TERAPI SINBIOTIK TERHADAP DIARE AKUT DENGAN INTOLERANSI LAKTOSA SEKUNDER

Abstract

Background : Rotaviral infection that change microvillus system could cause secondary lactase deficiency. Study shown 30%-50% baby with rotaviral infection suffering secondary lactose intolerance. Probiotic has been proven to promote recovery from acute diarrhea in children. Synbiotic is combination of probiotic and prebiotic that can improve the survival of the probiotic. Objective : This study was aimed to investigate the effect of synbiotic therapy on recovery of acute diarrhea in children with secondary lactose intolerance. Methods : A randomized clinical trial was conducted in 40 children aged 1-24 month, in pediatric ward of dr. Kariadi Hospital Semarang. Subjects were randomly allocated into 2 groups. Children in both groups received lowe lactose milk and standard diarrhea therapy. In treatment group, children were given 1 capsule of synbiotic containing Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus bulgaricus, Bifidobacterium breve, Bifidobacterium longum, Streptococcus thermophilus, dan Fructo-oligosaccharid, while in the control group, they received saccharum lactis capsul. Stool volume and body weight were measured everyday. Reduction test was conducted during liquid stool with Bennedict test. Mann Whitney U and t-test were used to analyze data. Result : The treatment group indicated reduction in the duration of diarrhea, with the mean duration of diarrhea in treatment group was 32 hours (± 20,7) compared to 59,4 hours (± 28,2) in control group (p=0,001). On the second day, the number of reduction test conversion was significantly higher in the treatment group compared to the control (p=0,011). There were no differences in stool volume and body weight gain between treatment and control groups. Conclusion : Symbiotic was effective to shorten the duration of diarrhea and accelerate reduction test conversion for acute diarrhea in children with secondary lactose intolerance.. Latar belakang : Infeksi rotavirus memberikan perubahan pada sistem mikrovili sehingga timbul defisiensi enzim laktase sekunder. Studi pada bayi menunjukan 30%-50% bayi dengan infeksi rotavirus menderita intoleransi laktosa sekunder. Probiotik dapat mempercepat penyembuhan diare akut pada anak. Kombinasi prebiotik dan probiotik (sinbiotik) akan meningkatkan daya tahan hidup probiotik. Tujuan Penelitian : Mengetahui pengaruh terapi sinbiotik terhadap penyembuhan diare akut dengan intoleransi sekunder. Metode : Penelitian ini merupakan uji klinis acak, dilakukan di bangsal anak, bagian Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Diponegoro, Rumah Sakit Dr Kariadi Semarang. Subyek sebanyak 40 anak usia 1-24 bulan. Semua penderita mendapatkan susu rendah laktosa dan terapi sesuai prosedur pengelolaan diare akut dengan intoleransi laktosa sekunder. Kelompok perlakuan mendapatkan sinbiotik 1 kapsul (campuran Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus bulgaricus, Bifidobacterium breve, Bifidobacterium longum, Streptococcus thermophilus, dan Fructo-oligosaccharide) sehari selama 5 hari. Feses ditimbang setiap hari dengan timbangan roti. Berat badan diukur tiap hari dengan timbangan digital. Pemeriksaan substansi reduksi dilakukan selama feses cair dengan uji Bennedict. Data dianalisis dengan uji t dan Mann Whitney U. Hasil : Terdapat penurunan lama diare pada kelompok yang mendapatkan sinbiotik dibandingkan kontrol, dimana rerata lama diare pada kelompok perlakuan 32 jam (± 20,7) dibanding 59,4 jam (± 28,2) pada kelompok kontrol (p=0,001). Jumlah kasus yang mengalami konversi tes reduksi pada hari kedua lebih tinggi pada kelompok perlakuan dibanding kontrol (p=0,011). Tidak didapatkan perbedaan yang bermakna pada berat feses dan kenaikan berat badan antara kedua kelompok. Kesimpulan : Sinbiotik memperpendek lama diare dan mempercepat konversi tes reduksi pada anak diare dengan intoleransi laktosa sekunder.