also for 12 weeks of follow-up. There were 608 subjects with diarrhoea in the probiotic group and 674 subjects in the nutrient group during the study period of 24 weeks. The level of protective efficacy for the probiotic was 14% (95% confidence interval 4–23, P<0·01 in adjusted model). The reduced occurrence of acute diarrhoea in the probiotic group compared to nutrient group was not associated with any specific aetiology. No adverse event was observed in children of either probiotic or nutrient groups. The study suggests that daily intake of a probiotic drink can play a role in prevention of acute diarrhoea in young children in a community setting of a developing country.

(Accepted June 29 2010)

(Online publication July 30 2010)

Correspondence:

c1 Author for correspondence: D. Sur, MBBS, M.D., National Institute of Cholera and Enteric Diseases, P 33 CIT Road, Scheme XM, Beliaghata, Kolkata 700010, India. (Email: dipikasur@hotmail.com)

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