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Probiotics & antibiotic-associated diarrhoea prevention in children

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THE MICROBIOME: A DELICATE BALANCE 

The microbiome refers to the collective bacterial species found in the gut, skin, and mouth. Mediclinic explains that together, the balance between the ‘good’ and ‘bad’ bacteria or micro-organisms in the gut can affect the proper functioning of the immune system, the body’s ability to absorb nutrients from food, blood sugar levels, and even emotions. Use of antibiotics is one of the factors known to alter the microbiome composition. 

ANTIBIOTIC-ASSOCIATED DIARRHOEA 

Antibiotic-associated diarrhoea (AAD) is one of the most common complications of antibiotic therapy in children. “Defined as diarrhoea that occurs in relation to antibiotic treatment with the exclusion of other aetiologies. It is more commonly caused by antibiotics that target anaerobic bacteria (e.g. clindamycin, penicillin, amoxicillin, and clavulanic acid etc.) which cause significant disruption of the enteric microbiome,” described paediatric gastroenterologist Dr Iva Hojsak (Probiotics in Children: What Is the Evidence? published in Paediatric gastroenterology, hepatology, & nutrition, Volume 20.3. 2017). “Clinically, AAD may present as mild diarrhoea, but it can also present as fulminant pseudomembranous colitis caused by Clostridium difficile.”  

Although the prevalence of AAD varies depending on the criteria used to diagnose it, in children it ranges from about 5-40%, Professor Hania Szajewska reported in What are the indications for using probiotics in children? (published in Archives of Disease in Childhood 2016. 101:398-403). 

PREVENTION OF AAD 

“Measures which can prevent AAD are limited mainly to reduction in antibiotic use, type of antibiotic prescribed, and the use of probiotics,” Dr Hojsak said. But she warned that not all probiotics have the same efficacy for every specific clinical indication. 

This makes it important to ensure the probiotic you recommend has the appropriate probiotic species for the targeted illness. 

“Evidence from several meta-analyses has consistently shown that most of the tested probiotics significantly reduce the risk of AAD in the general (mainly adult) population,” Dr Hojsak reported. “In children, two of the most effective probiotics for reducing the risk of AAD are S. boulardii (Saccharomyces boulardii) and LGG (Lactobacillus GG).” 

As a result of their previous research Prof Szajewska and Dr Hojsak joined forces in 2020 to conduct a full review on the most recent research available to identify the Health benefits of Lactobacillus rhamnosus GG and Bifidobacterium animalis subspecies lactis BB-12 in children. They identified 13 meta-analyses, three systematic reviews, and 15 randomised, controlled trials and found convincing evidence that LGG can prevent AAD. 

“We propose that LGG can be safely administered to toddlers and older children to prevent AAD. These findings should be considered for incorporation into clinical practice guidelines and should help to focus the efforts of the probiotic industry,” Szajewska and Hojsak concluded. 

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