Use Of Probiotics In Children Research Articles

Use of probiotics in children as prophylaxis for the development of atopic dermatitis: systematic review

Use of probiotics in children as prophylaxis for the development of atopic dermatitis: systematic review

Clinical Efficacy of Use of Probiotics in Children with Acute Watery Diarrhea

watery diarrhea in children aged 6 months to 5 years, at H.H Sheikh Khalifa Bin Zayed Al-Nahyan Hospital/Combined Military Hospital, Muzaffarabad. Methodology: The Randomized Controlled Trial was done at Pediatric department, H.H Sheikh Khalifa Bin Zayed Al-Nahyan Hospital/CMH, Muzaffarabad from January 2020 to December 2021. All patients aged 6 months to 5 years with acute watery diarrhea who present with severe, minimal, or no dehydration within the first five days of illness were included. Children meeting the inclusion criteria were consecutively enrolled and randomly assigned to either the study group (ORS plus oral administration of Saccharomyces Boulardii) or the control group (ORS alone). From day 1 to day 5, the quantity and consistency of feces were counted. On day 5, clinical effectiveness was indicated by 3 stools or fewer per day. SPSS version 26 was used for data analysis. Results: Of 252 patients, a significant mean difference of number of stools and consistency was observed on day 3, day 4, and day 5 (p:<0.005). A significant association of efficacy was observed with probiotic group (p: 0.021). After adjustment for other covariates, efficacy was 2.37 times higher among children who were in probiotic group as compared to control group (OR 2.37, 95% CI 1.07-5.24, p: 0.033). The efficacy was 3.23 times higher among children with age ?3 years than children with age >3 years (aOR 3.23, 95% CI 1.32-7.91, p: 0.010). The efficacy was 94% lower among children without dehydration (aOR 0.06, 95% CI 0.01-0.52, p: 0.011) and 91% lower among children with some dehydration (aOR: 0.09, 95% CI 0.01-0.77, p: 0.028). Conclusion: The efficacy of probiotics was observed to be higher in treatment of acute watery diarrhea in hospitalized children. Probiotics, when used as an adjunct to standard therapy, may be beneficial in reducing the severity and duration of diarrhea, potentially leading to improved clinical outcomes.

Досвід застосування засобу «Біоплазмікс спрей для горла» в комплексному лікуванні гострих вірусних фарингітів у дітей з атопічним фоном

The problem of therapy of acute respiratory infections in children remains relevant. The most common infectious pathology of the upper respiratory tract in both children and adults is acute viral pharyngitis. Irrational prescribing of antibiotics leads to medication-induced side effects and the spread of resistance of microorganisms to antibiotics in society. Topical application of respiratory probiotics may be an important component in the supportive treatment of acute respiratory infections and reducing antibiotic dependence. The use of probiotics in children with an atopic background is of particular importance due to the possible occurrence of adverse reactions. Purpose - to assess the safety and effectiveness of the local application of Bioplasmix throat spray in the complex treatment of acute viral pharyngitis in children with an atopic background. Materials and methods. 45 children aged 6-18 years with acute viral pharyngitis took part in the study. 2 research groups were formed: the Group I - main (n=25) - received protocol treatment + Bioplasmix throat spray locally and the Group II - comparison (n=20) - only protocol treatment. All patients were assessed for the severity of clinical symptoms (fever, headache, sore throat, scratching, cough) and oropharyngoscopy data (hyperemia, swelling of the mucous membrane of the oropharynx, granularity of the back wall of the pharynx) on the 1st, 2nd, 3rd, 4th, 5th and 7th days of using the product. Results. The use of the local application of Bioplasmix throat spray for acute pharyngitis in children ensures a faster reduction in the severity of the main clinical manifestations and signs of inflammation of the oropharynx. In the Group I, compared to the Group II, there were better indicators of a decrease in the severity of cough (1.2±0.91 points vs. 1.76±0.85 points), a scratching (1.12±0.92 points vs. 1.7±0.86 points), sore throat (1.6±0.81 points vs. 2.23±0.76 points) and hyperemia of the pharynx (1.4±0.7 points vs. 2.1±0.9 points) from the 3rd day, swelling of the pharynx (1.22±0.86 points vs. 1.8±1.04 points) from the 4th day. Adverse reactions were not noted during the use of the local application of Bioplasmix throat spray. Conclusions. Local probiotic therapy is an important component of the complex therapy of acute pharyngitis, the use of bacteria of the genus Bacillus in the form of Bioplasmix throat spray shows a positive effect on the course of acute viral pharyngitis in children, which manifests by a faster decrease in the severity of subjective symptoms of pharyngitis and inflammatory signs of the oropharynx. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

