Probiotics Antibiotics Increasingly Have Become

Probiotics Antibiotics increasingly have become a mainstay of healthcare in the United States. So much so, in fact, there are concerns that children are starting to become less immune. Another problem with antibiotics is the side effects. It is often the case that infants and children get diarrhea or yeast infection when taking the medicine. The antibiotics used to treat children with illnesses such as respiratory tract and skin infections often cause antibiotic-associated diarrhea (AAD). It is estimated that somewhere between 11% and 40% of children who take antibiotics suffer from AAD.

In response to this reaction, parents have characteristically given their children over-the-counter diarrhea medicines, such as Kaopectate or Imodium a-D. More recently, because of concerns regarding the amount of medication taken and wanting a more natural approach, these caregivers are starting to give the children probiotics dietary supplements, which containing healthy bacteria or yeasts that can help to restore the body's natural balance. This report looks at six studies on the use of probiotics for the antibiotic side effects (two each from Medline, CINHL, and Google Scholar).

This subject was chosen because of a personal interest in infants and children and what can be done to help with medicinal side effects. This topic is also of interest because of the ramifications of changing dietary patterns and now finding ways to once again regain those earlier eating habits. As is noted by Saavedra, J.M. (2001) for centuries humans have eaten fermented dairy and cereal products. More recently, young children have significantly increased their consumption of fermented milks yoghurt with no record of apparent adverse events.

A recent review identified 143 human clinical trials using multiple probiotic agents between 1961 and 1998, which involved 7500 subjects with no adverse events reported. Nevertheless, it is essential to determine the safety of long-term probiotic consumption by the general public and by high-risk groups in order to make recommendations. There have been a few studies that closely researched large populations for long time periods and monitored any negative effects. Intakes of 106-109 colony-forming units daily of bifidobacteria and lactobacilli for less than a year did not result in any observed adverse effects.

It was also the case that children receiving bifidobacteria not only tolerated the agent well from a gastrointestinal point-of-view, but generally experienced less-frequent and less-hard bowel movements and a decreased frequency of diaper rash. Despite the fact that only very rare instances of bacteremia from lactobacilli have been reported, most such studies have not reported on the occurrence by products or agents currently in the food supply.

In addition, it is not possible in most such cases to know if this was not lactobacilli bacteremia from translocation of the individual's own native colonic flora, which frequently contains certain components of lactobacilli. In summary, most lactobacilli and bifidobacteria used in the food industry, as well as the better-studied lactobacilli and bifidobacteria reported in clinical trials, appear to be safe for the general adult and pediatric populations. Articles were searched using "children" "infants" "antibiotics" "probiotics" and "diarrhea" as keywords. MEDLINE Johnston, B.C., Supina, a.L., Ospina, M.

& Vohra, S. (2007) Probiotics for the prevention of pediatric antibiotic-associated diarrhea. April 18(2) This is a review of ten studies on probiotics to determine the efficacy and adverse effects of probiotics for the prevention of antibiotic-associated diarrhea (AAD) in children. Various databanks were searched children, letters sent to authors of included trials, nutra/pharmaceutical companies, and experts in the field with a request for more information on ongoing or unpublished trials.

Ten studies met the inclusion criteria for trials with either Lactobacilli spp., Bifidobacterium spp., Streptococcus spp., or Saccharomyces boulardii alone or in combination. Six studies used a single strain probiotic agent and four combined two probiotic strains. The analysis for nine out of ten trials that reported on the incidence of diarrhea shows statistically significant results favoring probiotics over active/non active controls. Five of the ten trials were monitored for adverse events, and none reported a serious adverse event.

It is recommended that future studies should consist of probiotic strains and doses that have the most promising evidence (e.g., Lactobacillus GG and Lactobacillus sporogenes). Research is also needed on effect of age, for example, infant vs. older children, or antibiotic duration. Future trials would also gain from an outcome measure for (ADD) that is sensitive to change and reflects what treatment effect clinicians, parents, and children consider important. The current data are promising, but it is premature to routinely recommend probiotics for the prevention of pediatric AAD.

