Probiotics for the Prevention of Pediatric Antibiotic-Associated Diarrhea

Abstract

Background Antibiotics are frequently prescribed in children. They alter the microbial balance within the gastrointestinal tract, commonly resulting in antibiotic-associated diarrhea (AAD). Probiotics may prevent AAD via restoration of the gut microflora. Objectives The primary objectives were to assess the efficacy and safety of probiotics (any specified strain or dose) used for the prevention of AAD in children. Search methods MEDLINE, EMBASE, CENTRAL, CINAHL, AMED, and the Web of Science (inception to November 2014) were searched along with specialized registers including the Cochrane IBD/FBD review group, CISCOM (Centralized Information Service for Complementary Medicine), NHS Evidence, the International Bibliographic Information on Dietary Supplements as well as trial registries. Letters were sent to authors of included trials, nutraceutical and pharmaceutical companies, and experts in the field requesting additional information on ongoing or unpublished trials. Conference proceedings, dissertation abstracts, and reference lists from included and relevant articles were also searched. Selection criteria Randomized, parallel, controlled trials in children (0 to 18 years) receiving antibiotics, that compare probiotics to placebo, active alternative prophylaxis, or no treatment and measure the incidence of diarrhea secondary to antibiotic use were considered for inclusion. Data collection and analysis Study selection, data extraction as well as methodological quality assessment using the risk of bias instrument was conducted independently and in duplicate by two authors. Dichotomous data (incidence of diarrhea, adverse events) were combined using a pooled risk ratio (RR) or risk difference (RD), and continuous data (mean duration of diarrhea, mean daily stool frequency) as mean difference (MD), along with their corresponding 95% confidence interval (95% CI). For overall pooled results on the incidence of diarrhea, sensitivity analyses included available case versus extreme-plausible analyses and random- versus fixed-effect models. To explore possible explanations for heterogeneity, a priori subgroup analysis were conducted on probiotic strain, dose, definition of antibiotic-associated diarrhea, as well as risk of bias. We also conducted post hoc subgroup analyses by patient diagnosis, single versus multi-strain, industry sponsorship, and inpatient status. The overall quality of the evidence supporting the outcomes was evaluated using the GRADE criteria. Main results Twenty-three studies (3938 participants) met the inclusion criteria. Trials included treatment with either Bacillus spp., Bifidobacterium spp., Clostridium butyricum,Lactobacilli spp., Lactococcus spp., Leuconostoc cremoris, Saccharomyces spp., or Streptococcus spp., alone or in combination. Eleven studies used a single strain probiotic, four combined two probiotic strains, three combined three probiotic strains, one combined four probiotic strains, two combined seven probiotic strains, one included ten probiotic strains, and one study incl...

Protective Effect of Pediococcus pentosaceus LI05 Against Clostridium difficile Infection in a Mouse Model

“…The use Lactobacillus species either alone or in combination has been intensively investigated for its therapeutic effect against CDI ( Mills et al, 2018 ). Several evidence suggested an association between the absence of lactobacilli and the development of CDI among inpatients ( Banerjee et al, 2009 ; Goldenberg et al, 2015 ; Ratsep et al, 2017 ; Mills et al, 2018 ). Further, lactobacilli could successfully antagonize the cytotoxic effects of C. difficile ( Vanderhoof et al, 1999 ; Barker et al, 2017 ; Ratsep et al, 2017 ; Spinler et al, 2017 ).…”

Effect of probiotics in the treatment of acute noninflammatory diarrhea in hospitalized children aged 2–10 years

“…[29] In addition, milder complications such as bloating, abdominal pain, rash, increased mucus, chest pain, and constipation were also reported by an interventional study. [30] Therefore, necessary precautions should be taken to prevent sepsis and death of children.…”

Використання Розчину Для Оральної Регідратації (Оральної Регідратаційної Солі) З додаванням Пробіотичного Штаму Для Лікування Дітей Із Гострою Інфекційною Патологією

“…Отримані нами дані збігаються з даними літератури [3,4]. У метааналізі 5 рандомізованих досліджень було встановлено, що LGG знижували ризик розвитку ААД у дітей з 23,0 до 9,6 % [4].…”

“…Використання розчину для оральної регідратації (оральної регідратаційної солі) з додаванням пробіотичного штаму для лікування дітей із гострою інфекційною патологією [3,4,6]. Доведено, що пробіотичні препарати зміцнюють епітеліальний бар'єр, конкурують за місця адгезії з патогенними мікроорганізмами, синтезують антимікробні сполуки, модулюють імунну систему [7,8], з чим і пов'язують їх ефективність для профілакти-ки розвитку ААД.…”