FUNCTIONAL CONSTIPATION IN CHILDREN : A SYSTEMATIC REVIEW

It is essential to test and diagnose children as soon as possible for functional constipation (FC), which is considered a substantial burden of illness in children. When treated in a timely manner and with the proper medication, babies who have FC have a better chance of making a full recovery. It is estimated that inflammatory bowel disease is responsible for up to 25% of pediatric gastroenterologist visits and 3% of all pediatric outpatient visits globally. It is difficult to estimate the real prevalence of FC in children as a result of the variability of the studies in terms of target population sample, diagnostic criteria, participant ethnicity and environment, technique of data gathering, and lifestyle and psychological characteristics, amongst other considerations. It is possible that the key causes for the worldwide variation in prevalence among studies that have been published are the absence of consensus on diagnostic criteria and cultural variations. Probiotics have the capacity to improve the balance between species, impact intestinal motility by creating lactic acid and short-chain amino acids, and stimulate gut peristalsis by adjusting stool pH. Additionally, probiotics have the potential to increase the number of short-chain amino acids produced in the body. A wide variety of probiotic strains have been the subject of a significant number of investigations. On the other hand, there are not enough evidence available at this time to support the use of probiotics in children who suffer from chronic constipation.

Indian Academy of Pediatrics Consensus Guidelines for Probiotic Use in Childhood Diarrhea

Several probiotic species and strains, single or combined, have been evaluated in childhood diarrheal disorders, and recommendations have ever been changing as newer trials are published. Therefore, there is a need to develop a guideline for Indian children describing the current role of probiotics in clinical practice. To develop a guideline for the use of probiotics in children with diarrhea. A national consultative group (NCG) was constituted by the Indian Academy of Pediatrics (IAP), consisting of subjects experts. Sub-topics were allotted to various experts as paired groups for detailed review. Members reviewed the international and Indian literature for existing guidelines, systematic reviews, meta-analyses and trials. Thereafter, two virtual structured meetings of the group were held on 2nd and 22nd August, 2020. The management guidelines were formulated by the group and circulated to the participants for comments. The final guidelines were approved by all experts, and adopted by the IAP executive board. The NCG suggests Lactobacillus GG as a conditional recommendation with low-to-moderate level evidence or Saccharomyces boulardii as a conditional recommendation with very low-to-low level evidence as adjuvant therapy in acute diarrhea. The NCG also recommends the use of combination probiotics in neonatal necrotizing enterocolitis (NEC), as these reduce the risk of NEC stage II and above, late-onset sepsis, mortality and also time to achieve full feeds. The NCG does not recommend the use of any kind of probiotics in the therapy of acute dysentery, persistent diarrhea, Clostridium difficile diarrhea and chronic diarrheal conditions such as celiac disease, diarrhea-predominant irritable bowel syndrome and inflammatory bowel disease in children. Risk of antibiotic-associated diarrhea (AAD) is high with some antibiotics and most of these cases present as mild diarrhea. The NCG recommends probiotics only in special situations of AAD. L. rhamnoses GG or S. boulardii may be used for the prevention of AAD. VSL#3, a combination probiotic, may be used as an adjuvant in active pouchitis, prevention of recurrences and maintenance of remission in pouchitis.

Analysis of research on the effectiveness of using probiotics for children with autism spectrum disorders, in order to reduce the core and accompanying autism symptoms. Review of randomized clinical trials.

