Probiotics’ efficacy in paediatric diseases: which is the evidence? A critical review on behalf of the Italian Society of Pediatrics

Martinelli, Massimo; Banderali, Giuseppe; Bobbio, M; Civardi, Elisa; Chiara, A; D’Elios, Sofia; Vecchio, Andrea Lo; Olivero, Mattia; Peroni, Diego; Romano, Claudio; Stronati, Mauro; Turra, Renato; Viola, I; Staiano, Annamaria; Villani, Alberto

doi:10.1186/s13052-020-00862-z

Cited by 20 publications

(14 citation statements)

References 106 publications

(147 reference statements)

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“…As a consequence, daily practice differs substantially in different centers, resulting in a discrepancy in administration from 0 to 100% according to over 150 different neonatal intensive care units [ 103 ]. Many trials do not report any adverse event, but some cases of Lactobacillus or Bifidobacterium sepsis have been reported in infants receiving probiotics [ 104 , 105 , 106 , 107 ]. Most affected infants had severe diseases, such as short-bowel syndrome or immunodeficiency [ 103 ].…”

Section: Results: Evidence Of Efficacy Of Probioticsmentioning

confidence: 99%

Probiotics in Pediatrics. A Review and Practical Guide

Depoorter

Vandenplas

2021

Nutrients

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The potential benefit of the administration of probiotics in children has been studied in many settings globally. Probiotics products contain viable micro-organisms that confer a health benefit on the host. Beneficial effects of selected probiotic strains for the management or prevention of selected pediatric conditions have been demonstrated. The purpose of this paper is to provide an overview of current available evidence on the efficacy of specific probiotics in selected conditions to guide pediatricians in decision-making on the therapeutic or prophylactic use of probiotic strains in children. Evidence to support the use of certain probiotics in selected pediatric conditions is often available. In addition, the administration of probiotics is associated with a low risk of adverse events and is generally well tolerated. The best documented efficacy of certain probiotics is for treatment of infectious gastroenteritis, and prevention of antibiotic-associated, Clostridioides difficile-associated and nosocomial diarrhea. Unfortunately, due to study heterogeneity and in some cases high risk of bias in published studies, a broad consensus is lacking for specific probiotic strains, doses and treatment regimens for some pediatric indications. The current available evidence thus limits the systematic administration of probiotics. The most recent meta-analyses and reviews highlight the need for more well-designed, properly powered, strain-specific and dedicated-dose response studies.

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Section: Results: Evidence Of Efficacy Of Probioticsmentioning

confidence: 99%

Probiotics in Pediatrics. A Review and Practical Guide

Depoorter

Vandenplas

2021

Nutrients

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“…A number of strains have been proposed for the management of pediatric FGIDs ( Wojtyniak and Szajewska, 2017 ; Sung et al, 2018 ; Nocerino et al, 2020 ; Savino et al, 2020 ). However, no specific probiotic strains have gained enough clinical evidence to be recommended by experts except for Limosilactobacillus reuteri DSM 17938 but only in breastfed babies subgroup ( Tabbers et al, 2014 ; Guarner et al, 2017 ; Martinelli et al, 2020 ). In addition to the limited clinical support, strains are not always selected based on beneficial mechanisms to counteract pediatric FGIDs pathophysiology but generally tested in different adult and infant conditions.…”

Section: Discussionmentioning

confidence: 99%

Probiotic Properties of Bifidobacterium longum KABP042 and Pediococcus pentosaceus KABP041 Show Potential to Counteract Functional Gastrointestinal Disorders in an Observational Pilot Trial in Infants

