Acidified Milk Formula Supplemented With Bifidobacterium lactis: Impact on Infant Diarrhea in Residential Care Settings Probiotics and prebiotics in gastrointestinal disorders Prebiotic and Probiotic Fortified Milk in Prevention of Morbidities among Children: Community-Based, Randomized, Double-Blind, Controlled Trial World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics Long-term safety of early consumption of Lactobacillus fermentum CECT5716: A 3-year follow-up of a randomized controlled trial. Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting. Nitazoxanide vs. probiotics for the treatment of acute rotavirus diarrhea in children: a randomized, single-blind, controlled trial in Bolivian children. [Experience with gamma globulins per os in the therapy and prevention of infectious diarrhea]. Overview of Reviews The prevention of eczema in infants and children: an overview of Cochrane and non-Cochrane reviews. Micronutrients as adjunct therapy of acute illness in children: impact on the episode outcome and policy implications of current findings. A Randomized Formula Controlled Trial of Bifidobacterium lactis and Streptococcus thermophilus for Prevention of Antibiotic-Associated Diarrhea in Infants The effect of fermented yogurt on the prevention of diarrhea in a healthy adult population. Bifidobacterium animalis subsp. lactis BB-12 in reducing the risk of infections in early childhood The effect of early nutritional supplementation with a mixture of probiotic, prebiotic, fiber and micronutrients in infants with acute diarrhea in Indonesia. Probiotic Prophylaxis in Predicted Severe Acute Pancreatitis: A Randomised, Double-Blind, Placebo-Controlled Trial. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial Effect of probiotic Lactobacillus strains on acute diarrhea in a cohort of nonhospitalized children attending day-care centers Effect of probiotic Lactobacillus strains in young children hospitalized with acute diarrhea Effect of bifidobacterium Bb12 with or without Streptococcus thermophilus supplemented formula on nutritional status. Lactobacillus paracasei Strain ST11 Has No Effect on Rotavirus but Ameliorates the Outcome of Nonrotavirus Diarrhea in Children From Bangladesh Prophylactic Lactobacillus GGReduces Antibiotic-Associated Diarrhea in Children With Respiratory Infections: A Randomized Study Use of VSL♯3 in the Treatment of Rotavirus Diarrhea in Children: Preliminary Results The effects of perioperative probiotic treatment on serum zonulin concentration and subsequent postoperative infectious complications after colorectal cancer surgery: a double-center and double-blind randomized clinical trial.
Objectives Probiotics may be useful in preventing acute infectious diarrhea .  Bifidobacteria are particularly attractive as probiotics agent because they constitute the predominant colonic flora of breastfed infants and are thought to play a role in the decreased incidence of diarrhea in breastfed infants . Methods This was a multicenter , double-blind , controlled study to evaluate the efficacy of a milk formula supplemented with viable Bifidobacterium lactis strain Bb 12 ( BbF ) in the prevention of acute diarrhea in infants younger than 8 months living in residential nurseries or foster care centers . Results Ninety healthy children received either the BbF or a conventional formula ( CF ) daily . The mean duration of the stay in the residential center was similar ( 137 v 148 days ) . At enrollment , there were no differences between the two groups with respect to age ( 3.7 ± 2.1 months ) , gender , anthropometric data , history of allergy or gastrointestinal disease , frequency of breast-feeding in the neonatal period or timing of introduction of solid food . Altogether , 28.3 % of the BbF infants  had diarrhea during the study compared with 38.7 % of controls ( NS ) . There was a statistically insignificant trend for shorter episodes of diarrhea in the BbF group ( 5.1 ± 3.3 days v 7 ± 5.5 days , NS ) . The number of days with diarrhea was 1.15 ± 2.5 in the BbF group with a daily probability of diarrhea of 0.84 versus 2.3 ± 4.5 days and 1.55 , respectively , in the CF group ( P = 0.0002 and 0.0014 ) . Feeding infants with the BbF reduced their risk of getting diarrhea by a factor of 1.9 ( range , 1.33–2.6 ) . Analysis of the cumulative incidence of diarrheal episodes showed a trend that the first onset of diarrhea occurred later in the BbF group . Conclusion These results provide some evidence that viable Bifidobacterium lactis strain Bb 12 , added to an acidified infant formula , has some protective effect against acute diarrhea in healthy children Purpose of review This review summarizes the clinical efficacy of probiotics and prebiotics in gastrointestinal disorders and examines the mechanisms of action related to their therapeutic effect . Recent findings The demonstration that immune