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Probiotic supplementation in children with cystic fibrosis-a systematic review

Anitha Ananthan1, Haribalakrishna Balasubramanian2, Shripada Rao3,4

  • 1Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, 378 Bagot Road, Subiaco, Perth, WA, 6008, Australia. ani.gem81@gmail.com.

European Journal of Pediatrics
|September 1, 2016
PubMed

Insights

Probiotics may reduce pulmonary exacerbations and gut inflammation in cystic fibrosis (CF) patients. However, current evidence is limited, necessitating further high-quality research on probiotic supplementation for CF.

Area of Science:

  • Gastroenterology
  • Pediatrics
  • Microbiology

Background:

  • Gut dysbiosis is prevalent in children with cystic fibrosis (CF), contributing to gastrointestinal and respiratory issues.
  • Probiotics show potential in mitigating gut dysbiosis and enhancing gut function in pediatric populations.
  • Existing research on probiotics for CF is limited, with a need for comprehensive reviews.

Purpose of the Study:

  • To systematically review randomized controlled trials (RCTs) and non-RCTs on probiotic supplementation in children with CF.
  • To evaluate the effects of probiotics on primary outcomes like pulmonary exacerbations and secondary outcomes including gut health.

Main Methods:

  • A systematic review adhering to Cochrane methodology, PRISMA, and MOOSE guidelines.
  • Inclusion of nine studies (6 RCTs, 3 non-RCTs) with a total of 275 pediatric CF patients.
  • Analysis focused on pulmonary exacerbations, hospitalization duration, antibiotic use, mortality, gastrointestinal symptoms, gut inflammation markers, and microbial balance.

Main Results:

  • Probiotic supplementation significantly reduced the rate of pulmonary exacerbations (RR 0.25, p < 0.00001) with low-quality evidence.
  • A significant decrease in fecal calprotectin (FCLP) levels (MD -16.71, p = 0.002) was observed, also with low-quality evidence.
  • Improvements in gastrointestinal symptoms and gut microbial balance were noted, including shifts in bacterial populations.

Conclusions:

  • The current evidence regarding the efficacy and safety of probiotics in pediatric CF is limited and of low quality.
  • Further well-designed, adequately powered RCTs are essential to confirm the benefits of probiotics in CF management.
  • Future research should focus on clinically meaningful outcomes to guide probiotic use in children with cystic fibrosis.
Abstract

Keywords:
Cystic fibrosisFecal calprotectinGut dysbiosisProbioticsPulmonary exacerbation

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