From the Guidelines
Probiotics are indicated in pediatric patients for the prevention of necrotizing enterocolitis (NEC) in preterm, low-birth-weight infants, and for the prevention of antibiotic-associated diarrhea.
Indications for Probiotics in Pediatric Patients
- Prevention of NEC in preterm, low-birth-weight infants: The use of certain probiotic strains or combinations, such as Lactobacillus spp and Bifidobacterium spp, B animalis subsp lactis, L reuteri, or L rhamnosus, is suggested for the prevention of NEC in preterm infants less than 37 weeks gestational age and low birth weight 1.
- Prevention of antibiotic-associated diarrhea: The use of probiotics, such as Saccharomyces boulardii and Lactobacillus rhamnosus GG, is recommended for the prevention of antibiotic-associated diarrhea in pediatric patients 1.
- Treatment of infantile colic: L reuteri DSM 17938 may be recommended for the treatment of infantile colic, especially in breastfed babies 1.
Important Considerations
- Acute gastroenteritis: The use of probiotics is not recommended for the treatment of acute gastroenteritis in children in North America, as the current evidence does not support its effectiveness 1.
- Safety: The use of probiotics is generally considered safe, but caution is recommended in premature neonates, immunocompromised patients, critically ill patients, those with a central venous catheter, cardiac valvular disease, and short-gut syndrome 1.
From the Research
Indications for Probiotics in Pediatric Patients
The use of probiotics in pediatric patients has been studied for various indications, including:
- Treatment of infectious gastroenteritis 2, 3, 4
- Prevention of antibiotic-associated diarrhea 2, 3, 4
- Prevention of Clostridioides difficile-associated diarrhea 2, 3
- Prevention of nosocomial diarrhea 2, 4
- Treatment of necrotizing enterocolitis (NEC) 3
- Treatment of relapsing Clostridium difficile colitis 3
- Treatment of Helicobacter pylori infections 3
- Treatment of inflammatory bowel disease (IBD) 3
- Treatment of irritable bowel syndrome 5
- Treatment of Crohn's disease 5
- Treatment of short bowel syndrome 5
- Treatment of human immunodeficiency virus 5
- Treatment of food allergies 5
Specific Probiotic Strains
Certain probiotic strains have been shown to be effective for specific indications, including:
- Lactobacillus rhamnosus GG (LGG) for the treatment of acute gastroenteritis and prevention of antibiotic-associated diarrhea 4
- Saccharomyces boulardii for the treatment of acute gastroenteritis and prevention of antibiotic-associated diarrhea 4
- LGG for the prevention of nosocomial diarrhea and respiratory tract infection in day care centers 4
Safety and Efficacy
Probiotics are generally well tolerated and have a low risk of adverse events 2, 3. However, the efficacy of probiotics can vary depending on the specific strain, dose, and treatment regimen 2, 3. Therefore, healthcare professionals should consider the specific indications and strains when recommending probiotics for pediatric patients 2, 3, 6.