Treatment Of Antibiotic-associated Diarrhea Research Articles

Potential Probiotic Weizmannia coagulans WC10 Improved Antibiotic-Associated Diarrhea in Mice by Regulating the Gut Microbiota and Metabolic Homeostasis.

Antibiotic-associated diarrhea (AAD) is a common side effect of long-term and heavy antibiotic therapy. Weizmannia coagulans (W. coagulans) is an ideal probiotic because of its high viability, stability, and numerous health benefits to the host. In this study, the strains were first screened for W. coagulans WC10 (WC10) with a high combined ability based on their biological properties of gastrointestinal tolerance, adhesion, and short-chain fatty acid production ability. The effect of WC10 on mice with AAD was further evaluated. The results showed that WC10 was effective in improving the symptoms of AAD, effectively restoring antibiotic-induced weight loss, and reducing diarrhea status score and fecal water content. In addition, WC10 decreased the expression of pro-inflammatory cytokines and increased the expression of anti-inflammatory cytokines, alleviated intestinal tissue damage and inflammation, and improved intestinal epithelial barrier function by decreasing serum levels of enterotoxin, DAO, and D-lactic acid, and by increasing the expression of the intestinal mucosal immune factors sIgA and occludin. Importantly, the composition and function of the gut microbiota gradually recovered after WC10 treatment, increasing the number of SCFAs-producing Bifidobacterium and Roseburia. Subsequently, the short-chain fatty acid (SCFA) content was examined and WC10 significantly increased acetate, propionate, and butyrate production. Additionally, metabolomic analysis also showed that WC10 reversed the antibiotic interference with major metabolic pathways. These findings provide a solid scientific basis for the future application of W. coagulans WC10 in the treatment of AAD.

Probiotic use in pediatric kidney transplant recipients: What are current practices, and are they evidence-based? A pediatric nephrology research consortium study.

Probiotics are living microorganisms that may confer health benefits to their host if administered in sufficient quantities. However, data on the use of probiotics in transplant recipients are scarce. This multi-center survey of pediatric nephrologists aimed to examine variations in practice regarding the use of probiotics in pediatric kidney transplant recipients. The survey was conducted via a 10-item questionnaire (developed in Survey Monkey) administered to pediatric nephrologists participating in the Pediatric Nephrology Research Consortium meeting in April 2023. Sixty-four pediatric nephrologists completed the survey. Twenty-seven (42.2%) respondents reported having prescribed probiotics to pediatric kidney transplant recipients. The primary reason for probiotic use was the treatment of antibiotic-associated diarrhea (n = 20), with other reasons including recurrent Clostridium difficile infection (n = 15), general gut health promotion (n = 12), recurrent urinary tract infections (n = 8), and parental request (n = 1). Of those who prescribed probiotics, 48.1% held them during periods of neutropenia and 14.8% during central venous line use. Of the 64 respondents, 20 reported the lack of safety data as a concern for using probiotics in kidney transplant recipients. Pediatric nephrologists are increasingly prescribing probiotics to pediatric kidney transplant recipients; nevertheless, substantial practice variations exist. The paucity of safety data is a significant deterrent to probiotic use in this population.

Deciphering the pharmacological mechanisms of Shenlingbaizhu formula in antibiotic-associated diarrhea treatment: Network pharmacological analysis and experimental validation

