Skip to main content
Top
Published in: BMC Complementary Medicine and Therapies 1/2016

Open Access 01-12-2015 | Research article

Safety and acceptability of Lactobacillus reuteri DSM 17938 and Bifidobacterium longum subspecies infantis 35624 in Bangladeshi infants: a phase I randomized clinical trial

Authors: Yana Emmy Hoy-Schulz, Kaniz Jannat, Thomas Roberts, Saira Husain Zaidi, Leanne Unicomb, Stephen Luby, Julie Parsonnet

Published in: BMC Complementary Medicine and Therapies | Issue 1/2016

Login to get access

Abstract

Background

Probiotics have rarely been studied in young healthy infants from low-income countries. This phase I study investigated the safety and acceptability of two probiotics in Bangladesh.

Methods

Healthy infants aged four to twelve weeks from urban slums in Bangladesh were randomized to one of three different intervention dosing arms (daily, weekly, biweekly – once every two weeks) of Lactobacillus reuteri DSM 17938 and Bifidobacterium longum subspecies infantis 35624 over one month or to a fourth arm that received no probiotics. All subjects were followed for two additional months. Reported gastrointestinal and respiratory symptoms as well as breastfeeding rates, hospitalizations, differential withdrawals, and caretakers’ perception of probiotic use were compared among arms.

Results

In total, 160 infants were randomized (40 to each arm) with 137 (Daily n = 35, Weekly n = 35, Biweekly n = 35, Control n = 32) followed up for a median of twelve weeks; 113 completed the study. Illness and breastfeeding rates were similar across all arms. Ten hospitalizations unrelated to probiotic use occurred. Forty eight percent of the caretakers of infants in intervention arms believed that probiotics improved their baby’s health.

Conclusions

These two commonly used probiotics appeared safe and well-accepted by Bangladeshi families.

