Clinical Outcome of Zinc Plus Saccharomyces Boulardii versus Zinc Alone in the Treatment of Acute Diarrhea in Children Under 5 Years of Age
Keywords:
Children, diarrhea, probiotics, Saccharomyces boulardii, vomiting, zinc.Abstract
OBJECTIVE: To compare the time taken to resolve diarrhea, and the time taken to resolve vomiting in children (under 5 years of age) with zinc plus Saccharomyces boulardii (S. boulardii) versus zinc alone.
METHODOLOGY: This randomized controlled trial was conducted at the Department of Pediatric Medicine, Children's Hospital and Institute of Child Health, Multan, Pakistan, from February to July 2025. A total of 276 children (138 in each group) aged up to 5 years presenting with acute diarrhoea were enrolled using simple random sampling. After randomization, Group-A patients received zinc plus S. boulardii, while Group-B patients received zinc alone. All patients were treated following the institutional treatment protocol. The time taken to resolve diarrhea, and vomiting was noted and compared between the study groups. Data were analyzed using IBM SPSS 26.0.
RESULTS: Of 276 children, 141 (51.1%) were males and 135 (48.9%) were females, with a median age of 2.2 years (IQR 1.0–3.5). In Group-A, 70 (50.7%) were males and 68 (49.3%) females, while in Group-B, 71 (51.5%) were males and 67 (48.5%) females. Diarrhea resolved earlier in Group-A, 4.3 days (IQR 3.0–5.0) compared with 5.1 days (IQR 4.0–5.5) in Group-B (p<0.001). Vomiting resolved in 7.4 hours (IQR 5.0–10.0) in Group A compared with 11.2 hours (IQR 8.0–14.0) in Group B (p<0.001).
CONCLUSION: The addition of Saccharomyces boulardii to zinc supplementation significantly shortened the time to resolution of both diarrhea and vomiting in children under five years of age with acute diarrhea compared with zinc alone.
References
1. Organization WH. Diarrhoeal disease. 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease.
2. Hartman RM, Cohen AL, Antoni S, Mwenda J, Weldegebriel G, Biey J et al. Risk Factors for Mortality among Children younger than Age 5 years with severe diarrhea in Low- and Middle-income Countries: Findings from the World Health Organization-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks. Clin Infect Dis. 2023; 76(3): e1047-e1053. doi: 10.1093/cid/ciac561. Erratum in: Clin Infect Dis. 2023 Jan 6; 76(1): 183. doi: 10.1093/cid/ciac865.
3. Organization WH. Diarrhoeal disease. Available from: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease. Accessed 27 January 2020.
4. National Institute of Population Studies, ICF. Pakistan Demographic and Health Survey 2017-18. Islamabad, Pakistan, and Rockville, MD, USA: National Institute of Population Studies and ICF; 2019.
5. Sadiq K, Mir F, Jiwani U, Chanar S, Nathwani A, Jawwad M et al. Risk factors for acute diarrhoea in children between 0 and 23 months of age in a peri-urban district of Pakistan: a matched case-control study. Int Health. 2023; 15(3): 281-288. doi: 10.1093/inthealth/ihac022.
6. International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health. 2016 Pneumonia & Diarrhea Progress Report: reaching goals through action and innovation. Baltimore: International Vaccine Access Center; 2016.
7. Shrestha SK, Shrestha J, Mason CJ, Sornsakrin S, Dhakhwa JR, Shrestha BR et al. Etiology of Acute Diarrheal Disease and Antimicrobial Susceptibility Pattern in Children younger than 5 Years Old in Nepal. Am J Trop Med Hyg. 2022; 108(1): 174-180. doi: 10.4269/ajtmh.21-1219.
8. Pavlinac PB, Brander RL, Atlas HE, John-Stewart GC, Denno DM, Walson JL. Interventions to reduce post-acute consequences of diarrheal disease in children: a systematic review. BMC Public Health. 2018 Feb 1; 18(1): 208. doi: 10.1186/s12889-018-5092-7.
9. Aghsaeifard Z, Heidari G, Alizadeh R. Understanding the use of oral rehydration therapy: A narrative review from clinical practice to main recommendations. Health Sci Rep. 2022; 5(5): e827. doi: 10.1002/hsr2.827.