et al. 2022

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Functional gastrointestinal disorders (FGIDs) are a common concern during the first year of life. Recognized as gut-brain axis disorders by Rome IV criteria, FGIDs etiology is linked to altered gut-brain interaction, intestinal physiology, and microbiota. In this regard, probiotics have emerged as a promising therapy for infant FGIDs. In this study, we have investigated the probiotic potential of the strains Bifidobacterium longum KABP042 and Pediococcus pentosaceus KABP041—isolated from healthy children’s feces—in the treatment of FGIDs. To this scope, genome sequences of both strains were obtained and subjected to in silico analyses. No virulence factors were detected for any strain and only the non-transferable erm(49) gene, which confers resistance to erythromycin and clindamycin, was identified in the genome of B. longum KABP042. Safety of both strains was confirmed by acute oral toxicity in rats. In vitro characterization revealed that the strains tolerate gastric and bile challenges and display a great adhesion capacity to human intestinal cells. The two strains mediate adhesion by different mechanisms and, when combined, synergically induce the expression of Caco-2 tight junction proteins. Moreover, growth inhibition experiments demonstrated the ability of the two strains alone and in combination to antagonize diverse Gram-negative and Gram-positive bacterial pathogens during sessile and planktonic growth. Pathogens’ inhibition was mostly mediated by the production of organic acids, but neutralization experiments strongly suggested the presence of additional antimicrobial compounds in probiotic culture supernatants such as the bacteriocin Lantibiotic B, whose gene was detected in the genome of B. longum KABP042. Finally, an exploratory, observational, pilot study involving 36 infants diagnosed with at least one FGID (infant colic and/or functional constipation) showed the probiotic formula was well tolerated and FGID severity was significantly reduced after 14 days of treatment with the 2 strains. Overall, this work provides evidence of the probiotic and synergic properties of strains B. longum KABP042 and P. pentosaceus KABP041, and of their potential to treat pediatric FGIDs.Clinical Trial Registration: [www.ClinicalTrials.gov], [identifier NCT04944628].

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“…The use of LGG for the reduction of the duration of diarrhea is supported by convincing evidence [ 9 ]. A review of randomized clinical trials (RCTs) on LGG in the treatment of AGE in children has reported a reduced duration of diarrhea at a daily dose of ≥10 10 CFU or ≤10 10 CFU by approximately 20 hours [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Lactobacillus rhamnosus GG Evaluation in Acute Diarrhea (LEAD): An Observational Study

Sanklecha¹,

Verma²,

Pai³

et al. 2022

Cureus

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Background and objective Probiotics with documented efficacy such as Lactobacillus rhamnosus GG(LGG) and Saccharomyces boulardii might be utilized as adjuncts to rehydration for the management of acute gastroenteritis (AGE) in children. In this study, we aimed to evaluate the potential role of LGG in acute diarrhea in the Indian pediatric population. Methods An observational, cross-sectional study [ Lactobacillus rhamnosus GG Evaluation in Acute Diarrhea (LEAD)] was conducted among children aged one month to 12 years with acute watery diarrhea. In addition to standard management of diarrhea, LGG was given as an adjuvant treatment at the discretion of treating physicians based on their routine practice. Observations were documented on days one, three, and five. Outcomes such as frequency and duration of diarrhea, time to change in consistency of stools, Bristol Stool Chart (BSC) reading, and global assessment by healthcare practitioners (HCPs) and patients were also recorded. Results Of the 2,080 patients enrolled, 1,900 completed the five-day follow-up. There was marked improvement observed in the number of incidences of loose stools from day one (mean: 7.33) to day five (mean: 1.6). The mean time to improvement in stool consistency was 34 hours. The mean duration of diarrhea was 44.63 hours. A relatively shorter duration of diarrhea was reported among participants in this study. There was also a significant improvement in the number of vomiting episodes. Most patients and HCPs reported the product to be excellent/very good on the global assessment scale. No adverse effects were noted in any of the groups. Conclusion Based on our findings, LGG supplementation may be a beneficial adjuvant treatment in reducing the severity and duration of acute diarrheal episodes.

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Probiotics’ efficacy in paediatric diseases: which is the evidence? A critical review on behalf of the Italian Society of Pediatrics

Cited by 20 publications

References 106 publications

Probiotics in Pediatrics. A Review and Practical Guide

Probiotics in Pediatrics. A Review and Practical Guide

Probiotic Properties of Bifidobacterium longum KABP042 and Pediococcus pentosaceus KABP041 Show Potential to Counteract Functional Gastrointestinal Disorders in an Observational Pilot Trial in Infants

Lactobacillus rhamnosus GG Evaluation in Acute Diarrhea (LEAD): An Observational Study

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