Welcome We Products in the pharmacy for preparing the Traveller. - - PDF document

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PPG PPG Pre Pre‐con confer erenc ence pr presen entatio tion ‐ CI CIST STM16

Products in the pharmacy for preparing the Traveller.

We Welcome

Derek Evans Chair‐ elect of the Pharmacy Professional Group

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Sheila Seed PPG Council member

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Derek Evans PPG Chair elect

Nat Natural medicines medicines‐ availab ailable pr products

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Der Derek Ev Evans, FRPh FRPhS, FR FRGS GS, MF MFTM TM RC RCPS (Gla (Glasg)

Tr Travel Me Medici dicine Spec Specia iali list and and Consult Consultant Adj Adjunct Clinic linical Pr Prof

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essor in in Pha Pharmacy Pr Pract actice, ce, Ke Keck Gr Gradua aduate Institut itute, School School of

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Pharmacy and and He Health alth Scien Sciences

Pre Pre and and Pro Probiotics‐ ev evidence ence

• Differences between pre and probiotics
• Quick review of some of the key data for each group
• Use in travel medicine.

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Pro Probiotics

• Defined as live organisms that can confer a health benefit
• n the host
• Differ from prebiotics by colonising the bowel to displace

dangerous bacteria.

• Early studies concluded that probiotics reduced the risk of

acute diarrhoea by 26% in adults.

• WHO. Health and Nutritional Properties in food with live Lactic Acid bacteria)
• Mason. Probiotics: are they worth taking? Pharmaceutical Journal 2007
• Sazawal. Efficacy of probiotics in prevention of acute diarrhoea. Lancet Inf Diseases 2006, 6: 374‐82

Pre Prebiotics

• Non‐digestible food ingredient
• Selectively stimulates the growth, activity or both
• Of a limited number of species resident in the gut.
• Second generation using bifidobacterial‐galacto‐oligosaccharides (B‐

GOS) better functionality and selectivity.

• Non‐digestible substance that act as food for the gut microbiota
• Mason. Differences between pre and probiotics. Pharmaceutical Journal 2001
• Blackwood. A Proactive Management Approach to travellers diarrhoea in vulnerable travellers. J BGTHA 2013; XXII: 5‐10
• Hutkins. Prebiotics: why definitions matter. Curr Opin Biotechnology 2016; 37:1

Feedback eedback on

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PROBIO OBIOTICS TICS

• 2007 meta‐analysis of PROBIOTICS may offer a safe and effective

method to prevent TD

• 2014 meta‐analysis of PROBIOTICS did not have a significant effect
• n TD

VARIABILITY IN SETTING, STRAINS USED, CAUSES OF TD INDUSTRY NEEDING TO ADDRESS DEFICITS IN LISTING OF STRAIN SPECIFIC ORGANISMS

• Riddle. Guidelines for the prevention and treatment of travelers diarrhea: a graded expert panel report. Journal of Travel Medicine, 2017, vol

24, suppl 1, S2‐S19

• Evans. Non‐pharmacotherapeutic interventions in travellers diarrhoea. Journal of Travel Medicine, 2018, vol 25, suppl 1, S38‐S45

Da Data ana analysis is PREBIO PREBIOTICS TICS

• 8 literature references between 2005‐2018 on PREBIOTICS
• All using standardised B‐GOS (41171)
• 6 reports of providing protection bacterial infections (S typhii)
• 1 study highlighted 39% reduction in risk of TD symptoms.

UNABLE TO PERFORM A META‐ANALYSIS REVIEW INSUFFICIENT DATA FOR EXPERT REVIEW PANEL TO CONFIRM USE IN TD REDUCTION.

• Riddle. Guidelines for the prevention and treatment of travelers diarrhea: a graded expert panel report. Journal of Travel Medicine, 2017, vol

24, suppl 1, S2‐S19

• Evans. Non‐pharmacotherapeutic interventions in travellers diarrhoea. Journal of Travel Medicine, 2018, vol 25, suppl 1, S38‐S45

Re Results of

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Swedish tria trial‐ sin single le st study udy

B‐GOS reduces the risk of diarrhoea after 7 days

Confirmed that this was to be interpreted as starting 7 days before travel to be effective

• Hasle. Can a gala to‐oligosaccharide reduce the risk of travelers diarrhoea? A placebo‐controlled, randomised, double‐blinded study 2017.

Journal of Travel Medicine, 2017, 24: 5

• Connor. Letter to editor. 2018. Journal of Travel medicine doi: 10.1093/jtm/tax076

Pre Pre and and Pro Probiotic use use in in tr travel medi medici cine

• Travellers diarrhoea prevention, reduction or treatment

continues to be a major problem in travel related disease

• Question of antibiotic use and stewardship continues to be

debated on the value and risks

• Ruling of the use/abuse of loperamide and FDA ruling on

use.

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Di Discussion cussion

• With the answers regarding the use of antibiotics in TD

being unresolved

• An alternative approach would be to consider the natural

alternatives and consider the efficacy of these groups

• Prebiotics produced from a combination of bacteria and

long chain saccharides have studies that claim reduction in TD

• Probiotics produced from natural non‐pathogenic material

have a WHO definition and conflicting reports of the benefits in TD

Curr Current under erst standi ding ng

• Prebiotics: having a standardised preparation, have

insufficient studies published for a meta‐analysis review to support use in TD

• Single study data indicates potential use for reduction in TD
• Probiotics: suffer from having poor standardisation of test
• rganisms and bias in trial studies.
• Meta‐analysis data cannot support claims for use in

reduction of TD

Conc Conclu lusio sions

• Confusion and mixing of reviews together for pre and

probiotics‐ should be considered independently.

• Addressing of the reasons for poor study data with

probiotics by the pharma industry

• Requires separate studies for prebiotics

Questions ? Nat Natural Medi dicines: cines: Sel Select cted ed Products

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and Effecti ctiveness eness

Karl Hess PPG Council member

Av Avoiding in insect bi bites

Larry Goodyer PPG Council member

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pr practice actice and and evi evidence ence re relate ted to to Canadian Canadian pharm pharmacis acists ts as as tr travel el health health ca care re pr provider

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Sherilyn Houle PPG Council member

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collaborat ation betw between een a co community and and a tr travel el clin clinic ic in in a Swi Swiss uni university ity pri primar ary ca care re and and publ public health health cen center er

Marie Jose Barbalat Switzerland

Questions to speakers Close and Reception

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