and epithelial cells can discriminate between different microbial species has extended the known mechanism(s ) of action of probiotics beyond simple barrier and antimicrobial effects . It has also confirmed that probiotic bacteria modulate mucosal and systemic immune activity and epithelial function . The progressive unraveling of these mechanisms of action has led to new credence for the use of probiotics and prebiotics in clinical medicine . Level I evidence now exists for the therapeutic use of probiotics in infectious diarrhea in children , recurrent Clostridium difficile – induced infections and postoperative pouchitis . Level II evidence is emerging for the use of probiotics in other gastrointestinal infections , prevention of postoperative bacterial translocation , irritable bowel syndrome , and in both ulcerative colitis and Crohn disease . Nevertheless , one consistent feature has emerged over the past year : Not all probiotic bacteria have similar therapeutic effects . Future clinical trials will need to incorporate this fact into trial planning and design . Summary The use of probiotics and prebiotics as therapeutic agents for gastrointestinal disorders is rapidly moving into the “ mainstream . ” Mechanisms of action explain the therapeutic effects and r and omized ; controlled trials provide the necessary evidence for their incorporation into the therapeutic armamentarium Background Recent review s suggest common infectious diseases continue to be a major cause of death among preschool children in developing countries . Identification of feasible strategies to combat this disease burden is an important public health need . We evaluated the efficacy of adding prebiotic oligosaccharide and probiotic Bifidobacterium lactis HN019 to milk , in preventing diarrhea , respiratory infections and severe illnesses , in children aged 1–4 years as part of a four group study design , running two studies simultaneously . Methods and Findings In a community based double-masked , r and omized controlled trial , children 1–3 years of age , willing to participate , were r and omly allocated to receive either control milk ( Co ; n = 312 ) or the same milk fortified with 2.4 g/day of prebiotic oligosaccharide and 1.9 × 107 colony forming unit (c.f.u)/day of probiotic Bifidobacterium lactis HN019 ( PP ; n = 312 ) . Children were followed up for 1 year providing data for 1–4 years . Biweekly household surveillance was conducted to gather information on compliance and morbidity . Both study groups were comparable at baseline ; compliance to intervention was similar . Overall , there was no effect of prebiotic and probiotic on diarrhea ( 6 % reduction , 95 % Confidence Interval [ CI ] : −1 to 12 % ; p = 0.08 ) . Incidence of dysentery episodes was reduced by 21 % ( 95 % CI : 0 to 38 % ; p = 0.05 ) . Incidence of pneumonia was reduced by 24 % ( 95 % CI : 0 to 42 % ; p = 0.05 ) and severe acute lower respiratory infection ( ALRI ) by 35 % ( 95 % CI : 0 to 58 % ; p = 0.05 ) . Compared to children in Co group , children in PP group had 16 % ( 95 % CI : 5 to 26 % , p = 0.004 ) and 5 % ( 95 % CI : 0 to 10 % ; p = 0.05 ) reduction in days with severe illness and high fever respectively . Conclusions / Significance Milk can be a good medium for delivery of prebiotic and probiotic and result ed in significant reduction of dysentery , respiratory morbidity and febrile illness . Overall , impact of diarrhea was not significant . These findings need confirmation in other setting s. Trial Registration Clinical Trials.gov Background Prevalence of  allergic diseases in infants , whose parents and siblings do not have allergy , is approximately 10 % and reaches 20–30 % in those with an allergic first-degree relative . Intestinal microbiota may modulate immunologic and inflammatory systemic responses and , thus , influence development of sensitization and allergy . Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention . Objective The World Allergy Organization ( WAO ) convened a guideline panel to develop evidence -based recommendations about the use of probiotics in the prevention of allergy . Methods We identified the most relevant clinical questions and performed a systematic review of r and omized controlled trials of probiotics for the prevention of allergy . We followed the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach to develop recommendations . We search ed for and review ed the evidence about health effects , patient values and preferences , and re source use ( up to November 2014 ) . We followed the GRADE evidence -to-decision framework to develop recommendations . Results Currently available evidence does not indicate that probiotic supplementation  reduces the risk of developing allergy in children . However , considering all critical outcomes in this context , the WAO guideline panel determined that there is a likely