Antibiotic-associated Diarrhea In Children Research Articles

Development of enteric polymer-based microspheres by spray-drying for colonic delivery of Lactobacillus rhamnosus GG.

Antibiotics are well-known disruptive elements of the intestinal microbiota and antibiotic-associated diarrhea appeared as the most common complication related with post-antibiotic dysbiosis. Lactobacillus rhamnosus GG (LGG) strain is very effective in preventing antibiotic-associated diarrhea in children and adults. However, as any probiotics, it is concerned by the loss of viability during storage and gastrointestinal transit. The aim of this study was to develop an encapsulation system suitable for the specific colonic delivery of LGG strain after oral administration. For this purpose, spray-dried Eudragit® S100 microparticles encapsulating LGG bacteria were developed by using an aqueous based spray-drying approach, avoiding the use of organic solvents. Carbohydrates were added to the formulation since they are widely used as protective agents of bacteria against the harmful effect of dehydration stress. Here, both Surface Enhanced Raman Scattering (SERS) and conventional plate count methods showed that carbohydrates increased the survival ratio of bacteria after spray-drying from 3 to more than 50%. Moreover, these protective agents ensured low residual moisture content thus providing great stability of the cells in the spray-dried powder during storage. Significant improvement of the cell viability in simulated gastro intestinal fluid (SGIF) was observed for encapsulated cells as compared with free LGG bacteria for which no viable cell was detectable after 1h incubation in gastric fluid only. As a consequence, 4.5×107 CFU/g of encapsulated LGG were found viable after incubation of microparticles 1h in Simulated Gastric Fluid followed by 6h in Simulated Intestinal Fluid, corresponding to less than 3 log reduction of viable cells during the 7h incubation in Simulated Gastro Intestinal Fluid. These results attested that the developed encapsulation system is suitable for its use as a bacteria carrier for specific colonic delivery.

What methods are currently available to prevent and treat antibiotic-associated diarrhoea in children?

Unwanted drug reactions of the gastrointestinal tract (GIT), often with the development of antibiotic-associated diarrhoea (AAD), are the most frequent adverse effects of antibacterial therapy in outpatient practice. This review presents the most current data on antibiotic-associated intestinal lesions. It provides up-to-date information on the epidemiology and etiology of microbial factors of AAD and pseudomembranous colitis. The authors cite clinical forms of AAD, which range from idiopathic with a picture of enteritis to pathogen-specific AAD (antibiotic-associated colitis). A comprehensive approach to AAD verification and patient management tactics makes it possible to significantly reduce the number and severity of possible complications. AAD, including C. difficile-associated diarrhoea/colitis, should be suspected in any patient with diarrhoea who has received antibiotics in the previous 2 months. In addition to clinical signs, laboratory tests confirming clostridial infection should be evaluated. The article presents the algorithm of the comprehensive approach to the treatment of antibiotic-associated diarrhea (AAD), which along with the use of metronidazole and vancomycin places a high priority on the probiotics, which not only prevents relapse, but also protects from this pathology. The article presents general characteristics of probiotic preparations, mechanisms of action of probiotics: antagonistic influence on pathogenic and opportunistic bacteria of microbiota, strengthening of mucous barrier of gastrointestinal tract, and also influence on modulation of immune response, as a result of which the chain of mechanisms of immunological protection starts. On the basis of publications of domestic and foreign researchers, the possibilities of using various probiotic strains of bacteria, and in particular, the prospects of using Lactobacillus reuteri, have been considered.

Cost-Effectiveness of Lactobacillus rhamnosus GG on the Prevention of Antibiotic-Associated Diarrhea in Children in Colombia

Cost-Effectiveness of Lactobacillus rhamnosus GG on the Prevention of Antibiotic-Associated Diarrhea in Children in Colombia

The Effectiveness of Synbiotics in Preventing Antibiotic-Associated Diarrhea in Children: A Double-Blind Randomized Clinical Trial