Cremonini, F., DiCaro, S, & Nista, E.C. (2002) Do probiotics decrease antibiotic-associaated diarrhea? Ailment Pharmacology Therapy. 16: 1461-1467 The authors of this meta-analysis conducted a thorough search of MEDLINE, Cochrane database, abstracts of gastroenterology meetings, and unpublished data and focused on 41 studies, 7 that were randomized, placebo-controlled trials, with a minimum follow-up of 2 weeks. Four of the seven studies evaluated Lactobacillus spp and three included Saccharomyces boulardii. Two studies examined infants and children; the rest examined adults, and one of these focused on the elderly.

Diarrhea occurred during antibiotic therapy in 20% of the patients, which was decreased to 8% in patients taking any probiotic. When this study was published, the Bandolier Library analyzed and presented the data from the same seven studies and added the results from an additional two studies. In their analysis, the incidence of antibiotic-associated diarrhea decreased from 23% to 13% in patients given probiotics. Similar results were found Lactobacillus or Saccharomyces. CIHAHL D'Souza, a.L., Rajkumar, C., Cooke, J., & Bulpitt, C.J. (2002) Probiotics in prevention of antibiotic associated diarrhea: meta-analysis.

BMJ 324: 1361-4 This was another meta-analysis from studies between 1966 and 2000. It reviewed nine randomized double blind, placebo controlled trials of probiotics. The results show that two of the nine studies investigated the effects of probiotics in children. Four trials used a yeast (Saccharomyces boulardii), four used Lactobacilli, and one used a strain of enterococcus that produced lactic acid. Three trials used a combination of probiotic strains of bacteria. In all nine trials, the probiotics were given in combination with antibiotics and the control groups received placebo and antibiotics.

The odds ratio in favour of active treatment over placebo in preventing diarrhoea associated with antibiotics was 0.39 for the yeast and 0.34 for Lactobacilli. The authors concluced that probiotics can be used to prevent ADD and that Sboulardii and lactobacilli have the potential to be used in this situation. However, the efficacy of probiotics in treating ADD remains to be proved. A future trial in which probiotics are used as preventive agents should look at the costs of and need for routine use of these agents. Gagan, M.J.

(2003) Review: probiotics are effective in preventing antibiotic associated diarrhea. Evidence-Based Nursing 6(1): 16 For this meta-analysis, research was found by searching Medline (1966-2000) This analysis included nine trials, with two of the trials studying children. The results showed that probiotic treatment was more effective than placebo in the prevention of diarrhea Four trials that used S. boulardii also favoured probiotic treatment as did five other studies that used lactobacilli or enterococci. Once again the authors concluded that in patients being treated with antibiotics, coadministration with probiotics reduces the incidence of diarrhea.

Google Search Saavedra, J.M. (2001) Clinical Applications of Probiotics.); American Journal of Clinical Nutrition 73(6): 1147-51 Increasingly, the potential benefits of modifying the intestinal flora composition of, premature infants and children receiving antibiotics, are being noticed in the literature. Studies that point out therapeutic benefits in acute viral gastroenteritis and in atopic disease demonstrate not only to the possible applications, but also to the fact that these agents may be working due to their interaction with the gut as an immunologic organ.

The advantages found so far are variable and probably dependent on the medicines, the dose, the dosing patterns, and the characteristics of the person taking the medicine. Thus, the safety and specification of a particular probiotic agent and methods of delivery to a particular population for a particular purpose still need to be studied more extensively before making major recommendations. The cost-benefit assessment of adding probiotics to diet for prophylactic or therapeutic purposes and better regulation of these agents as commercial products, is also needed. McFarland, L.V.

(2001) Meta-Analysis of Probiotics for the Prevention of Antibiotic Associated Diarrhea and the Treatment of Clostridium difficile Disease. American Journal of Clinical Nutrition, 73(6)1147S-1151S. The object of this article was to compare the efficacy of probiotics for the prevention of AAD based on the published randomized, controlled clinical trials using meta-analyses, three types of probiotics (Saccharomyces boulardii, Lactobacillus rhamnosus GG, and probiotic.) the trials were included where specific probiotics for either prevention or treatment were the diseases of interest. Thirty-one of 180 screened studies (totally.