10. Carvalho MCDC, Ribeiro SA, de Sousa LS, Lima AÂM, Maciel BLL. Undernutrition and Intestinal Infections in Children: A Narrative Review. Nutrients. 2025; 17(9): 1479. doi: 10.3390/nu17091479
11. Lee KJ. Pharmacologic Agents for Chronic Diarrhea. Intest Res. 2015; 13(4): 306-12. doi: 10.5217/ir.2015.13.4.306.
12. Munir A, Javed GA, Javed S, Arshad N. Levilactobacillus brevis from carnivores can ameliorate hypercholesterolemia: In vitro and in vivo mechanistic evidence. J Appl Microbiol. 2022; 133(3): 1725-1742. doi: 10.1111/jam.15678.
13. Ali AA, Naqvi SK, Hasnain Z, Zubairi MBA, Sharif A, Salam RA et al. Zinc supplementation for acute and persistent watery diarrhoea in children: A systematic review and meta-analysis. J Glob Health. 2024 Dec 6; 14: 04212. doi: 10.7189/jogh.14.04212.
14. Dalgic N, Sancar M, Bayraktar B, Pullu M, Hasim O. Probiotic, zinc and lactose-free formula in children with rotavirus diarrhea: are they effective? Pediatr Int. 2011; 53(5): 677-682. doi: 10.1111/j.1442-200X.2011.03325.x.
15. Koppen IJN, Velasco-Benitez CA, Benninga MA, Di Lorenzo C, Saps M. Using the Bristol Stool Scale and Parental Report of Stool Consistency as Part of the Rome III Criteria for Functional Constipation in Infants and Toddlers. J Pediatr. 2016; 177: 44-48.e1. doi: 10.1016/j.jpeds.2016.06.055.
16. Amberti LM, Walker CL, Chan KY, Jian WY, Black RE. Oral zinc supplementation for the treatment of acute diarrhea in children: a systematic review and meta-analysis. Nutrients. 2013; 5(11): 4715-4740. doi: 10.3390/nu5114715.
17. Mateen M, Roshan E, Hayyat MK, Akram AR, Nasrin T, Khan SB. Comparative Study on the Effect of Zinc and Probiotic Therapy versus Zinc Supplementation alone on the duration of acute watery diarrhea in children. Biol Clin Sci Res J. 2025; 6(2): 1565. doi: 10.54112/bcsrj.v6i2.1565.
18. Ragavan PSK, Kaur A, Kumar M, Singhal V, Patel AM, Khunt A et al. Retrospective analysis of EMR database to assess the effectiveness of Saccharomyces boulardii CNCM I-745 in children with acute diarrhoea during routine clinical practice. New Microbes New Infect. 2020; 38: 100766. doi: 10.1016/j.nmni.2020.100766.
19. Abdulah DM, Sulaiman SJ, Ahmed ZW. Effect of probiotics plus zinc supplementation on clinical outcomes of infants and children with acute infectious diarrhea: a randomized controlled trial. Clin Exp Pediatr. 2024; 67(4): 203-212. doi: 10.3345/cep.2023.01340.
20. Raza A, Zahid M, Qadir E, Malik NA, Aslam S, Siddique K. Comparison of World Health Organization treatment for acute watery diarrhea in children with and without sacchromyces boulardii in terms of mean duration of diarrhea. Pak Armed Forces Med J. 2020; 70(5): 1371-1375.
21. Burande MA. Comparison of efficacy of Saccharomyces boulardii strain in the treatment of acute diarrhea in children: A prospective, single-blind, randomized controlled clinical trial. J Pharmacol Pharmacother. 2013; 4(3): 205-8. doi: 10.4103/0976-500X.114603.
22. Giles-Vernick T, Bainilago L, Fofana M, Bata P, Vray M. Home Care of Children with Diarrhea in Bangui's Therapeutic Landscape (Central African Republic). Qual Health Res. 2016; 26(2): 164-175. doi: 10.1177/1049732315570117.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Journal of Liaquat University of Medical & Health Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Submission of a manuscript to the journal implies that all authors have read and agreed to the content of the undertaking form or the Terms and Conditions.
When an article is accepted for publication, the author(s) retain the copyright and are required to grant the publisher the right of first publication and other non-exclusive publishing rights to JLUMHS.
Articles published in the Journal of Liaquat University of Medical & health sciences are open access articles under a Creative Commons Attribution-Noncommercial - Share Alike 4.0 License. This license permits use, distribution and reproduction in any medium; provided the original work is properly cited and initial publication in this journal. This is in accordance with the BOAI definition of open access. In addition to that users are allowed to remix, tweak and build upon the work non-commercially as long as appropriate credit is given and the new creations are licensed under the identical terms. Or, in certain cases it can be stated that all articles and content there in are published under creative commons license unless stated otherwise.
