TAMPERE, Finland - The co-administration of the probiotic strain Lactobacillus casei sps. rhamnosus GG (Lactobacillus GG) to children who are receiving antimicrobial therapy reduces the incidence of antibiotic-associated diarrhea, according to a recent Finnish study.
Probiotic preparations - which include bacteria such as lactobacilli and have documented health-promoting benefits - are frequently recommended to treat disturbances in intestinal microflora and antibiotic-associated diarrhea. While they have proven effective in the prevention and treatment of viral gastroenteritis, their usefulness during antimicrobial therapy in children was previously unconfirmed.
"It's quite likely that Lactobacillus GG will be utilized now that we know it helps children with recurrent antibiotic-associated diarrhea," said Jon A. Vanderhoof, MD, chief of pediatric gastroenterology, University of Nebraska and Creighton Medical School. "Co-administration [with an oral antibiotic in children with acute infectious disorders] could become very common."
Lactobacillus GG was deemed a safe and effective adjunct therapy to prevent antibiotic-associated diarrhea, which can range from a brief, self-limiting disease to diarrhea with electrolyte disturbances, dehydration, crampy abdominal pain, pseudomembranous colitis, toxic megacolon or even death.
The Finnish study evaluated the incidence of diarrhea after antimicrobial treatment in children with no history of antimicrobial use during the previous three months. Study participants, who ranged in age from 2 weeks to 12.8 years, were prescribed antimicrobial agents for the treatment of acute respiratory infections. Antibiotic use was continued for seven to 10 days and was divided into two to three dosages given every eight to 12 hours. Patients received 2x10 CFUs of Lactobacillus GG in capsules given twice daily during the antimicrobial treatment.
Participants kept a daily symptom diary and recorded stool frequency and consistency for three months. Diarrhea was classified as three watery or loose stools per day for a minimum of two consecutive days. Viral (adenovirus, rotavirus, calicivirus and astrovirus) and bacterial (Salmonella, Shigella, Yersinia, Campylobacter, Clostridium difficile, Staphylococcus aureus and yeast) analyses were studied in fecal samples. Metabolic activity of the gut microflora was assessed by analysis of fecal urease, b-glucuronidase and b-glucosidase.
The incidence of diarrhea was 5% in the Lactobacillus GG group and 16% in the placebo group within two weeks of antimicrobial therapy. Eighty percent of all gastrointestinal symptoms were reported within the first two weeks after beginning the antimicrobial treatment. The severity of diarrhea was similar in both study groups in frequency and duration.
A U.S. study on Lactobacillus GG revealed that 20% to 40% of children receiving broad-spectrum antibiotics suffered from diarrhea. In that study, 26% of the placebo-treated children experienced diarrhea, compared with 8% of the children who concurrently received Lactobacillus GG.
"Antibiotics are prescribed so frequently to kids. If you can decrease the side effects associated with them, that's significant for the parents and the kids, especially kids with a history of diarrhea," said Terri L. Hanner, RN, Children's Hospital, Omaha, Neb. "If concurrently given every time, it would be of great benefit to the parents, kids and everybody involved."
Antibiotic-associated diarrhea most often occurs because of disturbances of microbial flora in the GI tract, where more than 500 species of bacteria inhabit the gut. Probiotics generally enhance the intestinal microflora by replenishing suppressed bacteria and inhibiting the growth of more pathogenic flora.
"Lactobacilli are very different one from another," said Vanderhoof. " Many don't colonize in the gut or attach to the bowel."
According to the U.S. study, Lactobacillus GG one of the most extensively studied probiotics derived from the human digestive system, has also been shown to be effective in reducing the incidence of traveler's diarrhea, shortening the duration and severity of rotavirus diarrhea and ameliorating erythromycin-induced diarrhea in adults. It has also been shown useful in uncontrolled studies of patients with C. difficilediarrhea.
Lactobacillus GG (Culturelle, ConAgra) can be purchased over the counter. It is being studied for effectiveness in people with HIV, those with inflammatory bowel disease and in infants with formula allergies.
For more information
- Arvola T, Laiho K, Trokkeli S, et al. Prophylactic Lactobacillus GG reduces antibiotic-associated diarrhea in children with respiratory infections: A randomized study. Pediatrics. 1999;104(5):64.
- Vanderhoof J, Whitney D, Antonson D, et al. Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children. J Pediatr. 1999;135(5):564-568.
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Copyright 2000, SLACK Incorporated. Revised 15 September 2000.