net benefit from using probiotics result ing primarily from prevention of eczema . The WAO guideline panel suggests : a ) using probiotics in pregnant women at high risk for having an allergic child ; b ) using probiotics in women who breastfeed infants at high risk of developing allergy ; and c ) using probiotics in infants at high risk of developing allergy . All recommendations are conditional and supported by very low quality evidence . Conclusions WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents , clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding , and whether to give them to infants Lactobacillus fermentum CECT5716 is a probiotic strain originally isolated from human breast milk . Previous clinical studies in infants showed that the early administration of a milk formula containing this probiotic strain was safe and may be useful for the prevention of community-acquired infections . This is a 3-year follow-up study aim ed at evaluating the long-term effects produced by the early consumption of an infant formula supplemented with L. fermentum CECT5716 ( experimental group , EG ) compared with a control formula without the probiotic ( control group , CG ) . The infants included in this follow-up study had previously completed a 5-month r and omized double-blind controlled trial ( from 1 to 6 months of age ) , where the safety and tolerance of the probiotic formula was evaluated . The main outcome of the follow-up study was the growth of the children . The secondary outcomes included the incidence of infectious and non-infectious diseases , parameters related with intestinal function and faecal microbiota . At 3 years , the mean values of weight , length and head circumference were similar in children of the EG compared with those of the CG . No differences were observed in the incidence of infectious and non-infectious diseases or disorders related with intestinal function . The pattern of faecal microbiota was also similar between both groups . In conclusion , this 3-year study shows that the early administration of the probiotic of L. fermentum CECT5716 in an infant formula is safe and it does not produce measurable differences in children compared with a control formula OBJECTIVE Two r and omized controlled clinical trials have shown that Lactobacillus ( L ) reuteri DSM 17938 reduces the duration of diarrhea in children hospitalized due to acute infectious diarrhea . This was the first trial evaluating the efficacy of L. reuteri DSM 17938 in outpatient children with acute infectious diarrhea . METHODS This was a multicenter , r and omized , single-blinded , case control clinical trial in children with acute watery diarrhea . A total of 64 children who presented at outpatient clinics were enrolled .  The probiotic group received 1 × 10(8)CFU L. reuteri DSM 17938 for five days in addition to oral rehydration solution ( ORS ) and the second group was treated with ORS only . The primary endpoint was the duration of diarrhea ( in hours ) . The secondary endpoint was the number of children with diarrhea at each day of the five days of intervention . Adverse events were also recorded . RESULTS The mean duration of diarrhea was significantly reduced in the L. reuteri group compared to the control group ( approximately 15h , 60.4±24.5h [ 95 % CI : 51.0 - 69.7h ] vs. 74.3±15.3h [ 95 % CI : 68.7 - 79.9h ] , p<0.05 ) . The percentage of children with diarrhea was lower in the L. reuteri group ( 13/29 ; 44.8 % ) after 48h than the control group ( 27/31 ; 87 % ; RR : 0.51 ; 95 % CI : 0.34 - 0.79 , p<0.01 ) . From the 72nd hour of intervention onwards , there was no difference between the two groups in the percentage of children with diarrhea . No adverse effects related to L. reuteri were noted . CONCLUSION L. reuteri DSM 17938 is effective , safe , and well-tolerated in outpatient children with acute infectious diarrhea BACKGROUND In previous studies , nitazoxanide has demonstrated a cytoprotective effect against rotavirus , reducing the duration of diarrhea in comparison to placebo . We design ed a r and omized , single-blind , controlled trial in order to assess the effectiveness of nitazoxanide and probiotics in comparison with a control group . METHODS Seventy-five children aged from 28 days to 24 months , with rotavirus diarrhea , were r and omly assigned to receive either oral nitazoxanide ( 15 mg/kg/day ) twice a day for three days , a combination of oral probiotics , 1 g twice a day for five days , or only oral or systemic rehydration solutions . The duration of diarrhea and of hospitalization were the primary outcome measures , and daily stool frequency , vomiting , and fever were some of the secondary outcome measures analyzed . RESULTS The median duration of hospitalization was significantly shorter ( p = 0.017 ) in patients who received nitazoxanide ( 81 h ) and probiotics ( 72 h ) compared