difficile Prevent relapse of C difficille diarrhea Biller et al (1995), Bennet et al (1987), Silva et al (1987) ND is a major problem in pediatric hospital worldwide 81 children aged 1-36 months hospitalized for reason other than diarrhea RCT: LGG (n=45) vs placebo (n=36) LGG 6x109 cfu twice daily LGG reduced the risk of nosocomial diarrhea in comparison with placebo (6.7% vs 33.3%) LGG significantly reduced the risk of rotavirus gastroenteritis (2.2% vs 17.7%) Szajewska et al, 2001Īntibiotic associated diarrhea Metronidazole / vancomicyn Relapse Treatment with Lactobacillus casei Bacteria-produced substance inhibit in vitro the growth of enteropatogens, including C. Prevention of nosocomial diarrhea in infants: RCT Outcomes: diarrhea lasting >3 days and duration of diarrhea 23 studies: n=1917, 76% children Lactobacillus (21 studies), Saccharomyces boulardi (2 studies) Patients who receives probiotic were less likely to have diarrhea lasting >3 days Mean duration of diarrhea was reduced by 30 hours Allen et al, 2004ĥ5 infants aged 5-24 months hospitalized for non-GI diseases Formula : Bifidobacteria vs control Observe for 7 months Diarrhea episode decreased (7% vs 31%) Rotavirus infection decreased (10% vs 39%) Saavedra et al, 1994 Meta-analysis: Probiotics reduced diarrhea lasting at 3 days in children and adults Lactobacillus therapy for acute infectious diarrhea in children 9 studies (out of 26 studies published from 1966 to 2000) Reduction in diarrhea duration of 0.7 days (95% CI: 0.31.2 days) Reduction in diarrhea frequency of 1.6 stools on day 2 of treatment (95% CI: 0.7-2.6 fewer stools) Conclusion: Lactobacillus is safe and effective as a treatment for children with acute infectious diarrhea Van Niel at al, Pediatrics 2002 109:1-13 Treatment of Acute Diarrhea META-ANALYSIS RCT of probiotic for treatment of acute diarrhea PROBIOTIC Lactobacillus GG Lactobacillus acidophilus Bifidobacterium bifidum Enterococcus faecium Bifidobacterium longum Lactobacillus plantarum Streptococcus thermophilus Saccharomyces boulardii Produce volatile fatty acids and modify bile acids Probiotics intervention to modulate immune response Produce antibiotic molecules > Protection against enteral infections in a phase of insufficient immune response (Koletzko et al., 1998 Heine, 1998) > Induction of oral tolerance towards dietary allergens (Hanson & Telemo, 1997) Lowering pH in environment Synthesis of digestive enzymes Protective Properties of Bifidobacteria Inhibition of pathogens Kuman baik: efek positif thd kesehatan Bifidobacteri dan Lactobacillus Bermanfaat dalam tatalaksana diare akut, diare nosokomial, diare karena antibiotik adsorbant, mucoprotector, antisecretory, probiotic.Beberapa penelitian telah dilakukan dalam terapi diare.OVERGROWTH: - MONILIA - ENTEROCOCCUS - ANAEROB - PSEUDOMONAS 3. Pemberian yang kurang tepat memperlambat kesembuhan Gangguan keseimbangan intestinal microflora ĮFEK SAMPING ANTIMIKROBA 1.Reevaluate every 1-2 jam ORS After 6 hours (infants) or 4 hours (child) reevaluate plan treatment A,B,C PLAN TREATMENT C Dehidrasi Berat, IVFD Age Ist treatment 30 ml/BW in Infant 12 months ½ - 1 hoursĢnd treatment 70 ml/BW in 5 hour 2 ½ - 3 hours
Reevaluate after 3-4 hours plan th/ A, B, or C Continued feeding or early resumption DEDDY S PUTRA SUB BAG GASTROHEPATOLOGI ANAK FK-UNRI/RSUD ARIFIN ACHMAD