EVALUATING PROBIOTICS IN PEDIATRIC ANTIBIOTIC-ASSOCIATED DIARRHEA: A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS
Main Article Content
Keywords
Probiotics, antibiotic-associated diarrhea, pediatric populations, Lactobacillus rhamnosus GG,, Saccharomyces boulardii,, gut microbiota, randomized controlled trials
Abstract
Background: Antibiotic-associated diarrhea (AAD) is a common side effect of antibiotic therapy in children, occurring in 5–49% of cases due to disruptions in gut microbiota. Probiotics, defined as live microorganisms conferring health benefits when consumed in adequate amounts, have shown promise in managing AAD. However, the efficacy and tolerability of specific probiotic strains remain under investigation.
Objective: This review evaluates the efficacy and safety of probiotics in reducing the incidence and duration of AAD in children, focusing on evidence for the most effective strains and formulations.
Methodology: A systematic review was conducted, synthesizing data from randomized controlled trials (RCTs), meta-analyses, and observational studies. Primary outcomes assessed included the incidence, duration, and severity of AAD among pediatric patients receiving probiotics alongside antibiotics.
Results: Evidence indicates that Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii effectively reduce AAD incidence and duration in children. Probiotics were well tolerated with minimal adverse effects reported.
Conclusion: Probiotics, particularly LGG and S. boulardii, are effective in managing AAD in pediatric patients. Their use is associated with reduced diarrhea duration and minimal side effects, highlighting their potential as safe adjuncts to antibiotic therapy.
Objective: This review evaluates the efficacy and safety of probiotics in reducing the incidence and duration of AAD in children, focusing on evidence for the most effective strains and formulations.
Methodology: A systematic review was conducted, synthesizing data from randomized controlled trials (RCTs), meta-analyses, and observational studies. Primary outcomes assessed included the incidence, duration, and severity of AAD among pediatric patients receiving probiotics alongside antibiotics.
Results: Evidence indicates that Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii effectively reduce AAD incidence and duration in children. Probiotics were well tolerated with minimal adverse effects reported.
Conclusion: Probiotics, particularly LGG and S. boulardii, are effective in managing AAD in pediatric patients. Their use is associated with reduced diarrhea duration and minimal side effects, highlighting their potential as safe adjuncts to antibiotic therapy.
References
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20. Turck, D., Bernet, J. P., Marx, J., et al. (2003). Incidence and risk factors of oral antibiotic-associated diarrhea in an outpatient pediatric population. Journal of Pediatric Gastroenterology and Nutrition, 37(1), 22–26. https://doi.org/10.1097/00005176-200307000-00006
21. Zeaiter, S., et al. (2018). A systematic review of probiotics' impact on children's health. Journal of Pediatric Research, 83(3), 297–308. https://doi.org/10.24953/turkjped.2017.299
2. Bartlett, J. G. (2002). Antibiotic-associated diarrhea. New England Journal of Medicine, 346(5), 334–339. https://doi.org/10.1056/NEJMra012397
3. Cai, J., Zhao, C., Du, Y., Zhang, Y., Zhao, M., & Zhao, Q. (2018). Comparative efficacy and tolerability of probiotics for antibiotic-associated diarrhea: Systematic review with network meta-analysis. United European Gastroenterology Journal, 6(2), 169–180. https://doi.org/10.1177/2050640617736987
4. Casem, R. A. O. (2013). Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea in children: A randomized controlled trial. PIDSP Journal, 13(2), 70–76.
5. D’Souza, A. L., Rajkumar, C., Cooke, J., & Bulpitt, C. J. (2002). Probiotics in prevention of antibiotic-associated diarrhea: Meta-analysis. BMJ, 324(7350), 1361–1364. https://doi.org/10.1136/bmj.324.7350.1361
6. Dietrich, C., et al. (2014). The efficacy of probiotics for diarrhea prevention. Clinical Nutrition, 33(4), 592–598. https://doi.org/10.1016/j.clnu.2013.09.003
7. Diplock, A. T., Aggett, P. J., Ashwell, M., et al. (1999). Scientific concepts of functional foods in Europe: Consensus document. British Journal of Nutrition, 81(Suppl. 1), S1–S27. https://doi.org/10.1079/BJN19990003
8. Eddy, J. T., Stamatakis, M. K., & Makela, E. H. (1997). Saccharomyces boulardii for the treatment of Clostridium difficile-associated colitis. Annals of Pharmacotherapy, 31(8), 919–921. https://doi.org/10.1177/106002809703100809
9. Ghouri, Y. A., et al. (2014). Systematic review of probiotics and pediatric AAD. Journal of Gastroenterology, 49(9), 1231–1243. https://doi.org/10.1007/s00535-014-0985-9
10. Higgins, J. P., & Green, S. (Eds.). (2011). Cochrane handbook for systematic reviews of interventions. Cochrane Collaboration. https://doi.org/10.1002/9780470712184
11. Jafarnejad, S., et al. (2013). Probiotics for the prevention and treatment of antibiotic-associated diarrhea: Meta-analysis. Journal of Research in Medical Sciences, 18(2), 155–161.