to patients who received oral rehydration solution alone ( 108 h ) . Similarly , the median duration of diarrhea was significantly reduced ( p = 0.009 ) in children who received nitazoxanide ( 54 h ) and probiotics ( 48 h ) compared to the control group ( 79 h ) . CONCLUSIONS Treatment with nitazoxanide and probiotics is effective in the management of children with acute rotavirus diarrhea . Small differences in favor of nitazoxanide were found in comparison with probiotics . Nitazoxanide is an important treatment option for rotavirus diarrhea The efficacy of oral gammaglobulin in the treatment of acute infectious diarrhea in immunocompetent children has been evaluated in an open placebo controlled trial . Moreover the efficacy of oral gammaglobulin has been tested also for treatment of chronic diarrhea in IgA deficient infants and for prevention of rotavirus infection during an epidemic in the ward . 54 infants ( aged 1 - 36 months ) with acute diarrhea ( 30 rotavirus + ) were enrolled in the study . 24 out of 54 were assigned with r and omised method to group a receiving gammaglobulin 150 mg/kg x 2 in the first day of admission to hospital and the remaining 30 infants were assigned to group b receiving placebo .  Diarrhea cleared up in 2.57 + /- 1.4 days without a significant difference between group a and b ( 2.6 + /- 1.6 and 2.46 + /- 1.1 days respectively ) . The diarrhea 's duration in Rotavirus+infants was 2.78 + /- 1.4 days in group a and 3 + /- 1.4 days in group b again without a significant difference . The excretion time of rotavirus in the stools was significantly shorter in rotavirus+group a ( 2.6 + /- 1.3 ) than in rotavirus group b ( 3.9 + /- 1.6 ) with p < 0.04 . Three infants ( 4.9 months ) with chronic post-infectious diarrhea and IgA deficiency ( < 5 mg%ml ) received gammaglobulin 300 mg/kg/die for 3 days . The diarrhea recovered in 2 - 3 days . Out of 16 infants hospitalized during an epidemic rotavirus diarrhea 6 infants received oral gammaglobulin at the dose of 150 mg/kg/die during the hospitalization period ( that was at least 5 days ) . No one became ill . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND : Eczema is the most common inflammatory skin disease of childhood , characterized by an itchy red rash that usually involves the face and skin folds . There is currently no curative treatment for eczema , so the reduction of eczema incidence through disease prevention is a desirable goal . Potential interventions for preventing eczema include exclusive breastfeeding , hydrolysed protein formulas and soy formulas when bottle feeding , maternal antigen avoidance , omega oil supplementation , prebiotics and probiotics . OBJECTIVES : This overview of review s aims to present the current body of data from Cochrane and non-Cochrane review s to provide the most up-to- date evidence on the efficacy and safety of interventions to prevent eczema in infants and children at different risk levels for developing allergic disease . METHODS : Our pool of Cochrane and non-Cochrane review s came from the 2010 United Kingdom National Health Service ( NHS ) Evidence Skin Disorders Annual Evidence Up date s Mapping Exercise on Atopic Eczema . This group used a comprehensive search strategy last conducted in August 2010 to identify all systematic review s on eczema prevention . We identified all review s that met our pre-specified inclusion criteria , and data were extracted , analysed , compiled into tables and synthesized using quantitative and qualitative methods . MAIN RESULTS : Seven systematic review s containing 39 relevant trials with 11 897 participants were included in this overview . Overall , there was no clear evidence that any of the main interventions review ed reduced eczema incidence . In subgroup analyses of infants at high risk of allergic disease , an observational study found that exclusive breastfeeding for at least six months compared with introduction of solids at three to six months decreased the incidence of eczema by 60 % ( risk ratio ( RR ) : 0.40 ; 95 % confidence interval ( CI ) : 0.21 , 0.78 ) , and a r and omized controlled trial found that prebiotics compared with no prebiotics  decreased incidence by 58 % ( RR : 0.42 ; 95 % CI : 0.21 , 0.84 ) . However , each of these findings was based on the results of a single small trial , and no intervention reduced eczema incidence beyond the first two years of life . Although we pre-specified incidence of atopic eczema ( i.e. eczema associated with immunoglobulin E ( IgE ) sensitization ) as a primary outcome , data on whether participants diagnosed with eczema were truly atopic were largely lacking from systematic review s. Similarly , data on atopy , measured using skin prick tests or specific IgE tests to allergens , were not reported in many review s. No interventions were found to decrease atopy when reported . Adverse events