Evans Travel Health

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Posted on 13 November, 2018 at 9:15

Yet another study crossed my desk the other week discussing the values and virtues of the use of pre and probiotics in the reduction of travellers diarrhoea. As expected there is no further trial or study information available since the last report that changes the view point of the leaders in travel medicine. There remains insufficient study evidence to recommend if this group of products can be effective in the reduction of travellers diarrhoea.

Upon reading these studies and also the ISTM expert opinion I note that pre and probiotics are always reviewed together in the same group. Undertaking a little more work it became clear that pre and pro ad different types of products and therefore should they be considered separately rather than together.

Prebiotics are formed from long chain oligosaccharides that are produced to stimulate the body’s own gut bacteria (microbiota) to produce higher levels of its own protective bacteria. Probiotics formed from external bacterial cultures work by introducing additional bacteria into the human body.

The evidence to support both groups falls short of large scale trials with meta-analysis and therefore neither group can demonstrate a high evidence based benefit. That being said the prebiotic group does have a lead in the development of evidence. There is one particular product which provides a standardised product. This product is the only second generation one and in smaller scale trials has shown to provide a benefit in the reduction of TD when commenced 7 days before travel. This was first evaluate in a trial in 2010 and supported by another one in 2017. However as we know 2 good trials does not constitute enough evidence for a meta-analysis study.

Turning to the probiotics side my paper published earlier this year confirmed the comments that manufacturer claims of added value do not get off the starting blocks as the comparative data does not list the specific names of the bacteria used, and appears to have some bias in the test methods. The former points were raised and considered by the profession body for the industry as needing attention.

In conclusion there is a good reason to judge these 2 groups separately and accept that at least one of them has stronger clinical evidence towards reducing the incidence of TD. However full acceptance can only occur with larger amounts of study data. Therefore he suggestion is that we need to discuss these 2 groups separately as they do not work in the same manner and the prebiotic group seem to have a superior scientific focus in the manner they approach the issue.

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