Background: Antibiotic-associated diarrhea (AAD) is of great concern in children due to the wide range of antibiotic administration among this population. Studies considering the use of synbiotics for prevention or treatment of AAD are limited. In the current study, the effectiveness of synbiotics in preventing AAD was investigated. Methods: This randomized, double-blinded clinical trial was conducted on 100 patients undergoing antibiotic therapy for over five days. The patients were randomly divided into a case group receiving synbiotic therapy (Protexin; The United Kingdom) and a control group undergoing placebo therapy (consisting of starch sachets). Both groups began their medication within 24 hours after antibiotic initiation and continued it for further seven days after antibiotic therapy cessation. The two groups were compared regarding the incidence of diarrhea, stool consistency based on the Bristol Stool Scale (BSS), and the duration of diarrhea. Results: The members of case and control groups were not statistically different regarding age, gender distribution, length of hospitalization, the frequency of defecation, and stool consistency based on BSS before antibiotic therapy, primary and final diagnosis, the type of antibiotics prescribed, and duration of antibiotic therapy (P > 0.05). The incidence of AAD was significantly less in the case group compared with the control group (P = 0.016), while those with AAD did not show significant difference regarding the duration of diarrhea, stool consistency based on BSS, and the frequency of defecation a day (P = 0.51, 0.26, and 0.18, respectively). Conclusions: The findings of this study showed that early initiation of synbiotics and its long-term administration following antibiotic therapy cessation could considerably prevent AAD; however, in case of AAD occurrence synbiotic therapy cannot positively affect duration, stool consistency, and the frequency of defecation.

How effective are probiotics for the prevention of antibiotic-associated diarrhea in children?

How effective are probiotics for the prevention of antibiotic-associated diarrhea in children?

Can probiotics prevent antibiotic-associated diarrhea in children?

Can probiotics prevent antibiotic-associated diarrhea in children?

Probiotics for the prevention of pediatric antibiotic-associated diarrhea.

Probiotics for the prevention of pediatric antibiotic-associated diarrhea.

Role of Probiotics in Mycoplasma pneumoniae Pneumonia in Children: A Short-Term Pilot Project.

Mycoplasma pneumoniae is one of the most common pathogens causing community-acquired pneumonia in children. Mycoplasma pneumoniae pneumonia (MPP) can be successfully treated with azithromycin; however, antibiotic-associated diarrhea (AAD) is a common adverse effect. Increasing evidence suggests that some probiotics may prevent the development of AAD. The present study determined the effects of probiotics (live Clostridium butyricum plus Bifidobacterium infantis) on the prevention and treatment of AAD in children with MPP when co-administered with intravenous azithromycin. Fifty-five children with MPP were enrolled and received azithromycin (10 mg/kg/day; once daily for 7 days) combined with probiotics (starting on the third day of azithromycin treatment; 1,500 mg three times daily); 50 healthy children served as controls. At the end of the trial, the incidence of AAD, fecal microbiota, intestinal mucosal barriers, and systemic inflammation were analyzed using recommended systems biology techniques. No cases of AAD or other adverse events occurred in children with MPP after co-administration of probiotics with azithromycin. A live C. butyricum plus B. infantis preparation partly reconstructed the gut microbiota, especially restoration of bacterial diversity. The indicators of intestinal mucosal barrier function, such as D-lactate, endotoxin, and diamine oxidase, were significantly improved and the systemic inflammation (interleukin 10) was attenuated after probiotic therapy. The present study indicated that co-administration of probiotics with azithromycin is a promising therapy for MPP treatment which could prevent and treat AAD effectively.

Lactobacillus reuteri DSM 17938 in the prevention of antibiotic-associated diarrhoea in children: a randomized clinical trial

ObjectivesTo assess the effectiveness of Lactobacillus reuteri DSM 17938 for the prevention of diarrhoea and antibiotic-associated diarrhoea (AAD) in children. MethodsHospitalized children who received antibiotics were assigned by a computer-generated list to receive L. reuteri (at 2 × 108 CFU) or placebo, twice daily, for the duration of antibiotic treatment. Follow up was for 1 week after antibiotic cessation. The primary outcome measures were diarrhoea and AAD. Both were defined according to one of three definitions (i) three or more loose or watery stools per day for ≥48 h; (ii) three or more loose or watery stools per day for ≥24 h; or (iii) two or more loose or watery stools per day for ≥24 h. For AAD, it had to be diarrhoea caused by Clostridium difficile or otherwise unexplained diarrhoea. ResultsA total of 250 children were randomized and 247 were analysed (L. reuteri n = 123, placebo n = 124; median age 4 months). The occurrences of diarrhoea and AAD were similar in both groups, regardless of the definition used. Using the strictest definition (i.e. definition (i)), the occurrence of diarrhoea in the L. reuteri group was 25 (20%) compared with 16 (13%) in the placebo group (absolute risk reduction –0.07 (–0.17 to 0.02). The occurrence of AAD was 14 (11.4%) in the L. reuteri group compared with 8 (6.5%) in the placebo group (absolute risk reduction –0.05 (–0.13 to 0.02)). The groups were similar with respect to all secondary outcome measures, including adverse events. ConclusionsLactobacillus reuteri was not effective in the prevention of diarrhoea or AAD in children.