Trial registration

ClinicalTrials.gov NCT01899378. Registered July 10, 2013.
Literature
1.
go back to reference WHO/FAO. Health and nutritional properties of powder milk with live lactic acid bacteria. Córdoba, Argentina: WHO/FAO; 2001. WHO/FAO. Health and nutritional properties of powder milk with live lactic acid bacteria. Córdoba, Argentina: WHO/FAO; 2001.
2.
go back to reference Thomas DW, Greer FR. Nutrition AAoPCo, American Academy of Pediatrics Section on Gastroenterology H, and Nutrition: Probiotics and prebiotics in pediatrics. Pediatrics. 2010;126(6):1217–31.CrossRefPubMed Thomas DW, Greer FR. Nutrition AAoPCo, American Academy of Pediatrics Section on Gastroenterology H, and Nutrition: Probiotics and prebiotics in pediatrics. Pediatrics. 2010;126(6):1217–31.CrossRefPubMed
3.
go back to reference Ng SC, Hart AL, Kamm MA, Stagg AJ, Knight SC. Mechanisms of action of probiotics: recent advances. Inflamm Bowel Dis. 2009;15(2):300–10.CrossRefPubMed Ng SC, Hart AL, Kamm MA, Stagg AJ, Knight SC. Mechanisms of action of probiotics: recent advances. Inflamm Bowel Dis. 2009;15(2):300–10.CrossRefPubMed
4.
go back to reference Lin A, Bik EM, Costello EK, Dethlefsen L, Haque R, Relman DA, et al. Distinct distal gut microbiome diversity and composition in healthy children from Bangladesh and the United States. PLoS One. 2013;8(1), e53838.PubMedCentralCrossRefPubMed Lin A, Bik EM, Costello EK, Dethlefsen L, Haque R, Relman DA, et al. Distinct distal gut microbiome diversity and composition in healthy children from Bangladesh and the United States. PLoS One. 2013;8(1), e53838.PubMedCentralCrossRefPubMed
5.
go back to reference Mckay S, Gaudier E, Campbell DI, Prentice AM, Albers R. Environmental enteropathy: new targets for nutritional interventions. Int Health. 2010;2(3):172–80.CrossRefPubMed Mckay S, Gaudier E, Campbell DI, Prentice AM, Albers R. Environmental enteropathy: new targets for nutritional interventions. Int Health. 2010;2(3):172–80.CrossRefPubMed
6.
go back to reference Reid G, Anand S, Bingham MO, Mbugua G, Wadstrom T, Fuller R, et al. Probiotics for the developing world. J Clin Gastroenterol. 2005;39(6):485–8.CrossRefPubMed Reid G, Anand S, Bingham MO, Mbugua G, Wadstrom T, Fuller R, et al. Probiotics for the developing world. J Clin Gastroenterol. 2005;39(6):485–8.CrossRefPubMed
7.
go back to reference Topcuoglu S, Gursoy T, Ovalı F, Serce O, Karatekin G. A new risk factor for neonatal vancomycin-resistant Enterococcus colonisation: bacterial probiotics. J Matern Fetal Neonatal Med. 2014;1–4. Topcuoglu S, Gursoy T, Ovalı F, Serce O, Karatekin G. A new risk factor for neonatal vancomycin-resistant Enterococcus colonisation: bacterial probiotics. J Matern Fetal Neonatal Med. 2014;1–4.
9.
go back to reference Heimbach J, BioGaia AB. GRAS Notice 000254: Generally Recognized as Safe (GRAS) Determination of Lactobacillus reuteri Strain DSM 17938 Center for Food Safety and Applied Nutrition, Food and Drug Administration 2008:1–134 Heimbach J, BioGaia AB. GRAS Notice 000254: Generally Recognized as Safe (GRAS) Determination of Lactobacillus reuteri Strain DSM 17938 Center for Food Safety and Applied Nutrition, Food and Drug Administration 2008:1–134
10.
go back to reference Weizman Z, Alsheikh A. Safety and tolerance of a probiotic formula in early infancy comparing two probiotic agents: a pilot study. J Am Coll Nutr. 2006;25(5):415–9.CrossRefPubMed Weizman Z, Alsheikh A. Safety and tolerance of a probiotic formula in early infancy comparing two probiotic agents: a pilot study. J Am Coll Nutr. 2006;25(5):415–9.CrossRefPubMed
11.
go back to reference Mangalat N, Liu Y, Fatheree NY, Ferris MJ, Van Arsdall MR, Chen Z, et al. Safety and tolerability of Lactobacillus reuteri DSM 17938 and effects on biomarkers in healthy adults: results from a randomized masked trial. PLoS One. 2012;7(9), e43910.PubMedCentralCrossRefPubMed Mangalat N, Liu Y, Fatheree NY, Ferris MJ, Van Arsdall MR, Chen Z, et al. Safety and tolerability of Lactobacillus reuteri DSM 17938 and effects on biomarkers in healthy adults: results from a randomized masked trial. PLoS One. 2012;7(9), e43910.PubMedCentralCrossRefPubMed
12.
