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Press releases Saturday 11 August 2007

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(1) Despite claims, not all probiotics can treat diarrhoea say experts
(2) Preventive treatments in elderly people needs rethinking

(1) Despite claims, not all probiotics can treat diarrhoea, say experts
(Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations)
BMJ Online First

Several probiotic products are marketed as effective treatments for acute diarrhoea in children, but a study published on bmj.com today finds that not all of these preparations are effective.

Probiotics are defined as micro-organisms that exert beneficial effects on human health when they colonise the bowel.

Researchers at the University of Naples tested five different preparations in 571 children with acute diarrhoea. All the children were aged 3-36 months and were visiting a family paediatrician with acute diarrhoea. Children were randomly assigned to receive either a specific probiotic product for five days (intervention groups) or oral rehydration solution (control group).

At the time of the study, these products were among the most widely used probiotic preparations in Italy, they were available only in pharmacies and had a similar brand image and price.

Duration of diarrhoea and daily number and consistency of stools were monitored as primary outcomes. Secondary outcomes were duration of vomiting and fever and rate of admission to hospital. Safety and tolerance were also recorded.

Duration of diarrhoea was significantly lower in children receiving Lactobacillus GG and a mix of four bacterial strains than in patients receiving oral rehydration alone. The three other preparations had no significant effect.

Secondary outcomes were similar in all groups and no side effects were recorded.

These results suggest that not all commercially available probiotic preparations are effective in children with acute diarrhoea, say the authors.

The effectiveness of Lactobacillus GG was not unexpected as several previous studies have shown similar results. The other effective preparation contained four bacterial species, two of which have also been shown to protect against diarrhoea in chronically sick children.

However, the lack of effect in children receiving Saccharomyces boulardii was unexpected, they say, because a previous trial showed it to be beneficial in young children admitted to hospital for diarrhoea.

They conclude: the efficacy of probiotic preparations for the treatment of acute diarrhoea in children is related to the individual strains of bacteria, and physicians should choose preparations based on effectiveness data.

Contact:
Alfredo Guarino, Associate Professor, Department of Paediatrics, University of Naples Federico II, Naples, Italy
Email: alfguari@unina.it 

(2) Preventive treatments in elderly people need rethinking
(Preventive health care in elderly people needs rethinking)
http://www.bmj.com/cgi/content/short/335/7614/285

Rather than prolonging life, preventive treatments in elderly people may simply change the cause of death – the manner of our dying, say doctors in this week's BMJ.

They call for a more sophisticated way of assessing the benefits and harms of preventive treatment in elderly people.

Preventive health care aims to delay the onset of illness and disease and to prevent untimely and premature deaths, say Dr Dee Mangin and colleagues. But concerns about equity of access to treatments have led to preventive interventions being encouraged regardless of age, and this can be harmful to the patient and expensive for the health service.

In rapidly ageing populations, we urgently need to reappraise the complex and uncomfortable relations between age discrimination, distributive justice, quality, and length of life, they argue.

For example, preventive use of statins shows no overall benefit in elderly people as cardiovascular mortality and morbidity are replaced by cancer.

Is it possible, they ask, that by introducing preventive treatments in the elderly aimed at reducing the risk of a particular cause of death, we are simply changing the cause of death without the patient's informed consent?

This is fundamentally unethical, undermining the principle of respect for autonomy.

Financial incentives for doctors that are linked to guidelines and targets may coerce doctors into persuading patients to accept such preventive treatments, they add, but the best interests of elderly people might lie in investing the money in health care that will genuinely relieve suffering, such as cataract operations, joint replacement surgery, and personal care of people with dementia.

They believe that a more sophisticated model is needed to assess preventive treatment in the elderly that takes a wider perspective when balancing potential harms against putative benefits.

We should not carry on extrapolating data from younger populations and using linear models that use absolute risks of disease rather than all cause mortality and morbidity. If we do, the only ones to benefit will be drug companies, with increasing profits from an ageing population consumed by epidemics rather than enjoying their long life, they conclude.

Contacts:
Dee Mangin, Senior Lecturer, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand 
Email: derelie.mangin@chmeds.ac.nz 

Iona Heath, General Practitioner, Caversham Group Practice, London, UK 
Email: iona.heath@dsl.pipex.com 

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