Effect of a multispecies probiotic on reducing the incidence of antibiotic-associated diarrhoea in children: a protocol for a randomised controlled trial

IntroductionCertain individual probiotic strains have been proven to be effective in reducing the risk of antibiotic-associated diarrhoea (AAD). However, the effects of using multispecies probiotics (MPs) remain unclear. We aim...

A multicenter randomized controlled study of Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea in infants and young children

Objective: To evaluate the efficacy and safety of Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea (AAD) in infants and young children. Method: From November 2012 to September 2013, ten research units of large teaching hospitals or children's hospitals participated in this multicenter randomized controlled clinical trial. Hospitalized young children aged between 1 month and 3 years (nongastrointestinal infection and antibiotic therapy required)were involved in our study. The children were randomly divided into control group and prevention group by means of block random allocation method. The control group received antibiotic therapy and other conventional treatment. The prevention group was given additional Saccharomyces boulardii (250 mg/d) orally. Diarrhea rates of two groups were compared both during the usage of antibiotics and within 14 days after the antibiotics withdrawal. The adverse reactions of Saccharomyces boulardii were observed all through this study. The results were analyzed by χ(2) test or Kruskal-Wallis test or t test. Result: Totally 408 cases (213 cases in prevention group and 195 cases in control group) were enrolled. The age ranged from 1 month to 3 years, with an average age of 1.14 years. The basic diseases were parenteral infections: 368 cases with different kinds of respiratory tract infections or pneumonia, 10 cases of bacterial meningitis, 9 cases with septicemia or sepsis, 6 cases with pertussis or pertussis like syndrome, 5 cases with urinary infection, 5 cases with skin or subcutaneous tissue infections, 3 cases of Kawasaki disease, one with scarlet fever and one with congenital syphilis. During the administration of antibiotics, the incidence of AAD in prevention group was 10.3% (22 cases), which was significantly lower than that of control group (57 cases, 29.2%, χ(2)=23.296, P<0.05). Within 14 days after the discontinuation of antibiotics, the percent of new diarrhea cases in prevention group (2.4%, 5/213) was also significantly lower than that in control group (16.4%, 32/195, χ(2)=23.4, P<0.05). Further analysis revealed that the rate of AAD in children less than or equal to 1 year old (25.1%, 52/207) was significantly higher than that of over 1 year old (13.4%, 27/201, χ(2)=8.922, P<0.05). The incidence of AAD in children treated with antibiotics for more than 5 days was 22.2%(60/270), which was significantly higher than that of less than or equal to 5 days (13.8%, 19/138, χ(2)=4.180, P<0.05). Although no significant difference was observed, the AAD rate of patients with combined use of two antibiotics was higher than that of using one. During the antibiotic therapy, compared with the control group, the risk of AAD in children under 1 year old was reduced by 52% (χ(2)=9.217, P<0.05), and 91% (χ(2)=20.35, P<0.05) in the children over 1 year old in prevention group. The risk of AAD of prevention group decreased by 66% (χ(2)=13.67, P<0.05) in patients treated with one antibiotics, and 65% in children with combined use of antibiotics (χ(2)=10.57, P<0.05). In patients treated with antibiotics for less than or equal to 5 days, the risk of AAD decreased by 74% in prevention group (χ(2)=7.38, P<0.05); and 63% if the course lasted for over 5 days (χ(2)=16.87, P<0.05). Within 14 days after the withdrawal of antibiotics, compared with the control group, the risk of diarrhea in the prevention group decreased by 82% (χ(2)=13.35, P<0.05) in infants (≤1 year old) and 93% (χ(2)=12.00, P<0.05) in children (>1 year old); the risk of diarrhea was reduced by 86% (χ(2)=9.57, P<0.05) and 87% (χ(2)=17.71, P<0.05) respectively in prevention group with single and combined use of antibiotics. In patients treated with antibiotics for more than 5 days, the risk of diarrhea in prevention group was reduced by 63% (χ(2)=22.79, P<0.05), while there was no significant difference if the antibiotics course was less than or equal to 5 days (χ(2)=2.97, P>0.05). No adverse effects related with Saccharomyces boulardii were observed in our study. Conclusion:Saccharomyces boulardii is effective and safe to prevent AAD of infants and young children both during the usage of antibiotics and up to 14 days after drug discontinuance. It can be one of the drugs of for choice prevention of AAD in infants and young children. Trial registration Chinese Clinical Trial Tegister, ChiECRCT-2012-25.

