What is the role of Bifilac (probiotic) in managing diarrhea?

Role of Bifilac in Diarrhea Management

Bifilac and similar probiotics may be effective in reducing the duration of acute infectious diarrhea, particularly in rotaviral diarrhea, but are not recommended as first-line treatment for acute infectious diarrhea in North America. 1

Efficacy of Bifilac in Diarrhea

Bifilac is a probiotic preparation containing multiple bacterial strains that has shown some efficacy in managing diarrhea:

• A randomized controlled trial specifically evaluating Bifilac in children with acute viral diarrhea demonstrated significant reduction in:

  • Number of diarrheal episodes
  • Mean duration of diarrhea
  • Degree of dehydration
  • Duration of rotaviral shedding 2

• However, the American Gastroenterological Association (AGA) suggests against the routine use of probiotics in children with acute infectious gastroenteritis in the United States and Canada 1

Evidence-Based Considerations

Regional Differences in Efficacy

• Most studies showing benefits of probiotics in acute diarrhea were conducted in countries like India, Italy, Poland, Turkey, and Pakistan 1
• Two large multicenter studies in the United States and Canada failed to demonstrate benefits of probiotics in acute infectious gastroenteritis 1
• The AGA notes that differences in host genetics, diet, sanitation, and endemic enteropathogens between regions may explain these discrepancies 1

Specific Probiotic Strains

When considering probiotics for diarrhea management, strain selection is crucial:

• The most extensively studied probiotics with evidence of efficacy include:

  • Saccharomyces boulardii
  • Lactobacillus rhamnosus GG 3, 4

• Meta-analyses suggest probiotics may decrease mean duration of diarrhea by approximately 21.91 hours (95% CI, 16.17-27.64) 1

• However, a Cochrane review of high-quality trials with low risk of bias found that probiotics probably make little or no difference to the number of people with diarrhea lasting 48 hours or longer 5

Clinical Applications

Antibiotic-Associated Diarrhea

Bifilac and other probiotics show more consistent evidence for preventing and treating antibiotic-associated diarrhea:

• High-dose probiotics (≥10 billion CFU/day) are more effective than low-dose options 3
• Multi-strain probiotics may demonstrate better outcomes than single-strain options 3
• Probiotics should be taken 2 hours apart from antibiotics 3

Practical Recommendations

For antibiotic-associated diarrhea:

• Start probiotics within 24-48 hours of antibiotic therapy
• Continue for 1-2 weeks after completing antibiotics 3
• Consider higher doses (≥10 billion CFU/day) for better efficacy 3

For acute infectious diarrhea:

• Focus on rehydration as primary therapy 1
• Consider probiotics as adjunctive therapy in specific cases, particularly outside North America
• Early intervention (within 60 hours of symptom onset) may improve outcomes 6

Safety Considerations

• Probiotics are generally well-tolerated with low adverse event rates 3
• Common side effects include rash, nausea, gas, flatulence, and abdominal bloating 3
• Contraindicated in immunocompromised patients due to risk of fungemia/bacteremia 3
• Use with caution in critically ill patients and those with central venous catheters 3

Conclusion

While Bifilac has shown efficacy in specific studies for acute diarrhea, particularly rotaviral diarrhea 2, current North American guidelines do not recommend routine use of probiotics for acute infectious diarrhea in children 1. However, probiotics including Bifilac may have a role as adjunctive therapy in antibiotic-associated diarrhea, with the strongest evidence supporting Saccharomyces boulardii and Lactobacillus rhamnosus GG 3, 4.