Chemistry Reference
In-Depth Information
developing nosocomial diarrhea when infants were fed formula containing bifido-
bacteria and streptococci 7 percent versus 31 percent.
45
Randomized controlled studies suggest a modest protective effect of probiot-
ics in decreasing community-acquired diarrheal episodes. A Peruvian study of 204
malnourished children showed a reduction of the number of episodes of diarrhea per
child per year from 6.02 to 5.21 in those receiving
Lactobacillus
GG (46). A second
study from Finland involving 571 children attending daycare centers did not show
a significant difference in the number of days with diarrhea when
Lactobacillus
GG was used. However, there was a 16 percent reduction in the number of days of
absence due to gastrointestinal and respiratory illnesses.
47
Another study involving
210 healthy children in child healthcare centers using
L. reuteri
and
B. lactis
showed
a lower frequency and duration of diarrhea as compared to a control group.
48
The most common alteration of intestinal flora in children occurs with anti-
microbial therapy, especially with broad-spectrum antibiotics. Positive effects in
pediatric antibiotic-associated diarrhea have been identified with
Lactobacillus
GG. Arvola et al.
49
performed a double-blind trial in 119 children (mean age 4.5
years) receiving antibiotics for respiratory infections in Finland. They administered
Lactobacillus
GG twice a day during antibiotic therapy and demonstrated signifi-
cantly fewer incidences of diarrhea in the probiotic group (5 percent vs. 16 percent).
In this study, actual changes in gut microflora were also identified in patients who
had diarrhea as defined by three or more loose stools per day. Vanderhoof et al.
50
also reported a placebo-controlled study of 188 children receiving antibiotics for
common upper respiratory infections that demonstrated fewer episodes of diarrhea,
as defined by increased stool looseness and frequency, in the group receiving the
probiotic
Lactobacillus
GG (48 percent vs. 17 percent).
A meta-analysis of data from five randomized, controlled trials showed
Saccharomyce
s
boulardii
to be moderately effective in preventing antibiotic-associated
diarrhea in children and adults treated with antibiotics.
51
Not all probiotics are equally
effective in this condition as a combination of
L.
acidophilus
and
L. bulgaricus
was
ineffective in preventing diarrhea in children receiving amoxicillin therapy during a
double-blind, placebo-controlled trial.
52
Hospitalized children receiving limited enteral
intake and broad-spectrum antibiotics may significantly benefit from concurrent pro-
biotic therapy. Biller
53
reported a positive effect in an open-label case series of four
pediatric patients using
Lactobacillus
GG
for recurrent
Clostridium difficile
infection.
Necrotizing enterocolitis (NEC), a condition seen predominantly in premature
infants, often results in small bowel resection in severe cases. In three studies, the
use of a combination probiotic therapy administered to premature infants reduced
the incidence of NEC.
54-56
Other investigators, however, were unable to demonstrate
any benefit of
Lactobacillus
GG in NEC prevention.
57
A new area of research has demonstrated that probiotics may be particularly effec-
tive not only in intestinal inflammation, but may also affect the systemic immune
response that occurs with food-related allergies in infants and children. Probiotics
appear to redirect the immune system toward producing chemical mediators that are
more useful in controlling infections, rather than mediators that induce the aller-
gic response. Studies in infants with eczema receiving formulas supplemented with