go back to reference Oberhelman RA, Kosek MN, Penataro-Yori P, Paredes-Olortegui M, Connolly E. A Phase One Safety Study of Lactobacillus reuteri Conducted in the Peruvian Amazon: Observations from the Field. Am J Trop Med Hyg. 2014;90(4):777–80.PubMedCentralCrossRefPubMed Oberhelman RA, Kosek MN, Penataro-Yori P, Paredes-Olortegui M, Connolly E. A Phase One Safety Study of Lactobacillus reuteri Conducted in the Peruvian Amazon: Observations from the Field. Am J Trop Med Hyg. 2014;90(4):777–80.PubMedCentralCrossRefPubMed
13.
go back to reference Weizman Z, Asli G, Alsheikh A. Effect of a probiotic infant formula on infections in child care centers: comparison of two probiotic agents. Pediatrics. 2005;115(1):5–9.PubMed Weizman Z, Asli G, Alsheikh A. Effect of a probiotic infant formula on infections in child care centers: comparison of two probiotic agents. Pediatrics. 2005;115(1):5–9.PubMed
14.
go back to reference Gutierrez-Castrellon P, Lopez-Velazquez G, Diaz-Garcia L, Jimenez-Gutierrez C, Mancilla-Ramirez J, Estevez-Jimenez J, et al. Diarrhea in preschool children and Lactobacillus reuteri: a randomized controlled trial. PEDIATRICS. 2014;133(4):e904–9.CrossRefPubMed Gutierrez-Castrellon P, Lopez-Velazquez G, Diaz-Garcia L, Jimenez-Gutierrez C, Mancilla-Ramirez J, Estevez-Jimenez J, et al. Diarrhea in preschool children and Lactobacillus reuteri: a randomized controlled trial. PEDIATRICS. 2014;133(4):e904–9.CrossRefPubMed
15.
go back to reference Dinleyici EC, Dalgic N, Guven S, Metin O, Yasa O, Kurugol Z, et al. Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting. J Pediatr. 2015;91(4):392–6.CrossRef Dinleyici EC, Dalgic N, Guven S, Metin O, Yasa O, Kurugol Z, et al. Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting. J Pediatr. 2015;91(4):392–6.CrossRef
16.
go back to reference Savino F, Fornasero S, Ceratto S, De Marco A, Mandras N, Roana J, et al. Probiotics and gut health in infants: A preliminary case–control observational study about early treatment with Lactobacillus reuteri DSM 17938. Clin Chim Acta. 2015;451(Pt A):82–7.CrossRefPubMed Savino F, Fornasero S, Ceratto S, De Marco A, Mandras N, Roana J, et al. Probiotics and gut health in infants: A preliminary case–control observational study about early treatment with Lactobacillus reuteri DSM 17938. Clin Chim Acta. 2015;451(Pt A):82–7.CrossRefPubMed
17.
go back to reference Romani Vestman N, Chen T, Lif Holgerson P, Öhman C, Johansson I. Oral Microbiota Shift after 12-Week Supplementation with Lactobacillus reuteri DSM 17938 and PTA 5289. Randomized Control Trial PloS one. 2015;10(5), e0125812.CrossRefPubMed Romani Vestman N, Chen T, Lif Holgerson P, Öhman C, Johansson I. Oral Microbiota Shift after 12-Week Supplementation with Lactobacillus reuteri DSM 17938 and PTA 5289. Randomized Control Trial PloS one. 2015;10(5), e0125812.CrossRefPubMed
18.
go back to reference Szajewska H, Gyrczuk E, Horvath A. Lactobacillus reuteri DSM 17938 for the management of infantile colic in breastfed infants: a randomized, double-blind, placebo-controlled trial. J Pediatr. 2013;162(2):257–62.CrossRefPubMed Szajewska H, Gyrczuk E, Horvath A. Lactobacillus reuteri DSM 17938 for the management of infantile colic in breastfed infants: a randomized, double-blind, placebo-controlled trial. J Pediatr. 2013;162(2):257–62.CrossRefPubMed
19.
go back to reference Savino F, Cordisco L, Tarasco V, Palumeri E, Calabrese R, Oggero R, et al. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics. 2010;126(3):e526–33.CrossRefPubMed Savino F, Cordisco L, Tarasco V, Palumeri E, Calabrese R, Oggero R, et al. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics. 2010;126(3):e526–33.CrossRefPubMed
20.
go back to reference Chau K, Lau E, Greenberg S, Jacobson S, Yazdani-Brojeni P, Verma N, et al. Probiotics for infantile colic: a randomized, double-blind, placebo-controlled trial investigating Lactobacillus reuteri DSM 17938. J Pediatr. 2015;166(1):74–8.CrossRefPubMed Chau K, Lau E, Greenberg S, Jacobson S, Yazdani-Brojeni P, Verma N, et al. Probiotics for infantile colic: a randomized, double-blind, placebo-controlled trial investigating Lactobacillus reuteri DSM 17938. J Pediatr. 2015;166(1):74–8.CrossRefPubMed
21.
