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Lactobacillus GG in the Prevention of Antibiotic-Associated Diarrhea in the Pediatric Intensive Care Unit: A
Allison Chung1,2, Mukul Sehgal2, Cristina Gavrilita2
1Department of Pharmacy Practice (AMC), Auburn University Harrison College of Pharmacy, Mobile, AL.
Insights
Lactobacillus GG (LGG) may reduce antibiotic-associated diarrhea (AAD) in pediatric intensive care unit (PICU) patients. This pilot study found LGG to be safe and potentially beneficial for critically ill children receiving antibiotics.
Area of Science:
- Clinical microbiology
- Pediatric critical care medicine
- Gastroenterology
Background:
- Antibiotic-associated diarrhea (AAD) is a common complication in pediatric intensive care units (PICUs).
- Probiotics, such as Lactobacillus GG (LGG), are being investigated for their potential to prevent AAD.
- Limited data exists on LGG efficacy in critically ill pediatric populations.
Purpose of the Study:
- To evaluate the efficacy of Lactobacillus GG (LGG) in preventing antibiotic-associated diarrhea (AAD).
- To assess the safety of LGG supplementation in pediatric intensive care unit (PICU) patients.
- To explore the potential impact of LGG on PICU length of stay.
Main Methods:
- Prospective, randomized, double-blind, placebo-controlled pilot trial conducted in an academic PICU.
- 19 eligible pediatric patients (≤17 years) receiving antibiotics for ≥72 hours were randomized to receive LGG or placebo.
- LGG (30 × 10^9 CFU) or placebo administered twice daily during antibiotic therapy; diarrhea defined as ≥3 loose stools/24h.
Main Results:
- AAD occurred in 30% of patients receiving LGG versus 55.5% in the placebo group (p=0.375).
- The median PICU length of stay for patients with AAD was significantly shorter in the LGG group (6 days) compared to placebo (7.5 days) (p=0.033).
- No adverse events were reported or attributed to LGG supplementation.
Conclusions:
- Lactobacillus GG (LGG) appears safe for use in critically ill pediatric patients.
- LGG supplementation shows a potential trend towards reducing the incidence of antibiotic-associated diarrhea (AAD).
- Further investigation is warranted to confirm LGG's efficacy in preventing AAD in the PICU setting.
Objective:
The objective of this study was to assess the efficacy of lactobacillus GG (LGG) to prevent antibiotic-associated diarrhea (AAD) in the pediatric intensive care unit (PICU).
Methods:
This was a prospective randomized, double-blind, placebo-controlled pilot trial in an academic PICU over 1 year. Patients ≤ 17 years who required antibiotic therapy ≥ 72 hours were randomly assigned to receive placebo or LGG. Exclusion criteria included antibiotics ≥ 48 hours prior, prior probiotics, pre-existing diarrhea, laxative therapy, immunocompromise, and gastrointestinal (GI) disorders. LGG (30 × 109 colony forming units) or a matching placebo capsule was administered twice daily for the duration of antibiotic therapy. Diarrhea was defined as 3 or more loose stools in 24 hours.
Results:
A total of 36 patients were enrolled with 19 patients eligible for final analysis; 10 in the LGG group and 9 in the placebo group. Median age and weight of LGG vs placebo groups were 0.4 (0.17-1.42) vs 0.86 (1.21-10.92) years, p = 0.48, and 6 (3.4-9.9) vs 9.8 (3.71-39.6) kg, p = 0.31, respectively. Antibiotic associated diarrhea was experienced in 30% vs 55.5% of patients in the LGG groups vs placebo (p = 0.375), respectively. The median PICU length of stay for the patients with AAD was 6 days compared with 7.5 days in placebo group (p = 0.033). The RR ratio for AAD when using LGG was 0.59 (95% CI, 0.21-1.6). No adverse events were reported or attributed to LGG.
Conclusion:
Results of this pilot study indicate that LGG is safe and could potentially reduce the incidence of AAD in the critically ill pediatric patients at this academic institution. Our findings suggest clinicians should consider the use of LGG in appropriate PICU patients.
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