Regarding the use of probiotics, the available evidence did not support the routine use of probiotics in acute diarrhea; hence, the recommendation for need for more data was made. The authors will like to clarify that conducting a study for evaluating the role of probiotics is not the mandate for the Task force. The authors do not agree with the statement made by Dr Paul as it is for group of researchers to take up research questions and design and conduct studies for the same.

The issues of probiotic safety and efficacy are important. There is no reason to believe that the probiotics will cause significant adverse effects in Indian children. However, the efficacy needs to be proven. We are sure that the author will agree that one will not like to use a product that is safe but has no therapeutic effect. Even after the review of recently published literature, there is no change in the position on probiotics. It has recently been shown in a trial that not all commercially available probiotic preparations are effective in children with acute diarrhea(1). In this trial duration of diarrhea was significantly shorter in children who received L. rhamnosus strain GG and the mix of four bacterial strains-L. delbrueckii var bulgaricus, Streptococcus thermophilus, L. acidophilus, and Bifidobacterium bifidum than in children who received oral rehydration solution alone. Most of the probiotics that are marketed in the country do not have these strains. In addition, the data on efficacy from the developed world cannot be extrapolated to our scenario in view of the differences in the gut microbiology and breast feeding rates. Therefore, it is crucial that we have evidence to support the use of probiotics in acute diarrhea. While this issue is resolved, our fraternity should try to improve the implementation of the more agreed upon guidelines.

Shinjini Bhatnagar,
Rakesh Lodha,
Department of Pediatrics,
All India Institute of Medical Sciences,
New Delhi 110 029