go back to reference Francavilla R, Lionetti E, Castellaneta SP, Magistà AM, Maurogiovanni G, Bucci N, et al. Inhibition of Helicobacter pylori infection in humans by Lactobacillus reuteri ATCC 55730 and effect on eradication therapy: a pilot study. Helicobacter. 2008;13(2):127–34.CrossRefPubMed Francavilla R, Lionetti E, Castellaneta SP, Magistà AM, Maurogiovanni G, Bucci N, et al. Inhibition of Helicobacter pylori infection in humans by Lactobacillus reuteri ATCC 55730 and effect on eradication therapy: a pilot study. Helicobacter. 2008;13(2):127–34.CrossRefPubMed
22.
go back to reference Coccorullo P, Strisciuglio C, Martinelli M, Miele E, Greco L, Staiano A. Lactobacillus reuteri (DSM 17938) in infants with functional chronic constipation: a double-blind, randomized, placebo-controlled study. J Pediatr. 2010;157(4):598–602.CrossRefPubMed Coccorullo P, Strisciuglio C, Martinelli M, Miele E, Greco L, Staiano A. Lactobacillus reuteri (DSM 17938) in infants with functional chronic constipation: a double-blind, randomized, placebo-controlled study. J Pediatr. 2010;157(4):598–602.CrossRefPubMed
23.
go back to reference Romano C, Ferrau’ V, Cavataio F, Iacono G, Spina M, Lionetti E, et al. Lactobacillus reuteri in children with functional abdominal pain (FAP). J Paediatr Child Health. 2014;50(10):E68–71.CrossRefPubMed Romano C, Ferrau’ V, Cavataio F, Iacono G, Spina M, Lionetti E, et al. Lactobacillus reuteri in children with functional abdominal pain (FAP). J Paediatr Child Health. 2014;50(10):E68–71.CrossRefPubMed
24.
go back to reference Agustina RB-OI, Lukito W, Fahmida U, van de Rest O, Zimmermann MB, Firmansyah A, et al. Probiotics Lactobacillus reuteri DSM 17938 and Lactobacillus casei CRL 431 modestly increase growth, but not iron and zinc status, among Indonesian children aged 1–6 years. J Nutr. 2013;143(7):1184–93.CrossRefPubMed Agustina RB-OI, Lukito W, Fahmida U, van de Rest O, Zimmermann MB, Firmansyah A, et al. Probiotics Lactobacillus reuteri DSM 17938 and Lactobacillus casei CRL 431 modestly increase growth, but not iron and zinc status, among Indonesian children aged 1–6 years. J Nutr. 2013;143(7):1184–93.CrossRefPubMed
25.
go back to reference Grönlund M-M, Gueimonde M, Laitinen K, Kociubinski G, Grönroos T, Salminen S, et al. Maternal breast-milk and intestinal bifidobacteria guide the compositional development of the Bifidobacterium microbiota in infants at risk of allergic disease. Clin Exp Allergy. 2007;37(12):1764–72.CrossRefPubMed Grönlund M-M, Gueimonde M, Laitinen K, Kociubinski G, Grönroos T, Salminen S, et al. Maternal breast-milk and intestinal bifidobacteria guide the compositional development of the Bifidobacterium microbiota in infants at risk of allergic disease. Clin Exp Allergy. 2007;37(12):1764–72.CrossRefPubMed
26.
go back to reference Proctor and Gamble Company. New Dietary Ingrediant Notification Information - Bifidobacterium infantis 35624. In: US Regulatory Affairs. April 29, 2005. Proctor and Gamble Company. New Dietary Ingrediant Notification Information - Bifidobacterium infantis 35624. In: US Regulatory Affairs. April 29, 2005.
27.
go back to reference Lin A, Luby S. Personal communication - unpublished data from the WASH Benefits Study. 2013 Lin A, Luby S. Personal communication - unpublished data from the WASH Benefits Study. 2013
28.
go back to reference WHO. Global Strategy for Infant and Young Child Feeding. 2000, 1–5:1–37. WHO. Global Strategy for Infant and Young Child Feeding. 2000, 1–5:1–37.
29.
go back to reference Hartung C, Anokwa Y, Brunette W, Lerer A, Tseng C, Borriello G. Open Data Kit: Tools to Build Information Services for Developing Regions. ICTD. 2010;1–11. Hartung C, Anokwa Y, Brunette W, Lerer A, Tseng C, Borriello G. Open Data Kit: Tools to Build Information Services for Developing Regions. ICTD. 2010;1–11.
30.
go back to reference WHO. Infant and young child nutrition: Global strategy on infant and young child feeding. Fifty-Fifth World Health Assembly. Provisional Agenda Item. 2002;13.10(A55/15):1–18. WHO. Infant and young child nutrition: Global strategy on infant and young child feeding. Fifty-Fifth World Health Assembly. Provisional Agenda Item. 2002;13.10(A55/15):1–18.
32.