Ethnopharmacological relevanceShenlingbaizhu (SLBZ) formula, a classical traditional Chinese medicinal (TCM) formula, has been widely used for treating antibiotic-associated diarrhea (AAD). However, the underlying pharmacological mechanisms have not yet been investigated thoroughly. Aim of the studyTo explore the remission mechanism of SLBZ in the treatment of AAD, we conducted network pharmacological analysis and experimental validation in vitro and in vivo. Materials and methodsIn this study, the main compounds of SLBZ were identified by ultra-high-performance liquid chromatography-mass spectroscopy (UHPLC-MS) and online databases. The targets of the active components and AAD-related targets were predicted by network pharmacology, and the potential targets of SLBZ against AAD were obtained. Then the core targets were recognized after Protein-Protein Interaction (PPI) analysis. Based on these, gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway analyses were conducted, and the key pathway was screened. Subsequently, molecular docking was performed using Auto Dock Vina to find the key components that played a crucial role in that pathway. Molecular dynamics simulation was performed by Gromacs software to detect the binding mode. Finally, the results were confirmed by in vitro and in vivo experiments. ResultsA total of 66 active ingredients of SLBZ were detected by UHPLC-MS, and 128 active ingredients were screened out by network pharmacological analysis. Additionally, 935 drug targets and 1686 AAD-related targets were obtained. Seventy-eight intersected genes were selected as potential therapeutic targets and 19 genes were excavated as core targets. Enrichment analysis revealed PI3K-AKT signaling pathway was the key pathway in SLBZ against AAD. Topological analysis further revealed that JAK2, MTOR, TLR4, and SYK were the key targets affected by SLBZ on the PI3K-AKT pathway, and 52 components of SLBZ were associated with them. Molecular docking and dynamics simulation revealed strong binding affinities between MTOR and diosgenin. Subsequently, after SLBZ treatment, the expression levels of JAK2, MTOR, TLR4, and SYK were found significantly upregulated in the AAD model rats (p < 0.05). The cell experiment further validated the good binding ability between MTOR and diosgenin. ConclusionWe demonstrate that the therapeutic effect of SLBZ on AAD was achieved in part by inhibiting the PI3K-AKT pathway.

Approaches to the management of surgical patients with antibiotic-associated mild diarrhea

The paper highlights the issues of antibiotic-associated diarrhea (AAD) of mild severity in the treatment of surgical patients, its epidemiology, etiology, features of the clinical picture and approaches to therapy. The mild course of AAD includes diarrhea without signs of intoxication, leukocytosis and fever. Stool disorder in patients receiving antibiotics who are in a surgical hospital is an urgent medical problem, since this pathology prolongs the time of hospitalization, increases economic costs, reduces the quality of life and can even be the cause of the patient’s death. According to various authors, AAD develops in 40% of people receiving antibacterial therapy. A clinical example of the management of a patient with AAD and injury of the musculoskeletal system is considered in detail.The abolition of antibiotics is not a method of solving this problem, since the severity of the patient’s injuries requires further surgical treatment and prevention of purulent-septic complications. The key point in the treatment of mild AAD will be the appointment of probiotic drugs, which have an effect on the pathogenetic links of AAD. Probiotics are microorganisms that have been known since ancient times and are purposefully used for health improvement and longevity. One of the first probiotic drugs used before the era of the discovery of antibiotics can be considered Mechnikov curdled milk with unique medicinal properties. Prescribing probiotic therapy from the first day of taking antibiotics, without waiting for the results of laboratory examination, will significantly reduce the prevalence of clinical manifestations of both clostridial diarrhea and idiopathic AAD.

Effects of Lactobacillus plantarum and Weissella viridescens on the Gut Microbiota and Serum Metabolites of Mice with Antibiotic-Associated Diarrhea.

Antibiotic-associated diarrhea (AAD) refers to diarrhea caused by gut microbiota disorders after the use of antibiotics, which seriously threatens the health of humans and animals. Therefore, it is necessary to find an effective therapy to treat AAD. This research aimed to explore the effects of Lactobacillus plantarum H-6 (L. plantarum H-6) and Weissella viridescens J-1 (W. viridescens J-1) on alleviating antibiotic-associated diarrhea induced by lincomycin hydrochloride (LH) in mice. The results show that L. plantarum H-6 could significantly reduce the expression of pro-inflammatory factors such as IL-1β and IL-6 in colon tissue. At the same time, L. plantarum H-6 significantly increased the abundance of Lactobacillus and Akkermansia, decreased the abundance of Bacteroides, and increased the contents of L-tryptophan, LysoPC (20:4 (8Z, 11Z, 14Z, 17Z)), reduced riboflavin, threoninyl-methionine, and N-palmitoyl in serum. However, W. viridescens J-1 had little effect on the treatment of AAD. It can be concluded that L. plantarum H-6 can regulate mice's colonic microbial composition, improve their serum metabolic process, and alleviate antibiotic-associated diarrhea. This research may provide a novel therapeutic option for AAD.