The prevalence of autism spectrum disorder (ASD) has increased tenfold over the last 40 years and the World Health Organization (WHO) has placed it alongside other globally occurring common illnesses, such as cancer, cardiovascular disorders and diabetes. As there are yet no effective methods for treating ASD, the most frequently used therapeutic interventions are psychological, psychosocial, rehabilitation and developmental support, which in combination aim to support patients and their families. Early intervention improves the prognosis, but usually a cure is impossible. Patient's lives are often burdened with social difficulties in contact with their families, peers and in education, particularly when other disorders, diseases or intellectual impairment are present, leading to undesirable behaviours, including aggression or self-aggression. Aim of the study was to review the literature available, so as to determine the effectiveness of probiotics used for treating core and accompanying symptoms of autism in patients diagnosed with ASD, with a particular focus on children and adolescents. The randomised clinical trials available on the clinicaltrials.gov register (accessed on June 27th, 2021) and the PubMed database (search: probiotic + autism, probiotic + ASD, probiotic + Asperger syndrome, probiotic + pervasive developmental disorder, randomised controlled trial filter) have been analysed in the present study. All studies were included, without any operational time limit. The same PubMed search was also re-run for open-label trials. Out of the 140 papers found, five were open-trials. We also supplemented our study by additionally analysing the studies cited by the latest papers on probiotics in autism. There are still no consistent outcomes in studies on the use of probiotics in children and adolescents with ASD, and the scope of existing studies is limited. Nevertheless, the authors considered it worthwhile to explore whether probiotic interventions can indeed reduce the severity of ASD-related symptoms and behaviours. Further studies are required on specific indications, duration of treatment and the effectiveness of interventions in the defined problem areas.

Invasive Infections Associated with the Use of Probiotics in Children: A Systematic Review.

Although the effectiveness of probiotics has only been proven in specific conditions, their use in children is massively widespread because of their perception as harmless products. Recent evidence raises concerns about probiotics’ safety, especially but not only in the paediatric population due to severe opportunistic infections after their use. This review aimed at summarising available case reports on invasive infections related to probiotics’ use in children. For this purpose, we assessed three electronic databases to identify papers describing paediatric patients with documented probiotic-derived invasive infections, with no language restrictions. A total of 49 case reports from 1995 to June 2021 were identified. The infections were caused by Lactobacillus spp. (35%), Saccharomyces spp. (29%), Bifidobacterium spp. (31%), Bacillus clausii (4%), and Escherichia coli (2%). Most (80%) patients were younger than 2 years old and sepsis was the most observed condition (69.4%). All the patients except one had at least one condition facilitating the development of invasive infection, with prematurity (55%) and intravenous catheter use (51%) being the most frequent. Three (6%) children died. Given the large use of probiotics, further studies aiming at evaluating the real incidence of probiotic-associated systemic infections are warranted.

Probiotics: Popping the Prevalence and Parental Perspective

The aim of this project was to evaluate parental knowledge and opinions on the use of probiotics in children, specifically comparing those attending an allergy or gastroenterology clinic with parents of other paediatric patients. A survey containing nine items was administered to a convenience sample of parents in the inpatient and outpatient departments at the Children’s Hospital for Wales. The questions were asked face to face by one observer; answers were recorded anonymously on a tablet computer using the online survey tool KwikSurveys. A total of 304 parents completed the survey. Overall, 53.9% of parents knew what probiotics were, 75.3% thought that they could improve a child’s health and 53.6% had given their child probiotics. In the cohort attending allergy or gastroenterology clinics, 64.2% had given their child probiotics, compared with 50.2% of the remaining participants (OR 1.78; 95% CI 1.01, 3.12). Healthcare professionals were 13% more likely to recommend the use of a probiotic to a parent in this cohort. In conclusion, awareness and knowledge of probiotics was reasonable among parents, and most thought that they could improve a child’s health. Parents were more likely to give their child probiotics if they attended an allergy or gastroenterology clinic.

Единство системы «кишечник — легкие» и роль полезной микробиоты в защите от инфекций

NIH Human Microbiome Project determined particular attention of the worldwide medical community to the study of the human microbiome and the assessment of the impact of symbiont microorganisms in the development of various (not only gastrointestinal) disorders. Potential interactions between the bowel and lungs (bowel-lung axis) via microbiota that allow for the possible involvement of microorganisms in the development of respiratory diseases are actively debated. This paper reviews studies on the pattern of interactions between bowel and lungs in infectious diseases associated with mucosal inflammation. The association between gut microbiota and the protective barrier of the respiratory tract based on known mechanisms and novel data derived from recent studies on SARS-CoV-2 is discussed. The relevance of beneficial bacteria (symbionts) in local and systemic immune responses, their disease-modifying and, eventually, therapeutic strategymodifying properties, the ability to be a resource of preventive medicine and an orchestrating tool for infections are addressed. Practitioners’ difficulties with probiotics in preventive and treatment schedules for various conditions are highlighted. Finally, the use of probiotics in children with respiratory infections and COVID-19 is uncovered. KEYWORDS: microbiota, microbiome, probiotics, children, mucosal immunity, Bifidobacterium. FOR CITATION: Taranushenko T.E. Unity of bowel-lung axis and the role of beneficial microbiota in anti-infectious protection. Russian Journal of Woman and Child Health. 2021;4(4):355–361 (in Russ.). DOI: 10.32364/2618-8430-2021-4-4-355-361.

