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Probiotics to Prevent Antibiotic-Associated Diarrhea in Children

 

Am Fam Physician. 2020 Mar 1;101(5):online.

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PROBIOTICS TO PREVENT ANTIBIOTIC-ASSOCIATED DIARRHEA IN CHILDREN

BenefitsHarms

1 in 9 did not develop antibiotic-associated diarrhea

None

1 in 6 did not develop antibiotic-associated diarrhea when receiving high-dose probiotics (especially those containing Saccharomyces boulardii and Lactobacillus rhamnosus)

PROBIOTICS TO PREVENT ANTIBIOTIC-ASSOCIATED DIARRHEA IN CHILDREN

BenefitsHarms

1 in 9 did not develop antibiotic-associated diarrhea

None

1 in 6 did not develop antibiotic-associated diarrhea when receiving high-dose probiotics (especially those containing Saccharomyces boulardii and Lactobacillus rhamnosus)

Details for This Review

Study Population: Patients 0 to 18 years of age receiving antibiotics in inpatient and outpatient settings

Efficacy End Points: Incidence of antibiotic-associated diarrhea, mean duration of diarrhea

Harm End Points: Serious adverse reactions; common, nonsevere adverse effects (e.g., constipation, rash, abdominal bloating, gas, nausea, flatulence)

Narrative: Antibiotics often disrupt the natural balance of nonpathogenic bacterial flora within the gastrointestinal tract.1 This action can permit pathogenic bacteria to uncontrollably reproduce; interfere with mineral and vitamin metabolism; compromise mucosal integrity within the intestines; and lead to antibiotic-associated diarrhea.2 In children, stool frequency associated with antibiotic-associated diarrhea may be challenging to quantify, and significantly varies between infants and older children.

Antibiotics commonly associated with diarrhea include cephalosporins, lincosamides (especially clindamycin), and aminopenicillins. 35 Antibiotic-associated diarrhea is commonly classified as mild to moderate and self-limited, but rare cases of severe antibiotic-associated diarrhea have been reported and require immediate medical attention to treat electrolyte disturbances, volume depletion, toxic megacolon, and pseudomembranous colitis.6,7

Probiotics are supplements that contain nonpathogenic species of bacteria or yeast that reinforce the epithelial, mucosal, intestinal, and systemic immune regulatory activities of the gastrointestinal tract.8,9 Studies have demonstrated that probiotics are safe and effective when used in conjunction with antibiotics for preventing antibiotic-associated diarrhea in otherwise healthy children.10

The Cochrane Inflammatory Bowel Disease Group evaluated the prevention of antibiotic-associated diarrhea with probiotic use in children. The most beneficial strains and doses of probiotics were sought by identifying 33 randomized,

Author disclosure: No relevant financial affiliations.

References

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1. Madsen KL. The use of probiotics in gastrointestinal disease. Can J Gastroenterol. 2001;15(12):817–822....

2. Saavedra JM. Probiotics plus antibiotics: regulating our bacterial environment. J Pediatr. 1999;135(5):535–537.

3. McFarland LV. Antibiotic-associated diarrhea: epidemiology, trends and treatment. Future Microbiol. 2008;3(5):563–578.

4. Owens RC Jr, Donskey CJ, Gaynes RP, et al. Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis. 2008;46(suppl 1):S19–S31.

5. Wiström J, Norrby SR, Myhre EB, et al. Frequency of antibiotic-associated diarrhoea in 2462 antibiotic-treated hospitalized patients: a prospective study. J Antimicrob Chemother. 2001;47(1):43–50.

6. Arvola T, Laiho K, Torkkeli S, et al. Prophylactic Lactobacillus GG reduces antibiotic-associated diarrhea in children with respiratory infections: a randomized study. Pediatrics. 1999;104(5):e64.

7. National Clostridium difficile Standards Group: Report to the Department of Health. J Hosp Infect. 2004;56(suppl 1):1–38.

8. Gibson GR. Dietary modulation of the human gut micro-flora using prebiotics. Br J Nutr. 1998;80(4):S209–S212.

9. Goldin BR. Health benefits of probiotics. Br J Nutr. 1998;80(4):S203–S207.

10. Goldenberg JZ, Lytvyn L, Steurich J, et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev. 2015;(12):CD004827.

11. Guo Q, Goldenberg JZ, Humphrey C, et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev. 2019;(4):CD004827.

 

 

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