Luciano Amedee Peret Filho

Treatment of acute diarrhea with Saccharomyces boulardii in infants.

Objective: The aim of the study was to determine whether an oral treatment with a commercial pharmaceutical product containing Saccharomyces boulardii would reduce the duration of diarrhea in infants with acute diarrhea. Patients and Methods: In the present double-blind, placebo-controlled study, 186 infants, 6 to 48 months old and hospitalized within 72 hours after the onset of acute diarrhea in 2 hospitals in Goiânia, Goiás, Brazil, were randomly assigned to receive twice per day for 5 days 200 mg of a commercial pharmaceutical product containing 4 × 109 viable cells of S boulardii or a placebo. Stool samples were submitted to search for rotavirus. Among the 176 infants who completed the trial, those treated with S boulardii (90) showed a reduction in diarrhea duration (P < 0.05) when compared with the placebo group (86). Results: The present study shows a reduction in diarrhea duration when S boulardii was given to children within 72 hours after the onset of acute diarrhea. Conclusions: The present study suggests a complementary treatment of acute diarrhea in infants with daily oral doses of S boulardii.

[Up-to-date clinical and experimental basis for the use of probiotics]

OBJECTIVE: To evaluate the potential of probiotics or biotherapeutic agents for the prevention and/or treatment of selected intestinal infections. METHODS: Medline database was searched for all relevant articles between 1990 and February 1998. Bibliographies of articles were also used. All animal experiments and placebo-controlled human studies were reviewed in order to provide information on the mechanisms of action, potential efficacy, or adverse effects of these biotherapeutic agents. RESULTS: In the first part of this review, the different mechanisms of action that are effective in the treatment of diarrhea were discussed, and they were well demonstrated in laboratory animals. The most important are: enzymatic induction of disaccharidase activity, trophic effects on the intestinal mucosa, action in blocking bacterial toxins, and also induction of the immunologic response. Therapeutic effects of probiotics in humans, mainly in the gastrointestinal tract, were reported in the second part. Placebo-controlled studies have shown that biotherapeutic agents have been used successfully in the treatment of acute diarrhea in infants, traveler s diarrhea, antibiotic-associated diarrhea, with or without Clostridium difficile-associated enterocolitis (pseudomembranous colitis), and in immunosuppression-associated diarrhea, including AIDS. Lactobacillus, Bifidobacterium and Saccharomyces boulardii were the most important biotherapeutic agents to be considered. CONCLUSIONS: Currently, there is evidence that the administration of selected microorganisms is benefic in the prevention and treatment of certain intestinal infections. According to the literature, Saccharomyces boulardii is the most important probiotic. Possible future indications were discussed, such as the probable synergic effect of many probiotics due to their different and complementary mechanisms of action. The importance of new experimental and clinical studies for the better understanding of actions and the use of probiotics in other clinical situations was emphasized.

Prevalência baixa de adenovírus em crianças com diarreia em Belo Horizonte-MG

INTRODUCTION: Several microorganisms, among them enteric adenovirus, are widely recognized as etiological agents of acute diarrhea. The association between adenovirus and the disease varies among geographical regions and is poorly known in Brazil. OBJECTIVES: To investigate the presence of adenovirus in stool samples from children with and without diarrhea in Belo Horizonte-MG. To study factors associated with enteric adenovirus infection. MATERIAL AND METHOD: A qualitative immunochromatographic assay (kit VIKIA® Rota-Adeno, bioMerieux) was performed to detect adenovirus antigens in stool samples from 268 children with acute diarrhea and 124 without diarrhea at Hospital Infantil Joao Paulo II from January/2005 to December/2006. Clinical, laboratory, and epidemiologic data were recorded in SPSS database (SPSS Statistical package, IBM). RESULTS: Adenovirus was detected in 16 samples (4.1%): 12 of them (4.5%) were from children with acute diarrhea and 4 of them (3.2%) from children without diarrhea. The viral infection was more prevalent among girls and the age distribution was homogenous. Among the 16 children infected by adenovirus,11 (68.8%) were younger than 12 months old. However, no significant statistical difference was observed within the analyzed parameters. There was no seasonal distribution of adenovirus infection. CONCLUSION: Our data demonstrate that the prevalence of enteric adenovirus infection is low among children with diarrhea in Belo Horizonte-MG.