P.669 Use of probiotics in children with autism spectrum disorder and its effects on behavioral and gastrointestinal symptoms: a systematic review

Alterations of the gut microbiota have been associated with stress-related disorders including depression and anxiety and irritable bowel syndrome (IBS). More recently, researchers have started investigating the implication of perturbation of the microbiota composition in neurodevelopmental disorders including autism spectrum disorders and Attention-Deficit Hypersensitivity Disorder (ADHD). In this review we will discuss how the microbiota is established and its functions in maintaining health. We also summarize both pre and post-natal factors that shape the developing neonatal microbiota and how they may impact on health outcomes with relevance to disorders of the central nervous system. Finally, we discuss potential therapeutic approaches based on the manipulation of the gut bacterial composition.

Decrease of Postchemotherapy Complications With the Use of Probiotics in Children With Acute Lymphoblastic Leukemia.

During the administration of antineoplastic drugs, acute complications because of toxicity occur, determining their hospital readmission, visits to the emergency department, use of antimicrobials, and possibilities of presenting systemic infections, impacting on their life quality. Through a prospective cohort, 60 children with acute lymphoblastic leukemia were followed-up for 30 days after the hospital discharge because of chemotherapy administration, those patients were previously included in a single-blinded study in which 30 (group 1) received Lactobacillus rhamnosus GG probiotic during the administration of chemotherapy. The remaining 30 patients did not receive probiotics (group 2). There were evaluated gastrointestinal symptoms, such as diarrhea, dyspepsia, abdominal distension, meteorism, constipation, nausea, and vomit, development of infections, antibiotic use, number of emergency department visits, number of hospitalizations, and sepsis diagnosis. To assess the impact of the use of probiotics, the difference in proportions between both study groups was evaluated. Gastrointestinal manifestations (nausea, vomiting, diarrhea, constipation) occurred in 30% of patients in group 1 versus 63% of group 2 (P=0.009). Nine of 30 patients (30.0%) in group 1 went to the emergency room, versus 33.3% of group 2 (P=0.7). Antimicrobials were used in 8 subjects (26.6%) in group 1 versus 6 subjects (53.3%) in group 2 (P=0.03) suspected of an infectious disease. Four (13.3%) group 1 patients were hospitalized versus 30% of group 2 (P=0.1). Two subjects (6.6%) in group 1 had sepsis versus 7 (23.3%) in group 2 (P=0.07).Conclusions:The results indicate that the use of probiotics can be a great alternative in the improvement of gastrointestinal symptoms and the adverse effects associated with chemotherapy.

Probiotics for paediatric functional abdominal pain disorders: A rapid review.

Functional abdominal pain disorders (FAPD) are prevalent in the paediatric population, however, there is currently no consensus regarding best practices for treatment. The use of probiotics is becoming popular to treat FAPD. The goal of this rapid review is to synthesize the best evidence on the use of probiotics in children with FAPD. Searches were conducted on five main databases. Randomized controlled trials (RCTs) of probiotic use in children (0 to 18 years) with FAPD were searched. Populations of interest were patients with functional abdominal pain (FAP), irritable bowel syndrome (IBS), and functional dyspepsia (FD), recruited based on Rome criteria. Outcomes of interest were changes in abdominal pain severity, frequency, and duration. Eleven RCTs with 829 participants with the diagnosis of FAP (n=400), IBS (n=329), FD (n=45), and mixed population (n=55) were included. Of six studies of children with FAP, two (n=103) used Lactobacillus rhamnosus GG (LGG) and reported no significant effects on pain, and four (n=281) used Lactobacillus (L) reuteri DSM 17938, of which three (n=229) reported significant positive effects on either severity or frequency of pain. Of six trials of children with IBS, four (n=219) used LGG, of which three (n=168) reported a positive effect. One (n=48) used bifidobacteria and one used VSL #3 (n=59), both demonstrating positive effects with probiotics. Two studies of FD reported no benefit. No adverse events were attributed to probiotics. There is preliminary evidence for use of probiotics, particularly LGG, in reducing abdominal pain in children with IBS. There are inconsistent positive effects of other probiotics, including L. reuteri DSM 17938, in reducing pain in patients with FAP, IBS, or FD. More RCTs with rigorous methodology using single or combination probiotics are warranted.