data were generally lacking , but data from a trial of probiotics versus no probiotics showed significantly more spitting up in the first one ( RR : 1.88 ; 95 % CI : 1.03 , 3.45 ) and two ( RR : 1.69 ; 95 % CI : 1.02 , 2.80 ) months of life , but no overall increase in risk of gastrointestinal symptoms in the first year . AUTHORS # ENTITYSTARTX02019 ; CONCLUSIONS : Although there is currently no clear evidence showing that any of the interventions examined in this overview prevent eczema in participants not selected for risk of allergic disease , there is some evidence that exclusive breastfeeding for at least six months and prebiotics might reduce eczema incidence in high-risk participants . However , these conclusions are based on limited evidence with method ological shortcomings . Future research on prevention of eczema is needed and should examine different types of hydrolysed formulas , prebiotics and probiotics , as well as enhancement of the skin barrier and other novel approaches in infants at different risk levels for developing allergic disease Role of micronutrients namely vitamin A , zinc and folate , as adjunct therapy of illness episodes in children in developing countries have been discussed in the light of health policy . Apart from a selective review , attempts have been made to statistically combine results of several studies to address policy issues . In children , vitamin A supplementation during illness has ( a ) a profound effect in reducing mortality in measles , ( b ) possibly a significant effect in reducing persistent diarrhea episodes in children with acute diarrhea , and ( c ) no benefit in pneumonia . Use of large dose vitamin A is recommended during measles episodes but not in non-measles pneumonia . Its use in acute diarrhea is debatable but recommended in persistent diarrhea and in severe malnutrition as a component of a micronutrient mixture . Large dose vitamin A supplementation should be used with caution in young infants as there are unresolved concerns about its safety particularly , bulging fontanelle observed in infants when co-administered at immunization . In children , zinc supplementation during illness , ( a ) had a marked effect in reducing prolonged episodes and a modest effect on episode duration in acute diarrhea , ( b ) result ed in reduced rate of treatment failure and death in persistent diarrhea , ( c ) had no effect in measles and non-measles pneumonia , and ( d ) probably had a detrimental effect of increasing death rate when a large dose was used in severely malnourished children . The desirability of routine zinc supplementation therapy of undernourished children with acute diarrhea should be assessed further . Concerning policy , zinc supplementation as a component of a micronutrient mixture is recommended in the rehabilitation of severely malnourished children and in persistent diarrhea . However , recommendation for its routine use in all cases of acute diarrhea in children needs additional studies on effectiveness , cost , operations and safety . In two r and omized controlled trials folate has been evaluated in acute and persistent diarrhea and found to have no beneficial effect . Folate is not recommended as adjunct therapy of diarrhea . Role of folate in preventing severe disease and /or death deserves further evaluation Goals : This clinical trial was carried out to determine whether oral treatment with a commercial probiotic formula containing Bifidobacterium lactis and Streptococcus thermophilus would reduce the frequency of  antibiotic-associated diarrhea ( AAD ) in infants . Study : In this double-bind formula controlled study , 80 infants , 6 to 36 months of age , were r and omly assigned to receive a commercial formula containing 107 viable cells of B. lactis and 106viable cells of S. thermophilus at the initiation of antibiotics for a duration of 15 days . The infants were assessed daily for formula intake , stool frequency , and stool consistency for a total duration of 30 days . Seventy-seven infants received  nonsupplemented formula for the entire duration . Results : There was a significant difference in the incidence of AAD in the children receiving probiotic-supplemented formula ( 16 % ) than nonsupplemented formula ( 31 % ) . Conclusions : The present study shows that prevention against AAD in infants was obtained by oral treatment with daily dose of B. lactis and S. thermophilus BACKGROUND Probiotic dairy products are increasingly gaining popularity . Although the role of probiotic bacteria in the prevention and treatment of pediatric and antibiotic associated diarrhea is fairly well established , their role in the prevention of adult infectious diarrhea has not been well investigated . METHODS Five hundred forty-one , young male military recruits were enrolled and r and omly assigned to receive a yogurt containing Lactobacillus casei ( n = 275 ) or a nonprobiotic yogurt ( n = 266 ) . The incidence and duration of diarrhea were documented and stool sample s examined for bacteria and parasites . RESULTS Five hundred and two participants were eligible for final analysis , 254 receiving probiotic yogurt and 248 in the control group . Seventy-one participants ( 14.14 % ) experienced diarrhea during the study period . The incidence of diarrhea in the probiotic group and the control group was 12.2 % and 16.1 % , respectively ( P = .207 ) . The mean duration of diarrhea was 3 + /- 1.95 days in the probiotic group and 2.6 + /- 1.08 days in the control group ( P = .276 ) . CONCLUSION Our study demonstrated a nonsignificant trend for reduction of the incidence of diarrhea among healthy young adults consuming yogurt containing Lactobacillus casei . Further study is needed to evaluate the role of probiotics in adults Background : Specific probiotic bacteria have proven to be effective in the prevention and treatment of infectious diseases in early life in at-risk population s. The impact of administration of Bifidobacterium animalis subsp . lactis BB-12 ( BB-12 ) on the risk of acute infectious diseases was studied in healthy children . Methods : In this double-blind , placebo-controlled study , 109 1-mo-old infants were assigned r and omly to a probiotic group receiving a BB-12–containing tablet ( n = 55 ) or a placebo ( n = 54 ) . Test tablets were administered to the infants twice a day ( daily dose of BB-12 10 billion colony-forming units ) until the age of 2 y with a novel slow-release pacifier or a spoon . Breastfeeding habits , pacifier use , dietary habits , medications , and all signs and symptoms of acute infections were registered in diaries by parents and in question naires by trained professionals . Results : The infants receiving BB-12 were reported to have experienced fewer respiratory tract infections ( RTIs ; 87 vs. 100 % ; risk ratio : 0.87 ; 95 % confidence interval : 0.76 , 1.00 ; P = 0.033 ) than the controls . No significant differences between the groups were observed in reported gastrointestinal symptoms , otitis media , or fever . The baseline characteristics of the two groups were similar , as was the duration of breastfeeding . Conclusion : Administration of BB-12 in early childhood may reduce RTIs A r and omized double blind clinical trial was conducted to assess the efficacy of a special infant formula containing Lactobacillus rhamnosus LMG P-22799 ( probiotic : 5 x 10(8 ) CFU/100mL ) , inulin ( prebiotic : 0.15 g/100mL ) , dietary fiber ( soy polysaccharides : 0.2 g/100mL ) and increased amounts of zinc+iron ( + 0.4 and + 0.6 mg/100mL , respectively ) as active ingredients for the early dietary management of 58 Indonesian well-nourished male infants aged 3 - 12 months suffering from acute diarrhea with moderate dehydration . After adequate oral rehydration , the patients were r and omly assigned to receive either a low lactose infant formula supplemented with added precooked rice ( 1.5 g/100mL ) with the above active ingredients ( study group ) or a low lactose infant formula with added precooked rice without the above active ingredient supplement ( control group ) . No antibiotic , anti-secretory drug or antiemetic was given at all . Both study and control groups showed similar outcomes for weight gain and stool weight . The duration of diarrhea was significantly shorter in the study group than in the control group ( 1.63 versus 2.45 days ; p<0.05 ; for the study and control group respectively ) . No treatment failure or other side effects were observed during the course of the study . The present study supports the evidence for the efficacy of a special anti-diarrhea infant formula containing probiotic , prebiotic , fiber and iron+zinc after oral rehydration by shortening the duration of infantile diarrhea in developing countries . However , from the results of our study we can not discern the individual contribution of the active ingredients and also not whether they may act independent from each other or in a synergistic way BACKGROUND Infectious complications and associated mortality are a major concern in acute pancreatitis . Enteral administration of probiotics could prevent infectious complications , but convincing evidence is scarce . Our aim was to assess the effects of probiotic prophylaxis in patients with predicted severe acute pancreatitis . METHODS In this multicenter r and omized , double-blind , placebo-controlled trial , 298 patients with predicted severe acute pancreatitis ( Acute Physiology and Chronic Health Evaluation [ APACHE II ] score ≥8 , Imrie score ≥3 , or C-reactive protein > 150 mg/L ) were r and omly assigned within 72 h of onset of symptoms to receive a multispecies probiotic preparation ( n = 153 ) or placebo ( n = 145 ) , administered enterally twice daily for 28 days . The primary endpoint was