This document discusses probiotics and their role in managing diarrhea. It defines probiotics as live microbes that provide health benefits when consumed in adequate amounts. Common probiotic strains include Lactobacillus, Bifidobacterium, and Saccharomyces boulardii. Probiotics can help treat digestive disorders, allergies, and lower cholesterol. They are found naturally in foods like yogurt. Clinical studies show certain probiotic strains like L. rhamnosus GG and a mix of bacterial strains can significantly shorten the duration of acute diarrhea in children. The document also outlines guidelines for classifying and treating diarrhea based on dehydration signs, recommending oral rehydration, zinc and probiotic supplements,

1. PROBIOTICS
Presented by :
AND
DIARRHEA MANAGEMENT
MUHAMMAD USMAN SARWAR

2. CONTENTS
Definition
Characteristics
Probiotic strains
Role of Probiotics
Foods containing probiotics
Clinical implications of probiotics
DIARRHEA MANAGEMENT

3. INTRODUCTION
DEFINITION
Probiotics are defined as live microbes which when
administered in adequate amounts confer a
beneficial health effect on the host--- WHO 2002
Ellie Metchnikoff, the first scientist who proposed the
therapeutic use of lactic acid bacteria.
Probiotics term coined in 1965 by Lilly And Stillwell

4. Characteristics of Probiotics
• Be nonpathogenic and nontoxic to the host
• Resistant to gastric acid and bile acid
• Capable of surviving, colonizing and proliferating in the gut
• Produce antibacterial substances (bacteriocins)
• It should persist for short periods in the gastro-intestinal tract
• Able to inhabit in the S & L intestine
• Human in origin, genetically stable and capable of remaining
viable for long periods in field condition
• Good adhesion/ colonization to human intestinal tract.

5. Probiotic strains
Lactobacillusspecies
• L. acidophilus
• L. plantarum
• L. casei rhamnosus
• L. brevis
• L. bulgaricus
Bifidobacterium species
• B. adolescentis
• B. bifidum
• B. infantis
• B. breve
• Bacilus clausii
Others
• Streptococcus thermophilus
• Enteterococcus faecium
• Lactococcus lactis
• Yeast – Saccharomyces boulardii

6. ROLE OF PROBIOTICS
Probiotics have shown to provide a diverse variety of health benefits to human, animal,
and plants. It is important that the health benefits of probiotics must be documented with
the specific strain and specific dosage.
HUMANS
1. Probiotics Can Help Reduce Symptoms of Certain Digestive Disorders
2. Probiotic bacteria, such as Lactobacillus and Bifidobacterium, can synthesize and
supply vitamins to human body.
3. Probiotics Lactobacillus rhamnosus may Reduce the Severity of Certain Allergies
and Eczema
4. Probiotic Lactobacillus plantarum may significantly reduces both cholesterol and
blood pressure which Can Help Keep Your Heart Healthy
5. Probiotic Lactobacillus amylovorus may Help You Lose Weight and Belly Fat.

7. ANIMALS
• Probiotics can beneficially improve the intestinal microbial balance in host animal.
• Commercial probiotics for animal use are claimed to improve animal performance
by increasing daily gain and feed efficiency in feedlot cattle, enhance milk
production in dairy cows and enhanced growth.
• Probiotics improve health and performance of young calves and in improving
growth performance of chickens
• Probiotics provide the animal with additional source of nutrients and digestive
enzymes
PLANTS
• Plant probiotics is strong growing market for the use in agricultural biotechnology
• It has shown worldwide with an annual growth rate of approximately 10%.
• The plant probiotics products can be used as bio fertilizers, plant strengtheners,
phytostimulators, and bio pesticides

8. • Dairy drink
• Soya milk,
• Tofu
• Milk products – sour cream, butter milk, yogurt
Foods containing probiotics