Prospects of using probiotics containing &lt;i&gt;Lactobacillus acidophilus&lt;/i&gt; in the prevention and treatment of gastrointestinal diseases

Aim theoretical analysis and systematization of the knowledge on using probiotics containingLactobacillus acidophilusin the prevention and treatment of diseases of the gastrointestinal tract.&#x0D; The bibliographic databases of the scientific libraries eLIBRARY.RU, Cochrane Library and CyberLeninka, the electronic resources of the Global Health platform, the sites of scientific publications ScienceDirect and Elsevier, MEDLINE and PubMed-NCBI were searched for the relevant information. Next, the full-text sources were analysed. We used structural-logical and analytical methods in this work.&#x0D; The probiotics containingLactobacillus acidophiluswere reported to enhance eradication therapy in the presence ofHelicobacter pyloriinfection, reduce pain and normalize bowel function in irritable bowel syndrome, normalize liver function, reduce liver enzymes, prevent the development of hepatic encephalopathy in non-alcoholic fatty liver disease, support clinical remission in ulcerative colitis. Also, they demonstrated the effectiveness for the prevention and treatment of antibiotic-associated diarrhea, including clostridial infection, and the improvement of intestinal microbiota. In many gastrointestinal diseases, the effect of probiotics had a high level of evidence. The beneficial properties of probiotics can be used in the development of functional food products for therapeutic and prophylactic purposes.

Pathogenetic aspects of the development and treatment of antibiotic-associated diarrhea: the choice of a synbiotic from the standpoint of evidence-based medicine

Introduction. In recent years, diarrheal syndrome is the most common clinically significant negative effect of the antibiotic therapy (ABT), which constitutes a first-priority medical and social problem. The prescription of any antibiotic for any duration of treatment may cause a potential risk of developing antibiotic-associated diarrhea (AAD). In that regard, there is a need for the systematization of the main pathogenetic aspects of the deveopment of AAD and the rationale for the use of probiotics to prevent its development and treatment. Aim. To conduct a comparative evaluation of the efficacy, adherence and tolerability of a synbiotic Floriosa containing Bifidobacterium lactis Bl-04, Lactobacillus acidophilus La-14, Lactobacillus rhamnosus Lr-32, inulin, B vitamins, and an eubiotic Bifiform containing Enterococcus faecium, Bifidobacterium longum for the prevention of the development of AAD during and after the use of ABT in inpatients. Materials and methods. A total of 60 patients, which was used for the ABT in the hospital settings, were included in the study: the 1st group (30 patients) received a synbiotic, the 2nd group (30 patients) received an eubiotic. The efficacy of the preventive administration of drugs was assessed by Day 12 and 28 of the therapy. The methods included the patients’ assessment of the efficacy and satisfaction with treatment, an assay of short-chain fatty acids (SCFAs) in feces via gas-liquid chromatography and a Clostridium difficile Toxin A + B rapid test. Results. No cases of AAD were detected in both groups. The study drugs were comparable in terms of their efficacy assessment by the doctor and patients. A trend towards a higher assessment of the therapeutic effect and satisfaction with synbiotic therapy was observed. Changes in the absolute and relative content of SCFAs in the patients’ feces from the baseline level were established. More pronounced positive changes in the quantitative and qualitative composition of acids due to the treatment were identified in the patients who received the synbiotic and had more than 3 risk factors. Conclusions. The synbiotic Floriosa and probiotic Bifiform are effective drugs to prevent AAD. The synbiotic has advantages in terms of the overall assessment of the efficacy of the treatment and patient satisfaction, provides a pronounced protective effect on the intestinal microbiocenosis status during and after the ABT (as evidenced by the changes in SCFAs level in the feces), can be the drug of choice for the prevention of AAD, including AAD associated with C. difficile in individuals with more than 3 risk factors for the development of AAD.

Poria cocos Polysaccharide Ameliorated Antibiotic-Associated Diarrhea in Mice via Regulating the Homeostasis of the Gut Microbiota and Intestinal Mucosal Barrier.

