Frequency of Antibiotic-Associated Diarrhea and Related Complications in Pediatric Patients Who Underwent Hypospadias Repair: a Comparative Study Using Probiotics vs Placebo

Abstract

This study aimed to evaluate the effectiveness of probiotics (Lactobacillus rhamnosus GG), as a preventive measure of antibiotic-associated diarrhea (AAD) in children who underwent hypospadias repair and its clinical consequences on postoperative outcome, comparing the group treated with probiotics + antibiotics with two control groups (only antibiotics and antibiotics + placebo). We performed a prospective, randomized, placebo-controlled study with three groups of patients (30 boys for each group) who underwent hypospadias repair in our unit from March 2016 to December 2016. G1 received antibiotics + probiotics (L. rhamnosus GG), while G2 and G3 respectively received only antibiotics or antibiotics + placebo (glucose solution at 5%) for the same period. The patients were evaluated in regard to the number of evacuations/day, stool consistency, and the number of dressings/day. The overall incidence of postoperative AAD was 33.3% (30/90), and it was statistically lower in G1 patients compared to G2 and G3 ones (p = 0.002). The duration of AAD was significantly longer in G2 and G3 compared to G1 (p = 0.001). In G1, the frequency of dressing change was significantly lower compared to G2 and G3 (p = 0.001).The incidence of postoperative complications (fistula and dehiscence) was significantly higher in G2 and G3 compared to G1 (p = 0.001). Our study confirmed that the use of probiotic L. rhamnosus GG associated with antibiotics significantly reduced the incidence and the duration of postoperative AAD. In addition, the use of probiotics LGG reduced the frequency of dressing changes and the incidence of postoperative complications, such as urethral fistula and foreskin dehiscence.

Therapeutic, Prophylactic, and Functional Use of Probiotics: A Current Perspective

“…Data from 17 studies, for a total of 3,631 patients, demonstrated that use of probiotics can reduce the risk of AAD by 51% ( Blaabjerg et al, 2017 ). More recently, Esposito et al (2018) evaluated the efficacy of Lactobacillus rhamnosus (LGG), AAD in children with hypospadias repair. In the randomized controlled trial (RCT), L. rhamnosus GG associated with antibiotics significantly reduced the incidence and the duration of postoperative AAD and the incidence of postoperative complications, such as urethral fistula and foreskin dehiscence.…”

“…Data from 17 studies, for a total of 3,631 patients, demonstrated that use of probiotics can reduce the risk of AAD by 51% (Blaabjerg et al, 2017). More recently, Esposito et al (2018) evaluated the efficacy of Lactobacillus rhamnosus (LGG), AAD in children with hypospadias repair.…”

Probiotics for the prevention of antibiotic-associated adverse events in children—A scoping review to inform development of a core outcome set

“…In 22 (67%) of the 33 trials that assessed diarrhea as an outcome, the incidence of diarrhea was assessed during antibiotic treatment and an additional follow-up period, which varied from 1 week after the end of antibiotic therapy [34,41] to up to 7 months after its beginning [38]. Seven studies (21%) assessed diarrhea only during antibiotic treatment [30,32,33,37,52,53,56], and 3 studies (9%), only during the first 3 to 6 days of antibiotic therapy [29,43,45].…”

“…Among other characteristics of the diarrhea, its duration was reported in only 9 out of 33 studies, which corresponds to 27% of the studies with diarrhea as an outcome. In 6 of these studies, the duration was not defined [8,28,29,31,53,57], whereas in each of the 3 remaining studies its definition varied [30,33,47]. Diarrhea severity was reported as an outcome in only 4 of the studies (12%), and it was defined differently in every one of them, usually on the basis of discharge frequency and stool consistency [7,28,30,34].…”

Adverse Events Associated With Antibiotic Therapy in Pediatric Practice. The Role of Pre- And Probiotics in the Prevention of Antibiotic-Associated Diarrhea

“…Продолжительность AAД была значительно выше в кон-трольных группах по сравнению с продолжительностью в основной (p = 0,001). Установлено, что частота послеопе-рационных осложнений была значительно ниже в основ-ной группе (по сравнению с G2 и G3 (p = 0,001)) [9].…”