Combination therapy with probiotics in young children and adults

Although understandably an uncomfortable situation for some, diarrhoea affects many of us: between 20 and 50% of all passengers can develop what is known as travellers' diarrhoea. For these cases, widely used combination therapies are used to put an end to the liquid condition.
A wooden figure sits on a roll of toilet paper. Concept of the problem with / Alrandir

Definition Diarrhea:

Diarrhea (or diarrhea) is a symptom in which soft to liquid stools are passed several times a day. Medically, diarrhea is referred to as a term in which the following factors occur: A defecation at more than three times per day, the change in consistency of the stool to mushy to liquid, and an increasing amount of stool greater than 250 grams per day. In this case, diarrhea can manifest acutely or chronically, and it can also be accompanied by additional symptoms such as vomiting, fever or nausea.


Causes of the symptom can be infections with bacteria or viruses, certain (side) effects of medications, intolerance of food or other physical illnesses or psychological stress.

While acute diarrhoea can usually be harmless, a visit to the doctor should be considered in the case of severe, chronic diarrhoea in order to treat the actual illness. Diarrheal pathogens caused by bacteria can thus be treated with antibiotics.

Antibiotic-induced diarrhea:

Antibiotics can alter the microbial balance. This can lead to antibiotic-associated diarrhea, or AAD for short. This can cause various antibiotic-induced forms of diarrhea, such as segmental hemorrhagic colitis when penicillin or penicillin derivatives are used.

Probiotics, however, can prevent AAD by supporting physical mechanisms such as a gut barrier or restoration of our gut flora.

Compare antibiotics with loperamide:

Travelers' diarrhea is a common form of the symptom. As the name suggests, sufferers get this type of phenomenon when they have a bacterial infection during a (long-distance) trip. Approximately every second to fifth passenger meets this lot.

According to a study published in late 2017 in the journal Clinical Infectious Diseases, in such cases, the commonly used drug loperamide is generally recommended by doctors to combat the symptoms of AAD when treated with an antibiotic. In this randomized, double-blind, controlled trial, 324 participants from four countries (Afghanistan, Djibouti, Kenya, and Honduras) were tested between September 2012 and July 2015. To test the effect, three different types of antibiotics (azithromycin, levofloxacin and rifaximin) were administered within 24 hours each, plus loperamide.

The results provided a cure in 81.4%, 78.3% and 74.8% for levofloxacin, azithromycin and rifaximin administration respectively at the end. According to the study, this form of combination therapy is "safe and highly effective" in travelers.

Probiotics in children:

Another multicenter randomized controlled trial published in 2017, examined the effect of the probiotic Saccharomyces boulardii for the treatment of AAD in children.

Between November 2012 to September 2013, children aged one month to three years were divided into a test group and a control group in ten children's hospitals or teaching hospitals. Among the 408 study participants, it was found that administering the probiotic was an effective and safe method of preventing AAD in infants and toddlers who were given antibiotics.


In any case, attention should be paid to how long the acute symptom lasts and to what extent it develops. Especially during and after travel, bacteria could be the trigger for diarrhea and should be treated under medical advice. Both in adults and especially in infants and young children, diarrhea should be taken seriously and controlled as soon as possible.

Active ingredients:


  • Mark S Riddle, Patrick Connor, Jamie Fraser, Chad K Porter, Brett Swierczewski, Emma J Hutley, Brook Danboise, Mark P Simons, Christine Hulseberg, Tahaniyat Lalani, Ramiro L Gutierrez, David R Tribble, TrEAT TD Study Team, Trial Evaluating Ambulatory Therapy of Travelers’ Diarrhea (TrEAT TD) Study: A Randomized Controlled Trial Comparing 3 Single-Dose Antibiotic Regimens With Loperamide, Clinical Infectious Diseases, Volume 65, Issue 12, 15 December 2017, Pages 2008–2017,
  • Wan CM, Yu H, Liu G, Xu HM, Mao ZQ, Xu Y, Jin Y, Luo RP, Wang WJ, Fang F. [A multicenter randomized controlled study of Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea in infants and young children]. Zhonghua Er Ke Za Zhi. 2017 May 4;55(5):349-354. Chinese. doi: 10.3760/cma.j.issn.0578-1310.2017.05.008. PMID: 28482385.
  • Loperamid (Netdoktor)
  • Durchfall (Netdoktor)
  • Leitsymptom Diarrhö (Deutsches Ärzteblatt)
Danilo Glisic

Danilo Glisic

Last updated on 30.12.2020


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