Background and objectives: Irrational and repeated use of broad spectrum\nantibiotics for infectious diarrhea in children has resulted in their increased\nresistance along with several systemic toxic effects. Probiotics are also used in\nthe management of infectious diarrhea as these are supposed to be favorable\nin promoting overall health benefits including stability of the intestinal flora.\nHowever, these agents are not used as an alternative to antibiotics as their exact\nbactericidal/bacteriostatic effects have not been evaluated on the basis of\nany clinical or in-vitro samples (Culture and Sensitivity test). Hence the aim\nof our study was to compare the culture and sensitivity patterns of standard\nantibiotics and two probiotics, Lactobacilli (Lactobacillus paracasei/Lactobacillus\nacidophilus ) and Saccharomyces boulardii used for the treatment of infectious\ndiarrhea in children less than 5 years of age in a tertiary care hospital of\nKarachi, Pakistan. Methodology: This prospective quasi experimental study\nwas conducted for a period of six months. After getting informed consent\nfrom parents/guardians, the stool samples were obtained from children of\nages, 6 months to 5 years, presented with signs and symptoms of diarrhea in\noutpatient department (OPD) or being referred to microbiology department\nfor stool C/S (culture and sensitivity). The sensitivity patterns of the cultured\nisolates were assessed for standard antibiotics according to the CLSI guidelines\n(2018), while the two probiotics (Lactobacilli and Saccharomyces boulardii\n) were evaluated by means of Dried Modification method. The data was analyzed using statistical software SPSS version 19.0. Results: A total number\nof 325 stool samples were collected, out of which 152 samples were positive\nfor pathogens i.e. E. coli , Klebsiella and Salmonella typhi. The sensitivity of\ncombination of Lactobacilli for E. coli , Klebsiella and Salmonella typhi was\n28.3%, 25% and 25% respectively. While, for Saccharomyces boulardii the\nsensitivity for E. coli , Klebsiella and Salmonella typhi was 37%, 32.1% and\n25% respectively, which were slightly higher or equivalent to commonly prescribed\nantibiotics such as Amoxicillin/Clavulanic acid, Ceftazidime, Ampicillin,\nCefotaxime, Cefuroxime, Ceftriaxone, Aztreonam, Trimethoprim/\nSulfmethoxazole and Nalidixic acid. In comparison, the antibiotics which are\nnot frequently used for infectious diarrhea showed higher sensitivities for all\nisolated organisms; as for E. coli the highest sensitivity was observed for\nAmikacin (96.7%), Gentamycin (95.7%) Imipenim (95.7%) and Piperacillin/\nTazobactam (84.8%). Moreover, for Klebsiella the highest sensitivity was\nobserved for Imipenim (98.2%), followed by Amikacin (94.6%), Piperacillin/\nTazobactam (92.9%) and Gentamycin (89.3%). Conclusion: On in-vitro\ncultured samples, the two probiotics Lactobacilli and Saccharomyces boulardii\nhave shown slightly higher or equivalent sensitivity in comparison to the\nmost commonly prescribed antibiotics (Amoxicillin/Clavulanic acid, Ceftazidime,\nAmpicillin, Cefotaxime, Cefuroxime Ceftriaxone, Aztreonam, Trimethoprim/\nSulfmethoxazole and Nalidixic acid). However, both probiotics displayed\nlower sensitivity in comparison to some broad spectrum but less\ncommonly prescribed antibiotics (Amikacin, Gentamycin, Imipenim and Piperacillin/\nTazobactam) in our clinical settings.
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