Aim: To determine the efficacy of a combination of Bifidobacterium longum PL03, Lactobacillus rhamnosus KL53A and Lactobacillus plantarum PL02 for the prevention of antibiotic-associated diarrhea in children. Methods: Seventy-eight children (age: 5 months to 16 years) with otitis media, and/or respiratory tract infections, and/or urinary tract infections were enrolled in a double-blind randomized control trial in which they received standard antibiotic treatment plus a food supplement containing 108 colony-forming units of B. longum, L. rhamnosus and L. plantarum (n = 40) or a placebo (n = 38) orally twice daily for the duration of antibiotic treatment. Results: Patients receiving probiotics had a similar rate of diarrhea (≧3 loose or watery stools/day for ≧48 h occurring during or up to 2 weeks after the antibiotic therapy) as those receiving placebo (relative risk 0.5, 95% CI 0.06–3.5). The mean number of stools per day was significantly lower in the experimental group (mean difference –0.3 stool/day, 95% CI –0.5 to –0.07). No adverse events were reported. Conclusion: The administration of the 3 probiotics did not significantly alter the rate of diarrhea, although it reduced the frequency of stools per day. As the overall frequency of diarrhea was surprisingly low, these results should be interpreted with caution.

Journal Section:
Original Paper
Keywords:
Probiotics, Microbiota, Antibiotic-associated diarrhea, Randomized control trial
1.
Bartlett JG: Antibiotic-associated diarrhea. N Engl J Med 2002;346:334–339.
[PubMed]
https://doi.org/10.1056%2FNEJMcp011603
2.
Elstner CL, Lindsay AN, Book LS, Matsen JM: Lack of relationship of Clostridium difficile to antibiotic-associated diarrhea in children. Pediatr Inf Dis 1983;2:364–366.
[PubMed]
3.
Barbut F, Meynard JL, Guiguet M, Avesani V, Bochet MV, Meyohas MC, Delmée M, Tilleul P, Frottier J, Petit JC: Clostridium difficile-associated diarrhea in HIV-infected patients: epidemiology and risk factors. J Acquir Immune Defic Syndr Hum Retrovirol 1997;16:176–181.
[PubMed]
4.
McFarland LV, Surawicz CM, Stamm WE: Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients. J Infect Dis 1990;162:678–684.
[PubMed]
5.
Bartlett JG, Chang TW, Gurwith M, Gorbach SL, Onderdonk AB: Antibiotic-associated pseudomembranous colitis due to toxin producing Clostridia. N Engl J Med 1978;298:531–534.
[PubMed]
6.
Turck D, Bernet JP, Marx J, Kempf H, Giard P, Walbaum O, Lacombe A, Rembert F, Toursel F, Bernasconi P, Gottrand F, McFarland LV, Bloch K: Incidence and risk factors of oral antibiotic-associated diarrhea in an outpatient pediatric population. J Pediatr Gastroenterol Nutr 2003;37:22–26.
[PubMed]
https://doi.org/10.1097%2F00005176-200307000-00004
7.
Joint FAO/WHO Working Group Report on Drafting Guidelines for the Evaluation of Probiotics in Food: London, Ontario, 2002.
8.
Szajewska H, Ruszczynski M, Radzikowski A: Probiotics in the prevention of antibiotic-associated diarrhea in children: a meta-analysis of randomized controlled trials. J Pediatr 2006;149:367–372.
[PubMed]
https://doi.org/10.1016%2Fj.jpeds.2006.04.053
9.
Johnston BC, Supina AL, Vohra S: Probiotics for pediatric antibiotic-associated diarrhea: a meta-analysis of randomized placebo-controlled trials. CMAJ 2006;175:377–383. Erratum in: CMAJ 2006;175:777.
[PubMed]
10.
D’Souza AL, Rajkumar C, Cooke J, Bulpitt CJ: Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis. Br Med J 2002;324:1361–1364.
[PubMed]
https://doi.org/10.1136%2Fbmj.324.7350.1361
11.
Cremonini F, Di Caro S, Nista EC, Bartolozzi F, Capelli G, Gasbarrini G: Meta-analysis: the effect of probiotic administration on antibiotic-associated diarrhoea. Aliment Pharmacol Ther 2002;16:1461–1467.
[PubMed]
https://doi.org/10.1046%2Fj.1365-2036.2002.01318.x
12.
Szajewska H, Mrukowicz J: Meta-analysis: non-pathogenic yeast Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea. Aliment Pharmacol Ther 2005;22:365–372.
[PubMed]
https://doi.org/10.1111%2Fj.1365-2036.2005.02624.x
13.
Hawrelak JA, Whitten DL, Myers SP: Is Lactobacillus rhamnosus GG effective in preventing the onset of antibiotic-associated diarrhoea: a systematic review. Digestion 2005;72:51–56.
[PubMed]
https://doi.org/10.1159%2F000087637
14.
Kotowska M, Albrecht P, Szajewska H: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea in children: a randomized double-blind placebo-controlled trial. Aliment Pharmacol Ther 2005;21:583–590.
[PubMed]
https://doi.org/10.1111%2Fj.1365-2036.2005.02356.x
15.
Vanderhoof JA, Whitney DB, Antonson DL, Hanner TL, Lupo JV, Young RJ: Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children. J Pediatr 1999;135:564–568.
[PubMed]
https://doi.org/10.1016%2FS0022-3476%2899%2970053-3
16.
Tankanow RM, Ross MB, Ertel IJ, Dickinson DG, McCormick LS, Garfinkel JF: A double-blind, placebo-controlled study of the efficacy of Lactinex in the prophylaxis of amoxicillin-induced diarrhea. DICP 1990;24:382–384.
[PubMed]
© 2008 S. Karger AG, Basel
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