Poria cocos polysaccharides (PCP) have been validated for several biological activities, including antitumor, anti-inflammatory, antioxidant, immunomodulatory, hepatoprotective and modulation on gut microbiota. In this research, we aim to demonstrate the potential prebiotic effects and the therapeutic efficacies of PCP in the treatment of antibiotic-associated diarrhea (AAD), and confirm the beneficial effects of PCP on gut dysbiosis. Antibiotic-associated diarrhea mice models were established by treating them with broad-spectrum antibiotics in drinking water for seven days. Mice in two groups treated with probiotics and polysaccharide were given Bifico capsules (4.2 g/kg/d) and PCP (250 mg/kg/d) for seven days using intragastric gavage, respectively. To observe the regulatory effects of PCP on gut microbiota and intestinal mucosal barrier, we conducted the following experiments: intestinal flora analysis (16S rDNA sequencing), histology (H&E staining) and tight junction proteins (immunofluorescence staining). The levels of mRNA expression of receptors associated with inflammation and gut metabolism were assessed by real-time reverse transcription-polymerase chain reaction (RT-PCR). The study revealed that PCP can comprehensively improve the clinical symptoms of AAD mice, including fecal traits, mental state, hair quality, etc., similar to the effect of probiotics. Based on histology observation, PCP significantly improved the substantial structure of the intestine of AAD mice by increasing the expression levels of colonic tight junction protein zonula-occludens 1 (ZO-1) and its mRNA. Moreover, PCP not only increased the abundance of gut microbiota, but also increased the diversity of gut microbiota in AAD mice, including alpha diversity and beta diversity. Further analysis found that PCP can modulate seven characteristic species of intestinal flora in AAD mice, including Parabacteroides_distasonis, Akkermansia_muciniphila, Clostridium_saccharolyticum, Ruminoc-occus_gnavus, Lactobacillus_salivarius, Salmonella_enterica and Mucispirillum_schaedleri. Finally, enrichment analysis predicted that PCP may affect intestinal mucosal barrier function, host immune response and metabolic function by regulating the microbiota. RT-PCR experiments showed that PCP can participate in immunomodulatory and modulation on metabolic by regulating the mRNA expression of forkhead-box protein 3 (FOXP3) and G protein-coupled receptor 41 (GPR41). These results indicated that Poria cocos polysaccharide may ameliorate antibiotic-associated diarrhea in mice by regulating the homeostasis of the gut microbiota and intestinal mucosal barrier. In addition, polysaccharide-derived changes in intestinal microbiota were involved in the immunomodulatory activities and modulation of the metabolism.

An insight into the health-promoting effects of foods to prevent Antibiotic- associated Diarrhoea: A Review

The random use of antibiotics leads to gastrointestinal diseases with complications ranging from mild diarrhea to Pseudomembranous colitis, which is called antibiotic-associated diarrhea. Outbreaks of antibiotic-associated diarrhea are generally found in 10% to 30% of patients taking antibiotics, depending on the particular antibiotic used, and are caused by Clostridium difficile in general and Klebsiella oxytoca, Staphylococcus aureus, Clostridium perfringens, etc. in particular. Functional disturbances of intestinal carbohydrates, harmful effects of antibiotics on the intestinal mucosa, and allergic effects are responsible for mild antibiotic-associated diarrhea. In COVID-19, caused by SARS-CoV-2, patients treated with a variety of antibiotics have been noticed to suffer from severe antibiotic-associated diarrhea. Probiotics have been shown to play a significant role in preventing antibiotic- associated diarrhea in both COVID-19 patients and general patients. Prebiotics and dietary approaches also play a vital role in combating antibiotic-associated diarrhea. Given the increased demand for food associated with the treatment of antibiotic-associated diarrhoea, the current review paper attempted to orchestrate the effect of probiotics such as yogurt, kefir, cheese, probiotic milk, and dietary foods such as ripe papaya, bananas, and other fermented foods in developing an immune system capable of effectively combating antibiotic-associated diarrhea.

Polysaccharides from Bamboo Shoot (Leleba oldhami Nakal) Byproducts Alleviate Antibiotic-Associated Diarrhea in Mice through Their Interactions with Gut Microbiota.

A water-soluble polysaccharide BSP was extracted from the basal part of bamboo shoot, a main by-product of bamboo shoot processing. BSP is composed of glucose (72.8%), xylose (19.43%) and a small amount of galactose, arabinose, glucuronic acid and mannose. The effects of BSP on mice with antibiotic-associated diarrhea (AAD) were investigated. The mice fed with BSP exhibited significant higher bodyweight gain, lower pH value and higher concentrations of SCFAs in the feces compared with those fed with saline. BSP administration reduced the inflammatory cells in the small intestine and colon in the AAD mice, and Firmicutes/Bacteroidetes ratio in the gut was decreased from 0.56 to 0.19. Moreover, BSP administration affected the composition and diversity of the gut microbiota in the AAD mice, particularly on the improvement of beneficial bacteria such as Bacteroides, Lactobacillus and Lachnospiraceae_NK4A136_group. Our results suggest that the polysaccharides from bamboo shoot by-products could be an attractive natural component for gut health and AAD treatment.

