Risk and Protective Factors for Gastrointestinal Symptoms associated with Antibiotic Treatment in Children: A Population Study

Abstract

Purpose: Gastrointestinal symptoms are often related to antibiotic treatment. Their incidence, risk and protective conditions in children are not well defined and represent the aims of this study. Methods: We prospectively enrolled inpatient children submitted to antibiotic treatment. Indication, type, dose and duration of treatment, probiotic supplementation and gastrointestinal symptoms were recorded at recruitment, after two and four weeks. Antibiotic-associated diarrhea (AAD) was defined as the presence of at least 3 loose/liquid stools within 14 days from antibiotic onset. Results: AAD occurred in 59/289 (20.4%) of patients, with increased risk in children younger than 3 years (relative risk [RR]=4.25), in lower respiratory (RR=2.11) and urinary infections (RR=3.67), intravenous administration (RR=1.81) and previous AAD episodes (RR=1.87). Abdominal pain occurred in 27/289 (9.3%), particularly in children >6 years (RR=4.15), with previous abdominal pain (RR=7.2) or constipation (RR=4.06). Constipation was recorded in 23/289 (8.0%), with increased risk in children having surgery (RR=2.56) or previous constipation (RR=7.38). Probiotic supplementation significantly reduced AAD (RR=0.30) and abdominal pain (RR=0.36). Lactobacillus rhamnosus GG (LGG) and L. reuteri significantly reduced AAD (RR=0.37 and 0.35) and abdominal pain (RR=0.37 and 0.24). Conclusion: AAD occurred in 20.4% of children, with increased risk at younger age, lower respiratory and urinary tract infections, intravenous treatment and previous AAD. LGG and L. reuteri reduced both AAD and associated abdominal pain.

Gastrointestinal symptoms and fecal nucleic acid testing of children with 2019 coronavirus disease: a systematic review and meta-analysis

“…It is sometimes difficult to distinguish the gastrointestinal symptoms of pediatric COVID-19 from those caused by another viral illness, side effects of drugs, and digestive tract symptoms such as nausea and diarrhea caused by the disturbance of gastrointestinal flora by the fever itself. Some studies 49 have found that 20.4% children use antibiotics that cause diarrhea, and the diarrhea is more severe in younger patients with lower respiratory tract infections treated with intravenous antibiotics. Moreover, we discovered that the total incidence of gastrointestinal symptoms in children with COVID-19 was 17.7%; unfortunately, not all the studies described a control group when investigating the incidence of gastrointestinal symptoms in an antibiotic treatment group and non-antibiotic treatment group.…”

Gastrointestinal symptoms and fecal nucleic acid testing of children with 2019 coronavirus disease: a systematic review and meta-analysis

“…It is sometimes di cult to distinguish the gastrointestinal symptoms of pediatric COVID-19 from those caused by another viral illness, side effects of drugs, and digestive tract symptoms such as nausea and diarrhea caused by the disturbance of gastrointestinal ora by the fever itself. Some studies 49 have found that 20.4% children use antibiotics that cause diarrhea, and the diarrhea is more severe in younger patients with lower respiratory tract infections treated with intravenous antibiotics. Moreover, we discovered that the total incidence of gastrointestinal symptoms in children with COVID-19 was 17.7%; unfortunately, not all the studies described a control group when investigating the incidence of gastrointestinal symptoms in an antibiotic treatment group and non-antibiotic treatment group.…”

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

“…immunoassay [37]. In one study, testing for rota-and noroviruses was performed, but a specific method was not reported [57].…”

“…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].…”

“…Other outcomes regarding diarrhea included occurrence of infectious diarrhea-5 studies [28,31,37,39,44], stool consistency regardless of diarrhea occurrence-5 studies [33,40,41,53,54], bowel movement frequency-3 studies [50,53,55], and time to diarrhea onset from the start of antibiotic therapy-5 studies [8,30,31,34,57]. Additionally, the efficacy of…”