12. Johnston, B. C., et al. (2006). Probiotics for pediatric antibiotic-associated diarrhea: A meta-analysis of randomized placebo-controlled trials. Canadian Medical Association Journal, 175(4), 377–384. https://doi.org/10.1503/cmaj.051123
13. Kotowska, M., Albrecht, P., & Szajewska, H. (2005). Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea in children: A randomized double-blind placebo-controlled trial. Alimentary Pharmacology & Therapeutics, 21(5), 583–590. https://doi.org/10.1111/j.1365-2036.2005.02353.x
14. Lewis, S. J., Potts, L. F., & Barry, R. E. (1998). The lack of therapeutic effect of S. boulardii in the prevention of antibiotic-related diarrhea in elderly patients. Journal of Infection, 36(2), 171–174. https://doi.org/10.1016/S0163-4453(98)80002-6
15. McFarland, L. V., Surawicz, C. M., & Greenberg, R. N., et al. (1995). Prevention of β-lactam-associated diarrhea by Saccharomyces boulardii compared with placebo. American Journal of Gastroenterology, 90(3), 439–448.
16. Probiotics: Their potential to impact human health. (2007). Ames, IA: Council for Agricultural Science and Technology.
17. Surawicz, C. M. (2003). Probiotics, antibiotic-associated diarrhea, and Clostridium difficile diarrhea in humans. Best Practice & Research Clinical Gastroenterology, 17(5), 775–783. https://doi.org/10.1016/S1521-6918(03)00042-1
18. Tan, C. C., et al. (2012). Probiotics as adjunct therapy for pediatric infections. Pediatric Clinics of North America, 59(1), 207–225. https://doi.org/10.1016/j.pcl.2011.10.003
19. Thomas, D. W., et al. (2010). Clinical report—Probiotics and prebiotics in pediatrics. Pediatrics, 126(6), 1217–1231. https://doi.org/10.1542/peds.2010-2548
20. Turck, D., Bernet, J. P., Marx, J., et al. (2003). Incidence and risk factors of oral antibiotic-associated diarrhea in an outpatient pediatric population. Journal of Pediatric Gastroenterology and Nutrition, 37(1), 22–26. https://doi.org/10.1097/00005176-200307000-00006
21. Zeaiter, S., et al. (2018). A systematic review of probiotics' impact on children's health. Journal of Pediatric Research, 83(3), 297–308. https://doi.org/10.24953/turkjped.2017.299
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Published
Dec 18, 2024
Article Details
How to Cite
Fatima Abdalla Alshamsi, Mahra Khalid Alshamsi, Mariam Al Bedwawi, Areeb Jamil, Noora Alomaira, Meera Al Shamsi, Linda Saad A, Al Ghamdi, Teqwa Grib, Sundas Dildar, & Muhammad Awais Waheed. (2024). EVALUATING PROBIOTICS IN PEDIATRIC ANTIBIOTIC-ASSOCIATED DIARRHEA: A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 1943-1951. https://doi.org/10.53555/8khapm34
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Author Biographies
Fatima Abdalla Alshamsi
Al Qassimi Hospital, UAE.
Mahra Khalid Alshamsi
Al Qassimi Hospital, UAE.
Mariam Al Bedwawi
Sheikh Shakhbout Medical City, Abu Dhabi.
Areeb Jamil
RAK Medical & Health Sciences University, Abu Dhabi.
Noora Alomaira
Sheikh Khalifa Medical City (SKMC).
Meera Al Shamsi
Zayed Higher Organization for People of Determination.
Linda Saad A, Al Ghamdi
Faculty of Medicine in Al-Baha University.
Teqwa Grib
Abu Dhabi UAE.
Sundas Dildar
Fatima Jinnah Medical University.
Muhammad Awais Waheed
Fauji Foundation Hospital.
How to Cite
Fatima Abdalla Alshamsi, Mahra Khalid Alshamsi, Mariam Al Bedwawi, Areeb Jamil, Noora Alomaira, Meera Al Shamsi, Linda Saad A, Al Ghamdi, Teqwa Grib, Sundas Dildar, & Muhammad Awais Waheed. (2024). EVALUATING PROBIOTICS IN PEDIATRIC ANTIBIOTIC-ASSOCIATED DIARRHEA: A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 1943-1951. https://doi.org/10.53555/8khapm34