Prevention, diagnosis and treatment of antibiotic-associated diarrhea

抗生素相关性腹泻是使用抗菌药物后出现的常见不良反应，与继发性肠道菌群紊乱所致肠道碳水化合物和胆汁酸代谢降低及条件致病菌感染等机制相关，儿童尤其是婴幼儿和危重症住院患儿是高危人群。本文着重介绍抗生素相关性腹泻的诊断、预防和治疗的相关知识，有助于儿科医师提高对本病的认知和防治水平。.

Variety of effects of silicon dioxide colloid in the treatment of antibiotic-associated diarrhea in children

Antibiotic-associated diarrhea (AAD) is a key aspect of pediatrics concerning antibiotic therapy Purpose. The article aims at investigating the effects of colloidal silicon dioxide in the treatment of antibiotic-associated diarrhea in children. Materials and methods. Using parametric and nonparametric methods of analysis, 83 patients were examined (treatment group — 41 children who used colloidal silicon dioxide and the control group — 42 children) of both sexes (mean age (13.7 ± 2.6) years) with pathology of the lower respiratory tract (acute bronchitis or community-acquired pneumonia), who developed AAD against the background of ABT. Results. When using colloidal silicon dioxide in 75.6% of children, diarrhea decreased by the 2nd day and stopped by the 4th day (median — 0 points). Against the background of taking the drug throughout the treatment, there was a marked 3-fold decrease in all AAD values. The assessment of the efficacy and safety of the drug according to the data of medical researchers was 3.4 points. Analysis of subjective data on the tolerability of the drug showed «excellent» and «good». Against the background of the full course of treatment with colloidal silicon dioxide, a 2 times more pronounced decrease in the characteristics of AAD was noted. Conclusion. The presented data are intended to focus the attention of pediatricians on the rational use of ABT, timely diagnosis of an unwanted drug reaction in the form of AAD and its correction. The studied drug showed high efficacy and safety, which makes it possible to recommend it as a symptomatic treatment of diarrhea that developed against the background of ABT treatment in the complex therapy of diseases of the lower respiratory tract in children.

С. difficile infection: clinical and pharmacoeconomic assessment of treatment regimens in antibiotic-associated diarrhea

This paper provides a review of the largest studies (over the period of 2017 to 2022) on cost-effectiveness analysis of the recommended treatment algorithms for Clostridioides difficile infection in patients with antibiotic-associated diarrhea (AAD), including pseudomembranous colitis. The review showed that professional medical societies in Russia, EU and US as well as meta-analyses consistently consider vancomycin as the most important treatment option for AAD and pseudomembranous colitis. The role of metronidazole and fidaxomicin in the treatment of AAD is considered ambiguous. Teicoplanin is recommended for using more commonly based on cost-effectiveness analysis.

Clostridium perfringens – antibiotic-associated and sporadic diarrhea in children: age, anamnestic and clinical and laboratory features