go back to reference Boyle RJ, Robins-Browne RM, Tang MLK. Probiotic use in clinical practice: what are the risks? Am J Clin Nutr. 2006;83(6):1256–64. quiz 1446–1257.PubMed Boyle RJ, Robins-Browne RM, Tang MLK. Probiotic use in clinical practice: what are the risks? Am J Clin Nutr. 2006;83(6):1256–64. quiz 1446–1257.PubMed
33.
34.
go back to reference Sarker SA, Sultana S, Fuchs GJ, Alam NH, Azim T, Brüssow H, et al. Lactobacillus paracasei strain ST11 has no effect on rotavirus but ameliorates the outcome of nonrotavirus diarrhea in children from Bangladesh. PEDIATRICS. 2005;116(2):e221–8.CrossRefPubMed Sarker SA, Sultana S, Fuchs GJ, Alam NH, Azim T, Brüssow H, et al. Lactobacillus paracasei strain ST11 has no effect on rotavirus but ameliorates the outcome of nonrotavirus diarrhea in children from Bangladesh. PEDIATRICS. 2005;116(2):e221–8.CrossRefPubMed
35.
go back to reference Matsuda F, Chowdhury MI, Saha A, Asahara T, Nomoto K, Tarique AA, et al. Evaluation of a probiotics, Bifidobacterium breve BBG-01, for enhancement of immunogenicity of an oral inactivated cholera vaccine and safety: a randomized, double-blind, placebo-controlled trial in Bangladeshi children under 5 years of age. Vaccine. 2011;29(10):1855–8.CrossRefPubMed Matsuda F, Chowdhury MI, Saha A, Asahara T, Nomoto K, Tarique AA, et al. Evaluation of a probiotics, Bifidobacterium breve BBG-01, for enhancement of immunogenicity of an oral inactivated cholera vaccine and safety: a randomized, double-blind, placebo-controlled trial in Bangladeshi children under 5 years of age. Vaccine. 2011;29(10):1855–8.CrossRefPubMed
36.
go back to reference Neu J. The developing intestinal microbiome: probiotics and prebiotics. World Rev Nutr Diet. 2014;110:167–76.CrossRefPubMed Neu J. The developing intestinal microbiome: probiotics and prebiotics. World Rev Nutr Diet. 2014;110:167–76.CrossRefPubMed
37.
go back to reference Murgas Torrazza R, Neu J. The developing intestinal microbiome and its relationship to health and disease in the neonate. J Perinatol. 2011;31 Suppl 1:S29–34.CrossRefPubMed Murgas Torrazza R, Neu J. The developing intestinal microbiome and its relationship to health and disease in the neonate. J Perinatol. 2011;31 Suppl 1:S29–34.CrossRefPubMed
38.
go back to reference Cox Laura M, Yamanishi S, Sohn J, Alekseyenko Alexander V, Leung Jacqueline M, Cho I, et al. Altering the Intestinal Microbiota during a Critical Developmental Window Has Lasting Metabolic Consequences. Cell. 2014;158(4):705–21.PubMedCentralCrossRefPubMed Cox Laura M, Yamanishi S, Sohn J, Alekseyenko Alexander V, Leung Jacqueline M, Cho I, et al. Altering the Intestinal Microbiota during a Critical Developmental Window Has Lasting Metabolic Consequences. Cell. 2014;158(4):705–21.PubMedCentralCrossRefPubMed
39.
40.
41.
go back to reference Timmerman HM, Koning CJM, Mulder L, Rombouts FM, Beynen AC. Monostrain, multistrain and multispecies probiotics--A comparison of functionality and efficacy. Int J Food Microbiol. 2004;96(3):219–33.CrossRefPubMed Timmerman HM, Koning CJM, Mulder L, Rombouts FM, Beynen AC. Monostrain, multistrain and multispecies probiotics--A comparison of functionality and efficacy. Int J Food Microbiol. 2004;96(3):219–33.CrossRefPubMed
42.
go back to reference Gardiner GE, Casey PG, Casey G, Lynch PB, Lawlor PG, Hill C, et al. Relative ability of orally administered Lactobacillus murinus to predominate and persist in the porcine gastrointestinal tract. Appl Environ Microbiol. 2004;70(4):1895–906.PubMedCentralCrossRefPubMed Gardiner GE, Casey PG, Casey G, Lynch PB, Lawlor PG, Hill C, et al. Relative ability of orally administered Lactobacillus murinus to predominate and persist in the porcine gastrointestinal tract. Appl Environ Microbiol. 2004;70(4):1895–906.PubMedCentralCrossRefPubMed
Metadata
Title
Safety and acceptability of Lactobacillus reuteri DSM 17938 and Bifidobacterium longum subspecies infantis 35624 in Bangladeshi infants: a phase I randomized clinical trial
Authors
Yana Emmy Hoy-Schulz
Kaniz Jannat
Thomas Roberts
Saira Husain Zaidi
Leanne Unicomb
Stephen Luby
Julie Parsonnet
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2016
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/s12906-016-1016-1

Other articles of this Issue 1/2016

BMC Complementary Medicine and Therapies 1/2016 Go to the issue