1. Prebiotics for acute diarrhea in adults and children Rüdiger Schultz, MD, PhD Pediatrician Ilembula Hospital

2. Probiotics The definition of Probiotics: -Living micro-organisms that, upon ingestion in certain numbers, exert health benefiting effects beyond inherent general nutrition -The most commonly used probiotics are lactic acid bacteria such as bifidus or lactobacilla -Probiotics are believed to improve the immune response in allergic or infectional conditions

3. Precosa The drug Precosa consists of a strain of probiotic yeast, called Saccharomyces boulardii. It has been shown to be useful against enteropathogens Most of the proposed mechanisms by which this yeast exerts its beneficial effects on the gut are derived from animal studies and are of theoretical nature.

4. Possible mechanisms of Precosa Inhibition of if pathogen adhesion to gut mucosa Strengthening of enterocyte tight junctions Neutralization of bacterial virulence factors Enhancement of IgA on the surface of the gut mucosa

5. Meta-analysis: Saccharomyces boulardii for treating acute diarrhoea in children In five randomised-controlled trials (619 participants) S. boulardii significantly reduced the duration of diarrhoea compared with controls. The pooled mean difference of diarrhoea compard with controls was -1.1 to 1.3 days. Saccharomyces boulardii significantly reduced the risk for diarrhea on days 3, 6 and 7 and reduced significantly the risk for diarrhoea lasting more than 7 days. Szajewska H, Skórka A and Dylag M 2007. Aliment Pharmacol Ther 25:257-264

6. Indications for Precosa All kind of diarrhea, from watery to mucoid of viral origin So called tourist diarrhea, caused by E.coli Diarrhoea caused by entamebae In prevention of diarrhea, caused by antibiotics Prevention of diarrhoea caused by Clostridium difficile Precosa can be used together with metronidazole and vancomysin to prevent sequelae caused by this drugs Precosa can be preventivley used when travelling

7. Precosa should not be used In the severe immune compromised patient When the patient is unconscious Together with indwelling iv-catheters If the patient is intolerant to one more of the ingredients of the drug In combination with alcohol In hot drings or food

8. Unless new evidence for other use is established be careful if: the patient is moderately immune compromised When stools are bloody When the patient is in addition to diarrhoea also heavily vomiting The patient is under three month of age

9. How to use Precosa The normal dosage in children is 250 mg (1 package) x2/day. In cases of diarrhea the normal time of use is one week The normal dosage in adults is 500 mg ( 2 packages) x2/day. In cases of diarrhea the normal time of use is one week To prevent reoccurence of clostridium difficile, Precosa is used as soon as possible after starting an antibiotic that can cause infection of clostridium difficile or as an adjuvant to metronidazole in the dosages used above for 4 weeks To prevent any other diarrhea caused by antibiotics use Precosa at the latest 48-72 hours after starting the antibiotic and continue as long as the antibiotic is prescribed (usually for one week) To prevent tourist diarrhea, Precosa is started in the dosages above 2 days before travelling and is continued over the whole travel period

10. How to use Precosa Precosa is available in capsules, 250 mg each which are taken with a lot of clean water or juice. For children Precosa is available in form of granulate, 250 mg/package which is poured into clean water or juice. Because Precosa consists of living, dried yeast cells, don´t use Precosa in combination with hot foods or drings or in combination with alcoholic drinks Precosa, when used during pregnancy will have no impact on the fetus. It can also be used while nursing, Precosa is not excreted into breast milk

11. Donators of Precosa for Ilembula Hospital Ilembula Hospital has got until now over 1000 packages of Precosa in form of granulat from donations of a single private person in Finland and the Rotary Club Tampere-Hervanta The value of the donation is around 2 million Tzh-shillings The drug is available at the dispensary of the hospital Further donations will hopefully follow, one is allready waiting to be realized (Evangelical Free-Church of Tampere)