The article presents the data of the research on the problem of two clinical forms of enteroproducing Clostridium perfringens (C. perfringens) – associated infection in the children who are not connected with food – antibiotic-associated and sporadic forms. Within the period of 2019–2021 a retrospective analysis of the results of complex clinical and laboratory study of children aged from 2 months to 18 years with diarrhea (acute intestinal infection, n = 406 children) was carried out within the framework of the algorithm developed by Pediatric Research and Clinical Center for Infectious Diseases (Russia, Saint Petersburg). The material for the study included stool tests, coprofiltrates and strains of the microorganisms determinating microbiocoenosis of the intestines including enterotoxigenic strains of C. perfringens. The main group included children with diarrhea (n = 38 of 406 children with diarrhea) who at admission presented C. perfringens enterotoxin in coprofiltrates found by immune-enzyme analysis and there were identified the cultures of enterotoxigenic strains of C. perfringens by tests of intestinal contents. The first group included children (n = 30 of 406 children; 7 %) with antibiotic-associated diarrhea (AAD). The second group included children (n = 8 of 406 children; 2 %) with sporadic diarrhea. An overwhelming majority of patients with ААD (n = 20; 92.3 %) of the first 8 (100 %) years of life presented intensity of diarrhea syndrome in direct dependence on colonization activity of enterotoxigenic C perfringens (colony-forming units/g feces) (r = 0.78). The disease proceeded mainly with the syndromes of gastroenteritis, enterocolitis and hemorrhagic colitis. There was noted a reliable high frequency of severe forms of both ААD, and sporadic diarrhea (р &lt; 0.05) caused by enterotoxigenic strains of C perfringens in children of the first year of life. Deep decompensated disorders of large intestine microbiota associated with Klebsiella spp., Staphylococcus aureus and Candida albicans, were characterized by severity and prolonged character of the course (р &lt; 0.05). The received results determine the tactics of differential diagnosis and treatment of AAD and sporadic diarrhea caused by enteroproducing strains of C. perfringens.

Пробіотики при антибіотик-асоційованiй діареї в дітей: обґрунтований вибір

Призначення пробіотичних штамів для профілактики антибіотик-асоційованої діареї (ААД) у дорослих і дітей на сьогодні є стандартною схемою як віт­чизняних, так і європейських протоколів лікування. Сахароміцети Saccharomyces boulardii належать до дріжджових пробіотиків. Їх принциповою відмінністю від бактеріальних пробіотиків (Lactobacіllus та ін.) є стійкість до дії антибіотиків. У зв’язку з цим Saccharomyces boulardii можуть застосовуватися одночасно з антибіотиками для профілактики виникнення побічних явищ з боку травного тракту, викликаних антибіотикотерапією (перш за все ААД). Вибір у цій ситуації бактеріального пробіотика менш вдалий, оскільки антибіотики можуть пригнічувати активність введених бактерій. Важливо зазначити, що Saccharomyces boulardii не здатні передавати стійкість до дії антибіотиків патогенним бактеріям, у той час як у бактеріальних пробіотиків такий потенціал існує. Результати виконаних клінічних досліджень свідчать про високу ефективність та безпечність Saccharomyces boulardii в профілактиці та лікуванні антибіотик-асоційованої діареї в дітей. В Україні цей пробіотик представлений лікарським засобом Ентерол®.

Probiotics for the antibiotics associated diarrhea and for Clostridium difficile infection.

The term probiotic refers to live microorganisms that survive passage through the gastrointestinal tract and have beneficial effects on the host. Many strains of probiotic microorganisms have been shown to inhibit growth and metabolic activity as well as the adhesion to intestinal cells of enteropathogenic bacteria, to modulate the gut microbiota and to have immunostimulatory or regulatory properties. The use of probiotic microorganisms for the prevention and the treatment of Antibiotic Associated Diarrhea is an obvious measure and perhaps the most usual application of probiotics. This overview summarizes the most commonly used probiotic microorganisms for DAA and IBD.

Streptococcus thermophiles DMST-H2 Promotes Recovery in Mice with Antibiotic-Associated Diarrhea

Antibiotic-associated diarrhea (AAD) is the most common side effect of antibiotics and is routinely treated with probiotics in clinical. Streptococcus thermophiles, extensively utilized for producing dairy foods, has recently been regarded as a new promising probiotic candidate. In this study, the efficacy of Streptococcus thermophiles DMST-H2 (DMST-H2) for AAD treatment in mice was investigated. DMST-H2 was isolated from Chinese traditional yogurt, proved to be non-toxic, and presented tolerance against simulated gastrointestinal conditions in vitro. Additionally, genomic analysis revealed that it possessed genes related to acid tolerance, bile salt tolerance, adhesion, oxidative stress and bacteriocin production. The animal experiment results showed that both DMST-H2 treatment and natural recovery could reduce fecal water content. Compared with spontaneous recovery, DMST-H2 accelerated the recovery of the enlarged caecum and intestinal barrier injury from AAD, and further decreased endotoxin (ET), D-lactate (D-LA) and diamine oxidase (DAO) content in serum. Moreover, pro-inflammatory cytokines (TNF-α) were reduced, while interferon-γ (IFN-γ) and anti-inflammatory cytokines (IL-10) increased after treating with DMST-H2. Furthermore, DMST-H2 better restored the structure of intestinal flora. At the phylum level, Firmicutes increased and Proteobacteria decreased. These findings indicate that DMST-H2 could promote recovery in mice with antibiotic-associated diarrhea.