9. Clinical implications
1) Diarrhea:
Treatment & prevention of acute diarrhea:
- L. reuteri, L. rhamnosus,
- L. casei Saccharomyces
boulardii
Antibiotic associated diarrhea
- Saccharomyces boulardii,
L. rhamnosus
- L. casei effective in hospitalized adult patients
2) Inflammatory bowel disease:
- ulcerative colitis
3) Irritable bowel syndrome
- reduction in abdominal bloating and flatulence
- L. reuteri is widely used
4) Colon cancer
5) Lactose malabsorption
- Streptococcus thermophillus and L. delbrueckii
- prodution of β- D galactosidase enzymes that
breakdown lactose
6) Eradication of H. pylori
- Bifidobacteria and B. subtilis may inhibit the growth or
attachment of H. pylori
7) Allergy
- decreases serum IgE levels
- reduction of Th2 cytokine response
8) Lowering cholesterol

10. RESEARCH STUDY
Probiotics for treatment of acute diarrhea in children: randomized clinical trial of different preparations
Objective To compare the efficacy of five probiotic preparations recommended to patients in the treatment of
acute diarrhea in children.
Design Randomized controlled clinical trial in collaboration with family pediatricians over 12 months
.
Author
Year Country
Participants Main Outcome
Measures
Results Conclusions
Roberto Berni
Published 16
August 2007
University of
Naples, Italy
Children
aged 3-36
months
visiting a
family
pediatrician
for acute
diarrhea.
571 children
were
allocated to
intervention.
Main outcomes to
measure were
duration of diarrhea
and daily number
and consistency of
stools. Safety and
tolerance were also
recorded.
Duration of diarrhea was significantly
shorter in children who received L
rhamnosus strain GG (78.5 hours)
and the mix of four bacterial strains
(70.0 hours) than in children who
received oral rehydration solution
alone (115.0 hours). One day after
the first probiotic administration, the
daily number of stools was
significantly lower in children who
received L rhamnosus strain GG than
those who received the probiotic mix
than in the other groups. The
remaining preparations did not affect
primary outcomes.
Not all
commercially
available probiotic
preparations are
effective in
children with acute
diarrhea.
Pediatricians
should choose
bacterial
preparations
based on
effectiveness data.

11. MANAGEMENT OF
DIARRHEA

12. `1
‘Diarrhea is defined as the passage of three or more loose or liquid stools per day (or more
frequent passage than is normal for the individual). Frequent passing of formed stools is
not diarrhea, nor is the passing of loose, “pasty” stools by breastfed babies’’
It is a common cause of death in developing countries and the second most common cause
of infant deaths worldwide’’.
Three clinical types of diarrhea:
• acute watery diarrhea – lasts several hours or days, and includes cholera;
• acute bloody diarrhea – also called dysentery; and
• persistent diarrhea – lasts 14 days or longer.
Diarrhea Definition WHO

13. CLASSIFICATION
&
MANAGEMENT

14. SIGNS CLASSIFY AS TREATMENT OPTION
No dehydration signs No dehydration Give fluid, zinc supplements/ORS & food (BRAT) to treat
diarrhea at home
No hospitalization need.
5-days follow up, if no improvement
Two of following signs:
Restless
Some dehydration Give fluid, zinc supplements/ORS & food (BRAT) to treat
diarrhea at home.
Drinks eagerly, Sunken eyes Refer urgently to Hospital
Skin pinch goes back slowly. Give ORS and continue breastfed on the way to hospital.
Two of following signs:
Lethargic or unconscious
Severe dehydration Child is rehydrated quickly by using I/V infusion.
I/V infusions recommended :
 R/L solution
 N/S when R/L is not available
Sunken, not able to drink Reassess the infant every 15-30 min, until a strong radial pulse
is present.
Also give ORS (about 5 ml/kg/hour) as soon as the infant can
drink, Reassess the infant after 6 hours.
Skin pinch goes back very slowly. Before the mother leaves the hosp, 2 sachet of ORS be given.
Probiotics-Treatment and prevention of acute diarrhea
Lactobacillus rhamnosus GG and Bifidobacterium lactis

15. THANK YOU
Any Questions ?