the composite of infectious complications-i.e . , infected pancreatic necrosis , bacteremia , pneumonia , urosepsis , or infected ascites-during admission and 90-day follow-up . Analyses were by intention to treat . This study is registered , number IS RCT N38327949 . FINDINGS One person in each group was excluded from analyses because of incorrect diagnoses of pancreatitis ; thus , 152 individuals in the probiotics group and 144 in the placebo group were analysed . Groups were much the same at baseline in terms of patients ' characteristics and disease severity . Infectious complications occurred in 46 ( 30 % ) patients in the probiotics group and 41 ( 28 % ) of those in the placebo group ( relative risk 1.06 , 95 % CI 0.75 - 1.51 ) . 24 ( 16 % ) patients in the probiotics group died , compared with nine ( 6 % ) in the placebo group ( relative risk 2.53 , 95 % CI 1.22 - 5.25 ) . Nine patients in the probiotics group developed bowel ischaemia ( eight with fatal outcome ) , compared with none in the placebo group ( p = 0.004 ) . INTERPRETATION In patients with predicted severe acute pancreatitis , probiotic prophylaxis with this combination of probiotic strains did not reduce the risk of infectious complications and was associated with an increased risk of mortality  . Probiotic prophylaxis should therefore not be administered in this category of patients . ( Lancet . 2008;371(9613):651 - 659 ) MGH Besselink , HC van Santvoort , E Buskens , et al , for the Dutch Acute Pancreatitis Study Group BACKGROUND Infectious complications and associated mortality are a major concern in acute pancreatitis . Enteral administration of probiotics could prevent infectious complications , but convincing evidence is scarce . Our aim was to assess the effects of probiotic prophylaxis in patients with predicted severe acute pancreatitis . METHODS In this multicentre r and omised , double-blind , placebo-controlled trial , 298 patients with predicted severe acute pancreatitis ( Acute Physiology and Chronic Health Evaluation [ APACHE II ] score > or = 8 , Imrie score > or =3 , or C-reactive protein > 150 mg/L ) were r and omly assigned within 72 h of onset of symptoms to receive a multispecies probiotic preparation ( n=153 ) or placebo ( n=145 ) , administered enterally twice daily for 28 days . The primary endpoint was the composite of infectious complications -- ie , infected pancreatic necrosis , bacteraemia , pneumonia , urosepsis , or infected ascites -- during admission and 90-day follow-up . Analyses were by intention to treat . This study is registered , number IS RCT N38327949 . FINDINGS One person in each group was excluded from analyses because of incorrect diagnoses of pancreatitis ; thus , 152 individuals in the probiotics group and 144 in the placebo group were analysed . Groups were much the same at baseline in terms of patients ' characteristics and disease severity . Infectious complications occurred in 46 ( 30 % ) patients in the probiotics group and 41 ( 28 % ) of those in the placebo group ( relative risk 1.06 , 95 % CI 0.75 - 1.51 ) . 24 ( 16 % ) patients in the probiotics group died , compared with nine ( 6 % ) in the placebo group ( relative risk 2.53 , 95 % CI 1.22 - 5.25 ) . Nine patients in the probiotics group developed bowel ischaemia ( eight with fatal outcome ) , compared with none in the placebo group ( p=0.004 ) . INTERPRETATION In patients with predicted severe acute pancreatitis , probiotic prophylaxis with this combination of probiotic strains did not reduce the risk of infectious complications and was associated with an increased risk of mortality .  Probiotic prophylaxis should therefore not be administered in this category of patients Background . Certain strains of lactobacilli have been shown to promote recovery from rotavirus enteritis in hospitalized children . Few studies have examined the effect of probiotics in nonhospitalized children with mild diarrhea . Methods . We studied in a r and omized placebo-controlled trial the effect of lyophilized Lactobacillus rhamnosus 19070 - 2 and Lactobacillus reuteri DSM 12246 , 1010 colony-forming units of each strain twice daily for 5 days , on acute diarrhea in children in a cohort of children recruited from local day-care centers . The duration of diarrhea and assessment of stool consistency were recorded by the parents . Results . In patients treated with the selected Lactobacillus strains , the mean duration of diarrhea after intervention was reduced ( 76 h in patients treated with probiotics vs. 116 h in the placebo group;P = 0.05 ) . In patients with diarrhea for < 60 h before start of treatment ( early intervention ) , a more pronounced effect of probiotics was found . The time to recovery after early treatment was 79 h vs. 139 h in the placebo group ( P = 0.02 ) ; 1 of 17 patients treated early vs. 6 of 13 in the control group still had loose stools 120 h after start of treatment ( P = 0.03 ) . Conclusions . In children from day-care centers with mild gastroenteritis , the combination of L. rhamnosus 19070 - 2 and L. reuteri DSM 12246 was effective in reducing the duration of diarrhea Background . Oral bacteriotherapy promotes recovery from acute childhood diarrhea , but few strains have been shown to have therapeutic potentials . We examined the effect of two newly identified probiotic Lactobacillus strains in acute childhood diarrhea .  