L-isoleucine-supplemented oral rehydration solution in the treatment of acute diarrhoea in children: A randomized controlled trial

Antimicrobial peptides represent an important component of the innate immune defenses of living organisms,including humans. they are broad-spectrum surface-acting agents secreted by the epithelial cells of the body in response to infection. recently,l-isoleucine and its analogues have been found to induce antimicrobial peptides. the objectives of the study were to examine if addition of l-isoleucine to oral rehydration salts (ors) solution would reduce stool output and/or duration of acute diarrhoea in children and induce antimicrobial peptides in intestine. this double-blind randomized controlled trial was conducted at the dhaka hospital of icddr,b. fifty male children,aged 6-36 months,with acute diarrhoea and some dehydration,attending the hospital,were included in the study. twenty-five children received l-isoleucine (2 g/l)-added ors (study),and 25 received ors without l-isoleucine (control). stool weight,ors intake,and duration of diarrhoea were the primary outcomes. there was a trend in reduction in mean±standard deviation (sd) daily stool output (g) of children in the l-isoleucine group from day 2 but it was significant on day 3 (388±261 vs 653±446; the difference between mean [95% confidence interval (ci) (-)265 (-509,-20); p=0.035]. although the cumulative stool output from day 1 to day 3 reduced by 26% in the isoleucine group,it was not significant. also,there was a trend in reduction in the mean±sd intake of ors solution (ml) in the l-isoleucine group but it was significant only on day 1 (410±169 vs 564±301),the difference between mean (95% ci) (-)154 (-288,-18); p=0.04. the duration (hours) of diarrhoea was similar in both the groups. a gradual increase in stool concentrations of ß-defensin 2 and 3 was noted but they were not significantly different between the groups. l-isoleucine-supplemented ors might be beneficial in reducing stool output and ors intake in children with acute watery diarrhoea. a further study is warranted to substantiate the therapeutic effect of l-isoleucine. © international centre for diarrhoeal disease research,bangladesh.