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Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
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probiotics4January 6 2016

There is “moderate quality” evidence that probiotics can have a protective effect against antibiotic-associated diarrhoea (AAD) in children, a Cochrane review has concluded. However, Cochrane researchers could not find sufficient data to support any claims around probiotics having a protective effect against urinary tract infections (UTIs) in children or adults.

Cochrane researchers looking at probiotics’ action against diarrhoea looked at published data available up to November 2014. They investigated whether probiotics prevent AAD in children receiving antibiotic therapy and whether probiotics causes any side effects.

Data from 23 studies involving 3,938 children aged from two weeks to 17 years was used, covering a range of probiotics -Lactobacilli spp, Bifidobacterium spp, Streptococcus spp, and Saccharomyces boulardii - alone or in combination, as well as placebo and other treatments thought to prevent AAD.

“Analyses showed that probiotics may be effective for preventing AAD. The incidence of AAD in the probiotic group was 8% (163/1992) compared to 19% (364/1906) in the control group,” said the researchers. “Probiotics were generally well tolerated, and minor side effects occurred infrequently, with no significant difference between probiotic and control groups. The majority of side effects were reported in the placebo, standard care or no treatment groups.”

The researchers have suggested that Lactobacillus rhamnosus or Saccharomyces boulardii at 5 to 40 billion colony forming units/day “may be appropriate for preventing AAD in children receiving antibiotics.” However, “it is premature to draw conclusions about the effectiveness and safety of other probiotic agents for preventing AAD.”

Serious adverse events have been observed in severely debilitated or immunocompromised children with underlying risk factors including central venous catheter use and disorders associated with bacterial/fungal translocation. “Until further research has been conducted, probiotic use should be avoided in paediatric populations at risk for adverse events,” warned the researchers.

For UTIs, researchers found nine studies involving 735 participants were eligible for consideration. Seven of the studies involved women or girls with recurrent UTIs, one looked at children with abnormal urinary tracts, and one investigated UTIs in healthy women.

“Generally, studies were poor quality with high risk of bias. Aside from the different populations, there were also many different species of probiotics used, different dosage forms such as vaginal and oral, and probiotics were given for varying lengths of time. All of these factors may have affected our results,” say the researchers.

“No significant benefit was demonstrated for probiotics compared with placebo or no treatment, but a benefit cannot be ruled out as the data were few, and derived from small studies with poor methodological reporting.”

Links:

JZ Goldenberg et al. ‘Probiotics for the prevention of pediatric antibiotic-associated diarrhea’. Published online December 22 2015

EM Schwenger et al. ‘Probiotics for preventing urinary tract infections in adults and children’. Cochrane Library. Published online December 23 2015

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