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

Abstract

IntroductionRoutine use of probiotics during antibiotic therapy in children remains a subject of discussion. To facilitate synthesis of individual study results and guideline formulation, it is important to assess predefined, similar, and clinically important outcomes. Core outcome sets are a proposed solution for this issue. The aim of this review was to document choice, design, and heterogeneity of outcomes in studies that assessed the effects of probiotics used for the prevention of antibiotic-associated adverse events in children. MethodsA scoping literature search covering three major databases was performed. Studies that evaluated oral probiotics' use concomitant with antibiotic therapy in children were included. Data on outcome definitions, measurement instruments, and follow-up were extracted. The outcomes were assigned to predefined core areas and domains. Data were analyzed descriptively. ResultsThirty-seven studies were included in this review. Diarrhea, the most commonly reported outcome, had diagnostic criteria clearly defined only in 21 studies. In total, 16 different definitions of diarrhea were identified. Diarrhea duration, severity, and etiology were reported in 9, 4, and 7 studies, respectively. Twenty studies assessed gastrointestinal symptoms other than diarrhea. Seven studies reported outcomes related to resource use or the economic impact of the intervention. Only 2 studies assessed outcomes related to life impact. None of the studies predefined adverse events of probiotic use.

Multispecies Probiotic for the Prevention of Antibiotic-Associated Diarrhea in Children

“…However, the definitions of AAD in published studies vary, and in many studies it was similar to the definition of diarrhea, as applied in current study. To illustrate, a 2020 review found that microbiological tests were not performed to identify AAD outcomes in 28 of 33 previous studies on probiotic supplementation during antibiotic treatment in children . While this approach may pose a question as to whether the researchers really measured AAD or rather diarrhea during antibiotic treatment regardless of the etiology, it also represents a much more pragmatic point of view.…”

“…Antibiotic-associated diarrhea (AAD) is a common complication of antibiotic treatment . Several different definitions of AAD have been proposed, including “diarrhea that occurs in relation to antibiotic treatment with the exclusion of other etiologies.” In clinical practice and in most clinical trials, microbiological tests are not routinely performed to exclude an infectious origin of AAD, confirming its etiology . AAD is considered to result from gut dysbiosis by antibiotics, which may provoke overgrowth of specific pathogens, most prominently Clostridioides difficile , and lead to altered function of the microbiota …”

Probiotics for the Management of Pediatric Gastrointestinal Disorders: Position Paper of the ESPGHAN Special Interest Group on Gut Microbiota and Modifications

“…A 2021 systematic review of 33 RCTs confirmed the evidence-based efficacy of S boulardii CNCM I-745 or L rhamnosus GG in preventing AAD in outpatients and hospitalized children (37). However, in a scoping review performed to inform development of a core outcome set, substantial heterogeneity in the definition, duration, and severity of diarrhea as well as in outcomes was noted (38).…”

INFLUENCE OF ANTIBIOTICS, GLYPHOSATE AND A Bacillus sp. STRAIN ON PRODUCTIVITY PERFORMANCE AND GENE EXPRESSION IN CROSS ROSS 308 BROILER CHICKENS (Gallus gallus L.)

“…Полезные штаммы микроорганизмов, несомненно, занимают первое место среди таких агентов (27)(28)(29) и находят широкое применение в кормлении сельскохозяйственной птицы (30). Нередко полезные бактерии применяются одновременно с антибиотиками для профилактики побочных эффектов последних (31). Доказано воздействие микроорганизмов на иммунитет (32) и экспрессию генов хозяина (33).…”