After Clinical Trial In India, Probiotics Found To Prevent A Deadly Condition Called Sepsis

A trial that took more than a decade to complete – involving the treatment of 4,556 newborns in rural Odisha – has finally yielded a solution to one of the worst causes of infant mortality and morbidity around the world.

Sepsis is a condition which develops when the body’s immune mechanism ends up attacking the body itself. Though it is not limited to children, sepsis becomes deadly in their case because children, especially when they are about three months old, do not have a well-developed immune system. According to a 2016 report in The Lancet journal, sepsis kills 57,000 children in India every year. The treatment of the condition in children has been mostly based on studies done on adults. However, a study done in 2014 argued that “the management of pediatric sepsis must be tailored to the child’s age and immune capacity, and to the site, severity, and source of the infection”. Things get complicated further in the case of children with neonatal sepsis, which is caused by bacteria resistant to first-line antibiotics.

It is in these circumstances that Dr Pinaki Panigrahi, a professor at the University of Nebraska and a native of the state of Odisha, started “the randomized, double-blind, placebo-controlled trial of an oral synbiotic preparation (Lactobacillus plantarum plus fructooligosaccharide) in rural Indian newborns”. The results published on 16 August in the journal Nature showed “a significant reduction in the primary outcome (combination of sepsis and death) in the treatment arm, with few deaths”.

The synbiotic combination (made up of both prebiotics and probiotics), which is cost-effective at only $1 per treatment, has reduced sepsis deaths by 40 per cent. The interesting part of the science is the aiding of non-pathogenic Lactobacillus plantarum to out-compete pathogenic rivals like Escherichia coli. The synbiotic combination of L plantarum and fructooligosaccharide, a low-calorie carbohydrate found in natural sources like onion and which can maintain the gut bacterial population in a way so as to aid human health, makes the digestive tracts of infants a safe and protected place from pathogens which cause sepsis.

The Scientist magazine quoted Dr Panigrahi as saying, “Our critics said, ‘You will never be able to do this trial because it is too complicated,’ which is now a compliment for me.” According to the report, Dr Panigrahi’s “ultimate aim is prevention of all kinds of diseases with probiotics, particularly in the context of the growing problem of antibiotic resistance and the rise in inflammatory disorders around the world”.

There is great appreciation for this breakthrough in the paediatric medical community. Dr Andi Shane of the Department of Pediatrics at Emory University School of Medicine, in her communication to The Scientist has said studies like this one with “a rigorous and creative approach are beneficial and while it is important to understand mechanisms, clinical outcomes may be just as, if not more relevant”.

Dr Panigrahi has also been a strong advocate for hygiene campaigns in India and stresses their importance in the prevention of diseases. His work in his own home state in India, saving the lives of children and opening a new front in alleviating the suffering of infants across the world, can inspire medical students in the country to take up such innovative projects for human welfare.