Lebanese Registry in the Management of Antibiotic Associated Diarrhea in Children: Observational Study in Daily Practice

Background: Antibiotic-associated diarrhea (AAD) is a common complication in patients prescribed antibiotics, and represents an economic and health burden. Evidence that probiotics may be beneficial for the prevention of AAD is increasing. The aims of this registry were to assess the prevalence of probiotic prescriptions in pediatric patients for whom an antibiotic treatment regimen was prescribed, and to explore the potential health benefits that such an administration may provide. Methods: This longitudinal, multicenter, observational study enrolled 249 pediatric patients prescribed an antibiotic treatment for 5 - 14 days, with or without a concomitant probiotic. The number of probiotic-administered patients, and AAD incidence rates throughout the 15-day follow-up period, were assessed. Results: Of the 246 patients who met inclusion/exclusion criteria in Lebanon, the investigators had prescribed an additional probiotic treatment to 118 (48%) of them, while, the other 128 (52%) did not receive such additional treatment. A significantly higher number of patients in the probiotic group were at high risk of developing diarrhea (probiotic: 27.1% vs. no probiotic: 6.3%; P < 0.001). Among high risk patients, the frequency of diarrhea was doubled in the group with no probiotics (probiotic: 21.9% (n = 7) vs. no probiotic: 50.0% (n = 4); P = 0.182). Despite the significantly larger number of probiotic-administered patients that were at high risk of developing diarrhea, the proportion of patients who reported developing diarrhea was not statistically different between the two groups (probiotic: n = 22 (18.6%) vs. no probiotic: n = 24 (18.8%); P = 0.983). Conclusions: In conclusion, this Lebanese disease registry demonstrated that almost half of pediatric patients with mild to moderate infections were prescribed probiotics in combination with antibiotics to decrease the risk of AAD. This observation was particularly significant in the high risk population as per the treating physicia n’ s judgment. Int J Clin Pediatr. 2017;6(1-2):8-19 doi: https://doi.org/10.14740/ijcp269w

Preventive Role of Probiotic in Antibiotic Associated Diarrhoea in Children

Preventive Role of Probiotic in Antibiotic Associated Diarrhoea in Children

Lactobacillus reuteri DSM 17938 in the prevention of antibiotic-associated diarrhoea in children: protocol of a randomised controlled trial

IntroductionAdministration of some probiotics appears to reduce the risk of antibiotic-associated diarrhoea (AAD). The effects of probiotics are strain-specific, thus, the efficacy and safety of each probiotic strain should be...

Antibiotic-associated diarrhea in children: a current view of the problem

Antibiotic-associated diarrhea (AAD) is a common and quite dangerous complication of antibiotic therapy. AAD treatment is associated with certain challenges; the disease can be recurrent, while hospitalized patients can pose an epidemiological risk. The article tells about the etiology and pathogenesis of AAD, the main approaches in the diagnosis and treatment. The use of modern probiotic drugs against a background of antibacterial therapy seems effective in preventing AAD. The article demonstrates that Linex® Forte is one of the most efficient drugs for the treatment and prevention of the disease.

Antibiotic-associated diarrhea in children: how to identify, what to do and how to treat?

Rational antibiotic therapy is one of the most important components in the treatment of children with various infectious and inflammatory diseases. However, wide and sometimes unjustified use of AB in pediatric practice often leads to the development of a variety of complications. Children receiveing AB, especially during the first 5 years of life, are at a very high risk of developing antibiotic-associated diarrhea (AAD) which manifests itself in three or more episodes of unformed stools for two or more consecutive days or for 8 weeks after withdrawal. The most relevant pathogen of AAD is C. difficile which, according to various data, causes from 10 to 25% of AAD cases and 90 to 100% of all cases of pseudomembranous colitis (PMC). Given the high probability of developing dangerous complications such as PMC, special attention should be paid to the prevention of the infection associated with C. difficile by reducing the frequency of uncontrolled and unjustified use of AB. A new generation of eco-antibiotics can be recommended which allow to maintain diversity of the intestinal microbiota and are less likely to cause complications.

Probiotics can help prevent antibiotic-associated diarrhea in children

Probiotics can help prevent antibiotic-associated diarrhea in children

Probiotics and the Prevention of Antibiotic-Associated Diarrhea in Infants and Children.

In children prescribed an antibiotic, is the co-administration of a probiotic associated with lower rates of antibiotic-associated diarrhea without an increase in clinically important adverse events? Moderate-quality evidence suggests that probiotics are associated with lower rates of antibiotic-associated diarrhea in children (aged 1 month to 18 years) without an increase in adverse events.

Probiotics for the Prevention of Pediatric Antibiotic-Associated Diarrhea

Probiotics for the Prevention of Pediatric Antibiotic-Associated Diarrhea

Can probiotics prevent antibiotic-associated diarrhea in children?

Can probiotics prevent antibiotic-associated diarrhea in children?