ORS With Probiotics - Drugs FAQs

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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Question
Should ors+ probiotics(lacolite, bio-rs) be used as combinations or should ors and probiotics be used separately.? 2.when should meningococcal -a+c vaccines given? 3.which carbohydrate, lactose or sucrose be used in infant milk formula? Which one is more infant friendly?
Answer
Combination of ORS with probiotics is not recommended currently. There is presently insufficient evidence to recommend probiotics in acute diarrhea for following reasons-a) most studies on probiotics are done in developed countries. The findings cannot be extrapolated to Indian setting where breastfeeding rates are high and the microbial colonization of the gut is different; b) there is paucity of data to establish the efficacy of probiotic species available in Indian market; c) beneficial effect is seen in rotavirusrotavirus diarrhea which was present in >75% cases in studies from the west. Rotavirus accounts for only 15 to 25% diarrhea cases in India; d) only duration of diarrhea has been studied so far instead of the more objective parameter of stool output. (Source: Statement. Consensus Statement of IAP National Task Force: Status Report on Management of Acute Diarrhea. Indian Pediatrics 2004; 41: 335-348.) Meningococcal vaccine is indicated for use (as an adjunct along with chemoprophylaxis) in close contacts of patients with the disease. It may be considered in children with complement deficiency, prior to splenectomy and those with sickle cell anemia. It is also recommended during disease outbreaks (cause by serogroups included in the vaccine) and prior to travel to the high endemicity meningococcal belt in the African continent. It can be given to children above 18 months of age and is administered SC or IM. In special circumstances (e.g. epidemics, close household contact) it may be offered to even younger infants but the protective efficacy is like to be low. The vaccine is not recommended for universal immunization at present. (Source: IAP Guide Book on Immunization, Third Edition, 2005) Lactose or sucrose both can be used in infant milk formula. Lactose, sucrose, and maltose oral tolerance tests conducted on 2-week-old, low birth weight infants previously fed formulas containing either lactose or sucrose as the sole carbohydrate revealed no significant differences in the utilization of these three disaccharides. Addition of sucrose in milk formula showed lower incidence of diarrhea and metabolic acidosis in some infants. However, lactose, as the natural sugar of human milk, has been the usual choice for milk formula. Lactose enhances calcium absorption in the small intestine and promotes a fermentative, less putrefactive bacterial flora and reduces the incidence of constipation. (Source: American Academy of Pediatrics. Committee on Nutrition. Nutrition Needs of Low Birth Weight Infants. Pediatrics 1977; 60: 519-530) Back to All Questions

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