Probiotics in Paediatric Practice

This review summarizes the clinical indications for the use of probiotics in paediatric clinical practice, based on the available scientific evidence. The recent panel of the International Scientific Association of Probiotics and Prebiotics recommended in 2014 that the term “probiotic” should only be used for products that deliver live microorganisms with a suitable viable count of well-defined strains with a reasonable expectation of delivering benefits for the wellbeing of the host. In this review we searched the relevant guidelines on the use of probiotics in children, recommendations and position papers covering the paediatric clinical indications and summarize the high – quality evidence. Some specific Probiotic strains are effective in preventing antibiotic-associated diarrhoea, nosocomial diarrhoea and upper respiratory tract infections, in the treatment of acute gastroenteritis, infantile colic in breastfed infants, and mild ulcerative colitis, but have disappointing results in remission of Crohn’s disease and prevention of food allergies. Conclusion – The capacity of probiotics to prevent, improve illnesses and relieve symptoms varies, as well as their mechanisms, effects and safety, are strain specific. Therefore, every strain is disease specific and not all probiotics should be considered equal. Special caution is advised in immunocompromised and severely ill patients in the Intensive Care Unit.

Mutans streptococci estimation in saliva before and after consumption of probiotic curd among school children.

Background:According to the World Health Organization, probiotics are live microorganisms which when administered in adequate amounts and confer a health benefit to the host. Use of probiotics in children to improve oral health may lead to non-pathogenic bacteria replacing cariogenic bacteria. Dairy foods like cheese, curd, and milk are considered useful vehicles for probiotic bacteria.Aim:To compare the levels of salivary mutans streptococci before and after consumption of probiotic curd.Materials and Methods:Thirty school children of Mathura city who were caries free, in the age group of 12–14 years, were selected and divided equally into group I and II which were given 200 ml probiotic curd and normal curd for 7 days, respectively. Assessment of saliva samples was done at baseline, 1 h after consumption, and on the 7th day. Mitis Salivarius Bacitracin Agar was used for analysis. The number of colonies was counted and subjected to statistical analysis using unpaired Student's t-test.Results:The study showed mark reduction in salivary mutans streptococci counts in saliva after 1 h and on the 7th day in the probiotic group. Results were found to be statistically significant (P ≤ 0.05) when the differences in the reduction of mutans streptococci counts with probiotic curd and normal curd at 1 h and on the 7th day were compared.Conclusion:Pathogenic microorganisms could be displaced by probiotic bacteria. Thus, use of probiotic products could be exploited for the prevention of enamel demineralization.

Impact of emergency department probiotic treatment of pediatric gastroenteritis: study protocol for the PROGUT (Probiotic Regimen for Outpatient Gastroenteritis Utility of Treatment) randomized controlled trial.