Practical Recommendations of Scientific Society for the Study of Human Microbiome and Russian Gastroenterological Association (RGA) for Probiotics in Treatment and Prevention of Gastroenterological Diseases in Adults

Aim. To provide practical recommendations on the use of probiotics for the treatment and prevention of gastroenterological diseases in adults.General provisions. Probiotics are living microorganisms that benefit the health of the host when administered in adequate amounts. The main functions of probiotics include the support for colonisation resistance, the metabolism of food substrates and utilisation of end metabolites, the production of substrates necessary for the macro-organism, as well as the regulation of local and adaptive immune responses. Probiotics can be registered in the Russian Federation as biologically active food additives (BAFA) or as pharmaceutical products (drugs) in accordance with the microbiological standards and legislative requirements of the Russian Federation. The probiotics registered in the Russian Federation as BAFA for adults include bacteria of the Lactobacillus, Bifidobacterium, Enterococcus, Pediococcus, Lactococcus, Streptococcus, Bacillus, and Escherichia genera, and fungi of the Saccharomyces genus; probiotics registered as drugs — bacteria of Lactobid, Lactobacid, Escherichia and Enterococcus genera and fungi of the Saccharomyces genus. Some probiotics registered in the Russian Federation include probiotic strains that have proved to be effective for the prevention and treatment of antibiotic-associated diarrhea, the prevention of C. difficile-associated disease, the eradication of H. pylori infection, as well as for the treatment of irritable bowel syndrome and functional constipation.Conclusions. The clinical efficacy of probiotics depends on the probiotic strains included in their composition and is confirmed by a comparative analysis of the results of appropriate clinical studies. Not all probiotics registered in the Russian Federation as BAFA or drugs contain bacterial or fungal strains; as a result, the expected clinical effect may not be achieved.

Childhood functional gastrointestinal disorders: rational therapy

Introduction. Gastrointestinal dysfunctions remain one of the most frequent problems in young children (0 to 2 years). Among the main causes are immaturity of the enzymatic system, morphology and function of the gastrointestinal tract, regulatory mechanisms of the nervous system, immune response. The composition of intestinal microflora in children in the first years of life is unstable and can easily change under the influence of unfavorable factors: feeding disorders, infectious pathogens, congenital defects, incomplete immunity. Modern scientific literature and clinical guidelines most accurately reflect the results of studies on the positive role of probiotics, for example, in the prevention and treatment of antibiotic-associated diarrhoea and acute diarrhoea of various genesis. The research base is so large that in 2012 the World Gastroenterology Organization developed an international practical guide to the use of probiotics in clinical practice, recommending the use of probiotics that meet certain criteria. The review is devoted to evaluating the effectiveness and safety of treatment with probiotics containing Bifidobacterium lactis, BB-12 and Streptococcus thermophilus TH-4 in children aged 0 to 2 years. Data from meta-analyses of the Cochrane library, PubMed, EMBASE, CENTRAL, and Russian open clinical randomized, placebo-controlled studies on the use of probiotics containing Bifidobacterium lactis, BB-12, and Streptococcus thermophilus TH-4 in pediatric practice are presented. Study objective. A comparative description of the most popular commercial drugs used for the treatment and prevention of functional disorders of the gastrointestinal tract in children aged 0 to 2 years, containing at least one of these strains, is presented. Results . Evidence of the significance of probiotic therapy for various disorders of the gastrointestinal tract in children aged 0 to 2 years with complex drugs containing a combination of Bifidobacterium lactis, BB-12 and Streptococcus thermophilus TH-4 strains in children aged 0 to 2 years is presented. There is no reliable evidence of the effectiveness of multi-strain drug combinations in this age group. Conclusion . The combination of Bifidobacterium lactis, BB-12 and Streptococcus thermophilus TH-4 is an effective and safe combination for the treatment of gastrointestinal disorders in children aged 0 to 2 years.

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.