Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Children
Hania Szajewska1, Roberto Berni Canani, Alfredo Guarino
1*Medical University of Warsaw, Department of Paediatrics, Warsaw, Poland †Department of Translational Medical Science ‡European Laboratory for The Investigation of Food Induced Diseases and CEINGE Advanced Biotechnology, University of Naples "Federico II," Italy §Department of Paediatrics, Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia ||Department of Pediatrics, University Hospital Policlinico, University of Bari, Bari, Italy ¶Department of Gastroenterology, Hepatology and Nutrition, Children's Hospital, University Medical Centre, Ljubljana, Slovenia #Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel **Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium ††Department of Pediatrics, Emma Children's Hospital-AMC and VU Universit Medical Center, Amsterdam, The Netherlands ‡‡Pediatric Gastroenterology and Nutrition Unit, Soroka Medical Center. Ben-Gurion University, Beer-Sheva, Israel.
Insights
For preventing antibiotic-associated diarrhea (AAD) in children, Lactobacillus rhamnosus GG and Saccharomyces boulardii are recommended. These probiotics are suggested when risk factors for AAD are present.
Area of Science:
- Pediatric Gastroenterology
- Microbiology
- Evidence-Based Medicine
Background:
- Antibiotic-associated diarrhea (AAD) is a common adverse effect of antibiotic therapy in children.
- Probiotics are increasingly explored for preventing gastrointestinal disturbances during antibiotic treatment.
Purpose of the Study:
- To provide evidence-based recommendations for the use of probiotics in preventing AAD in pediatric populations.
- To guide clinicians on specific probiotic strains and their efficacy based on rigorous systematic reviews.
Main Methods:
- Systematic review of existing systematic reviews and subsequent randomized controlled trials (RCTs).
- Quality of Evidence (QoE) assessment using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines.
- Formulation of recommendations based on at least two RCTs with strain specification.
Main Results:
- Lactobacillus rhamnosus GG and Saccharomyces boulardii are recommended for preventing AAD in children with identified risk factors (moderate QoE, strong recommendation).
- Saccharomyces boulardii is suggested for preventing Clostridium difficile-associated diarrhea (low QoE, conditional recommendation).
- Insufficient evidence exists for other probiotic strains or combinations for AAD prevention.
Conclusions:
- Specific probiotic strains, Lactobacillus rhamnosus GG and Saccharomyces boulardii, demonstrate efficacy in preventing AAD in children.
- Clinical guidelines should incorporate these recommendations for targeted probiotic use in pediatric antibiotic therapy.
- Further research is needed for other probiotic strains and for the treatment of AAD.
Abstract:
This article provides recommendations, developed by the Working Group (WG) on Probiotics of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, for the use of probiotics for the prevention of antibiotic-associated diarrhea (AAD) in children based on a systematic review of previously completed systematic reviews and of randomized controlled trials published subsequently to these reviews. The use of probiotics for the treatment of AAD is not covered. The recommendations were formulated only if at least 2 randomized controlled trials that used a given probiotic (with strain specification) were available. The quality of evidence (QoE) was assessed using the Grading of Recommendations Assessment, Development, and Evaluation guidelines. If the use of probiotics for preventing AAD is considered because of the existence of risk factors such as class of antibiotic(s), duration of antibiotic treatment, age, need for hospitalization, comorbidities, or previous episodes of AAD diarrhea, the WG recommends using Lactobacillus rhamnosus GG (moderate QoE, strong recommendation) or Saccharomyces boulardii (moderate QoE, strong recommendation). If the use of probiotics for preventing Clostridium difficile-associated diarrhea is considered, the WG suggests using S boulardii (low QoE, conditional recommendation). Other strains or combinations of strains have been tested, but sufficient evidence is still lacking.
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