BackgroundThe burden of acute gastroenteritis on children and their families continues to be enormous. Probiotics, defined as viable microbial preparations that have a beneficial effect on the health of the host, represent a rapidly expanding field. Although clinical trials in children with gastroenteritis have been performed, most have significant flaws, and guidelines do not consistently endorse their use.Methods/DesignPROGUT is a randomized, placebo-controlled, double-blind, five-center, Canadian, emergency department trial. Children aged 3 months to 48 months who present between November 2013 and June 2017 with <72 hours of gastroenteritis symptoms will be assessed for eligibility. A total of 886 children will be randomized (1:1 allocation via an internet based, third party, randomization service) to receive 5 days of a combination probiotic agent (Lactobacillus rhamnosus and L. helveticus) or placebo. All participants, caregivers, and outcome assessors will be blinded to group assignment. The study includes three key outcomes: 1) clinical - the development of moderate to severe disease following an emergency department (ED) evaluation that employs a validated clinical score (Modified Vesikari Scale); 2) safety - side effect; and 3) mechanism - fecal secretory immunoglobulin A levels.DiscussionDefinitive data are lacking to guide the clinical use of probiotics in children with acute gastroenteritis. Hence, probiotics are rarely prescribed by North American physicians. However, the following current trends obligate an urgent assessment: 1) probiotics are sold as food supplements, and manufacturers can encourage their use while their relevance has yet to be established; 2) North American and European government agencies remain concerned about their value and safety; 3) some institutions are now recommending the routine use of probiotics; and 4) parents of affected children are often providing probiotics. With probiotic consumption increasing in the absence of solid evidence, there is a need to conduct this definitive trial to overcome the limitations of prior work in this field.Trial registrationClinicalTrials.gov: NCT01853124; first registered 9 May 2013.

Role of Probiotics in Short Bowel Syndrome in Infants and Children—A Systematic Review

Short bowel syndrome (SBS) is a cause of significant morbidity and mortality in children. Probiotics, due to their beneficial effects on the gastrointestinal tract (e.g., improving gut barrier function, motility, facilitation of intestinal adaptation and decreasing pathogen load and inflammation) may have a therapeutic role in the management of SBS. To conduct a systematic review of the current evidence for the effects of probiotic supplementation in children with SBS, the standard Cochrane methodology for systematic reviews was used. The databases, Pubmed, Embase, ACTR, CENTRAL, and the international trial registry, and reference lists of articles were searched for randomised (RCT) or quasi-randomised controlled trials reporting on the use of probiotics in SBS. Our search revealed no RCTs on the use of probiotics in children with SBS. We found one small cross-over RCT (placebo controlled crossover clinical trial), one case control study and nine case reports on the use of probiotics in children with SBS. In the crossover RCT, there was no consistent effect on intestinal permeability (primary outcome) after supplementation with Lactobacillus rhamnosus (LGG) in nine children with SBS. The case control study (four cases: four controls) reported a trend for increase in height and weight velocity and improvement in non-clinical outcomes, such as gut flora, lymphocyte count and serum prealbumin. Five of the nine case reports showed that children (n = 12) with SBS were benefited (e.g., cessation of diarrhoea, improved faecal flora, weight gain and weaning from parenteral nutrition) by probiotic supplementation. The remaining four reported on the adverse effects, such as Lactobacillus sepsis (n = 3) and D-lactic acidosis (n = 2). There is insufficient evidence on the effects of probiotics in children with SBS. The safety and efficacy of probiotic supplementation in this high-risk cohort needs to be evaluated in large definitive trials.

The Rationale and Clinical Effectiveness of Probiotics in Irritable Bowel Syndrome

The pathophysiology of irritable bowel syndrome (IBS) is still unknown. However, several lines of epidemiological, physiological, and clinical data suggest a role for intestinal bacteria in the pathogenesis of the disorder. Recent microbiology studies demonstrated differences in the composition of the intestinal microbiota between patients with IBS and healthy individuals. In addition, physiological studies have shown that manipulation of the intestinal microbiota by antibiotics, prebiotics, or probiotics can affect intestinal functions (eg, motility and sensation) relevant in the pathogenesis of IBS. Several randomized control trials comparing the effects of probiotics versus placebo in IBS have been published. Despite considerable differences in study design, dosing regimens, probiotic species used, and reported clinical end points, the current data indicate improving IBS symptoms and reducing the risk of persistent IBS symptoms. The data on the use of probiotics in children with IBS is more limited but is also suggestive for beneficial effects. The inconsistencies between the studies underline the need to look at each probiotic product separately for specific conditions, symptoms, and patient populations. This review article discusses the rationale for targeting the intestinal microbiota in patient with IBS and provides an overview and a critical evaluation of the currently available clinical data on the use of probiotics in the treatment of patients with IBS.

A Recommendation for the Use of Probiotics in Children to Prevent Antibiotic-associated Diarrhea

Method: Assessment of health care policy barriers was determined through a review of current literature. Assessment of quality of care includes reports of patient satisfaction through survey results and determination of whether a pediatric NMC met or exceeded selected national benchmarkpediatricHealthCare Effectiveness and Data Information Set (HEDIS) quality indicators as well as HEDIS targets set by the Office of Medicaid and Policy Planning in Indiana.

