In-Vitro Comparison of Antimicrobial Actions of Probiotics (Lactobacilli Species and Saccharomyces boulardii) with Standard Antibiotics for the Treatment of Diarrhea in Pediatric Population

Background and objectives: Irrational and repeated use of broad spectrum antibiotics for infectious diarrhea in children has resulted in their increased resistance along with several systemic toxic effects. Probiotics are also used in the management of infectious diarrhea as these are supposed to be favorable in promoting overall health benefits including stability of the intestinal flora. However, these agents are not used as an alternative to antibiotics as their exact bactericidal/bacteriostatic effects have not been evaluated on the basis of any clinical or in-vitro samples (Culture and Sensitivity test). Hence the aim of our study was to compare the culture and sensitivity patterns of standard antibiotics and two probiotics, Lactobacilli (Lactobacillus paracasei/Lactobacillus acidophilus) and Saccharomyces boulardii used for the treatment of infectious diarrhea in children less than 5 years of age in a tertiary care hospital of Karachi, Pakistan. Methodology: This prospective quasi experimental study was conducted for a period of six months. After getting informed consent from parents/guardians, the stool samples were obtained from children of ages, 6 months to 5 years, presented with signs and symptoms of diarrhea in outpatient department (OPD) or being referred to microbiology department for stool C/S (culture and sensitivity). The sensitivity patterns of the cultured isolates were assessed for standard antibiotics according to the CLSI guidelines (2018), while the two probiotics (Lactobacilli and Saccharomyces boulardii) were evaluated by means of Dried Modification method. The data was analyzed using statistical software SPSS version 19.0. Results: A total number of 325 stool samples were collected, out of which 152 samples were positive for pathogens i.e. E. coli, Klebsiella and Salmonella typhi. The sensitivity of combination of Lactobacilli for E. coli, Klebsiella and Salmonella typhi was 28.3%, 25% and 25% respectively. While, for Saccharomyces boulardii the sensitivity for E. coli, Klebsiella and Salmonella typhi was 37%, 32.1% and 25% respectively, which were slightly higher or equivalent to commonly prescribed antibiotics such as Amoxicillin/Clavulanic acid, Ceftazidime, Ampicillin, Cefotaxime, Cefuroxime, Ceftriaxone, Aztreonam, Trimethoprim/ Sulfmethoxazole and Nalidixic acid. In comparison, the antibiotics which are not frequently used for infectious diarrhea showed higher sensitivities for all isolated organisms; as for E. coli the highest sensitivity was observed for Amikacin (96.7%), Gentamycin (95.7%) Imipenim (95.7%) and Piperacillin/Tazobactam (84.8%). Moreover, for Klebsiella the highest sensitivity was observed for Imipenim (98.2%), followed by Amikacin (94.6%), Piperacillin/Tazobactam (92.9%) and Gentamycin (89.3%). Conclusion: On in-vitro cultured samples, the two probiotics Lactobacilli and Saccharomyces boulardii have shown slightly higher or equivalent sensitivity in comparison to the most commonly prescribed antibiotics (Amoxicillin/Clavulanic acid, Ceftazidime, Ampicillin, Cefotaxime, Cefuroxime Ceftriaxone, Aztreonam, Trimethoprim/Sulfmethoxazole and Nalidixic acid). However, both probiotics displayed lower sensitivity in comparison to some broad spectrum but less commonly prescribed antibiotics (Amikacin, Gentamycin, Imipenim and Piperacillin/Tazobactam) in our clinical settings.