Recommendation of different clinical use of Probiotics in Children

Probiotics

Probiotics are viable organisms that have health benefits following administration.

Common bacterial genera include bifidobacteria, lactobacilli, streptococci, enterococci, and E. coli.

Probiotics as Additional Therapies

· The use of probiotic nonpathogenic bacteria for prevention and therapy of diarrhea has been successful in some settings although the evidence is inconclusive to recommend their use in all settings.

· In addition to restoring beneficial intestinal flora, probiotics can enhance host protective immunity such as down regulation of pro-inflammatory cytokines and up regulation of anti-inflammatory cytokines. A variety of organisms (Lactobacillus, Bifidobacterium) have a good safety record; therapy has not been standardized and the most effective (and safe) organism has not been identified.

Dietary supplements are the most commonly used complementary therapies for children and adolescents. Some uses are common and recommended, such as probiotics to prevent -

· Antibiotic-associated diarrhea;

· Clostridium difficile–associated diarrhea;

· Irritable bowel syndrome;

· Pouchitis;

· Prevention and reduction of atopy in high risk children;

· Reduction in Necrotizing enterocolitis (NEC) among preterm infants;

According to American Family Physicians (AAFP)

Probiotic Doses:

· 5 to 10 billion CFUs per day for children

Following are the Recommendation in Nelson textbook of Pediatrics, 20th Ed:

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Antibiotic-associated diarrhea

Antibiotic-associated diarrhea is reduced in frequency and duration by probiotic use.

Metaanalysis indicated a relative reduce of risk of antibiotic-associated diarrhea with probiotic administration using Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus.

Rota Virus diarrhea

Lactobacillus rhamnosus GG is associated with reduced diarrheal duration and severity, which reduction is more evident in cases of childhood rotavirus diarrhea.

C. difficile–associated diarrhea (CDAD)

There is moderate evidence that probiotics may reduce the incidence of C. difficile–associated diarrhea.

Metaanalysis specifically for the efficacy of probiotics in decreasing the incidence of CDAD demonstrated moderate evidence for the practice.

In an analysis of more than 1,800 trials, including many in the pediatric population, probiotics reduced CDAD by 64%. A pediatric subgroup was analyzed across relevant studies, revealing benefit in pediatric patients and a well-child

A number of probiotics were used, including different Lactobacillus strains and S. boulardii.

Infectious Persistent Diarrhea

Probiotics Lactobacillus for a minimum period of 7 days or until diarrhea stopped

Saccharomyces boulardii for a minimum period of 7 days or till diarrhea stopped

Gastroenteritis in children

The broad principles of management of acute gastroenteritis in children include oral rehydration therapy, enteral feeding and diet selection, zinc supplementation, and additional therapies such as probiotics.

Atopic dermatitis

Metaanalysis suggests a modest benefit from probiotic administration to prevent the development of atopic dermatitis.

Perinatal administration of the probiotic Lactobacillus rhamnosus strain GG has been shown to reduce the incidence of AD (Atopic dermatitis) in at-risk children during the first 2 yrs of life. The treatment response has been found to be more pronounced in patients with positive skin prick test results and elevated IgE values.

Data suggest that atopic dermatitis is influenced by the local skin microbiome and more distant microbiomes such as in the intestinal tract, also suggesting why the administration of oral probiotics such as Lactobacillus spp. may decrease atopic dermatitis and increased interferon-γ, which are part of immune tolerance.