Probióticos en diarrea aguda infecciosa

ABSTRACT Probiotics in acute infectious diarrhea Background: Acute infectious diarrhea in children represents a worldwide problem and it relates todesnutrition, morbility and death. Objective: Determine the usefulness of probiotics in the treatment ofacute infectious diarrhea in children by reviewing the scientific information available in the form of meta-analysis. Methods: A detailed search was performed in electronic databases. Four of the articles found metinclusion criteria. Results: The four meta-analysis studied demonstrated that the administration of probioticsin children with acute infectious diarrhea decreased the episode duration in approximately one day withminimal adverse events. Conclusions: Despite methodological limitations of the analysed articles, thestudies showed the same trend towards observing a benefit in the use of probiotics in acute infectiousdiarrhea in children. The latter supports the consistency of this association. In general, the use ofprobiotics in children with acute infectious diarrhea would be useful in general practice reducing diarrheaduration in approximately one day.(

Clinical Effects of Probiotics Are Associated With Increased Interferon-γ Responses in Very Young Children With Atopic Dermatitis

Prescott SL, Dunstan JA, Hale J, Breckler L, et al. Clin Exp Allergy. 2005;35:1557–1564 PURPOSE OF THE STUDY. The authors recently demonstrated that young children with moderate-to-severe atopic dermatitis (AD) had significant clinical improvement in the severity and extent of their disease with the use of probiotics. The purpose of this study was to assess the effects of probiotics on underlying immune function and relate that to clinical improvement. STUDY POPULATION. Fifty-six Australian children aged 6 to 23 months with moderate-to-severe AD (based on a modified scoring AD [SCORAD] index of ≥25). METHODS. Subjects were randomly assigned to receive probiotics (1 × 109 colony-forming units of Lactobacillus fermentum; n = 26) or placebo (n = 27) twice daily for 8 weeks. Peripheral blood mononuclear cells were isolated from 53 children at baseline and at 8 and 16 weeks (8 weeks after the supplementation period). Cytokine (interleukin 5 [IL-5], IL-6, IL-10, IL-13, interferon γ [IFN-γ], and tumor necrosis factor α [TNF-α]) responses to allergens (egg ovalbumin, β-lactoglobulin, and house dust mite), vaccines (tetanus toxoid and diphtheria toxoid), intestinal flora (heat-killed L fermentum), skin flora (heat-killed Staphylococcus aureus), S aureus enterotoxin B (SEB), and mitogen (phytohemagglutinin) were assessed. RESULTS. The children who received probiotics showed a significant increase in T-helper 1 cytokine IFN-γ responses to SEB and phytohemagglutinin at 8 and 16 weeks compared with baseline. The increase in IFN-γ response to SEB was directly proportional to the decrease in the severity of AD during the study period. After supplementation with probiotics (week 8) children had significantly higher TNF-α responses to heat-killed L fermentum and heat-killed S aureus compared with those in the placebo group. This was not sustained at 16 weeks. IL-13 (a T-helper type 2 cytokine) responses to ovalbumin decreased significantly during the supplementation period, but this was not sustained after its discontinuation. No other effects of probiotics were seen on allergen-specific responses. CONCLUSIONS. Probiotics led to an increase in IFN-γ responses to nonspecific stimuli (SEB and phytohemagglutinin) and an increase in TNF-α responses to skin and intestinal flora. Clinical improvement in AD severity with probiotics was associated with significant increases in the T-helper 1 IFN-γ responses and altered responses to skin and intestinal flora but not consistent effects on allergen-specific responses. REVIEWER COMMENTS. It is interesting to note that this study did not show any consistent effects of probiotics on allergen-specific responses, which suggests more of an impact on innate immune pathways rather than allergen-specific ones. The results of this study show some promise for the use of probiotics in children with AD. However, there are many variables that need to be addressed, such as impact of underlying food allergy, exposure to antibiotics, and environmental factors. Larger studies are needed to further demonstrate clinical efficacy (short-term and long-term), to determine optimal timing and dosing of treatment, to further investigate immunologic mechanisms, and to determine the impact of probiotic treatment on later development of other atopic disorders (eg, asthma) in young children with AD.