Methods . Sixty-nine children were r and omized during hospitalization for acute diarrhea to receive a mixture of Lactobacillus rhamnosus 19070 - 2 and Lactobacillus reuteri DSM 12246 , 1010 colony-forming units of each strain or placebo twice daily for 5 days . Before selection of these stains their potential probiotic characteristics were demonstrated in vitro and in healthy volunteers . Results . In patients receiving probiotics , the diarrheal phase was reduced by 20 % . The duration of diarrhea was 82 h in the treatment group vs. 101 h in the control group ( not significant , P = 0.07 ) . However , 3 of 30 patients from the treatment group vs. 13 of 39 from the control group still had loose stools at the end of the study period ( P = 0.03 ) . In patients with diarrhea for < 60 h before start of treatment ( early intervention ) , a clear effect of the probiotics was demonstrated ( 80 h in the treatment group vs. 130 h in the control group , P = 0.003 ) . After early intervention , the length of hospitalization was reduced by 48 % ( 3.5 vs. 1.7 days , P = 0.03 ) . At the end of the intervention , rotavirus antigen was found in 12 % of patients from the treatment group vs. 46 % from the control group ( P = 0.02 ) . Conclusions . The two probiotics , L. rhamnosus 19070 - 2 and L. reuteri DSM 12246 , ameliorated acute  diarrhea in hospitalized children and reduced the period of rotavirus excretion . Oral bacteriotherapy was associated with a reduced length of hospital stay . The beneficial effects were most prominent in children treated early in the diarrheal phase Acute diarrhea is a common cause of infant morbidity and mortality . Probiotic supplemented infant formula is one of the effective methods for prevention of rotavirus diarrhea . Other benefits of the probiotics supplemented formula were evaluated by monitoring the growth of the children . A double-blind , placebo-controlled trial was done in 148 children aged 6 - 36 months . They were divided into 3 groups : the Bb12 group , 51 children received infant formula with Bifidobacteria Bb12 supplement ; the Bb12+ST  group , 54 children  received infant formula with Bb12 and Streptococcus thermophilus supplement ; and the control group , 43 children received infant formula without supplement . The mean weight Z-score according to WHO reference st and ard of the Bbl2 group was -1.8 + /- 0.12 , the Bb12+ST group was -1.4 + /- 0.11 and the control group was -1.8 + /- 0.13 at entry . The mean weight Z-score of children after 6 month showed that the children in the Bbl2+ST group had the highest increase in weight which was increased from -1.4 + /- 0.11 to -0.9 + /- 0.12 compared to the Z-score of the Bb12 group which had increased from -1.8 + /- 0.12 to -1.2 + /- 0.13 and in the control group from -1.8 + /- 0.13 to -1.7 + /- 0.25 . In terms of the mean height Z-score , the Bb12 group was -2.7 + /- 0.14 to -1.7 + /- 0.16 which was higher than the Bb12+ST group ( - 2.2 + /- 0.13 to -1.7 + /- 0.13 ) but was not different from the control group . However , the mean weight/height Z-score of the Bbl2+ST group had approached the reference st and ard ( Bb12 group -0.1 + /- 0.11 to -0.1 + /- 0.13 , Bb12+ST group -0.1 + /- 0.10 to 0.3 + /- 0.17 , control group -0.4 + /- 0.12 to -0.1 + /- 0.16 ) . Data showed that children who received the probiotics supplement formula had better growth during the 6 month period Background . Previous studies have shown that selected strains of lactobacilli that are administered orally result in a modest reduction of diarrhea duration . However , duration alone is not considered optimal for therapeutic evaluation of any agent in diarrhea . Objective . To examine the effect of a new probiotic , Lactobacillus paracasei strain ST11 ( ST11 ) , in acute childhood diarrhea by using evaluation criteria recommended by the World Health Organization . Methods . In a r and omized , double-blind , placebo-controlled clinical trial , 230 male infants and young children , 4 to 24 months of age , presenting with diarrhea of < 2 days ' duration were admitted to the metabolic research ward of the International Centre for Diarrheal Disease Research , Bangladesh , and fed 1010 colony-forming units of lyophilized ST11 or placebo daily for 5 days . Stool output and frequency , oral rehydration solution intake , and excretion of rotavirus were monitored daily . Results . No effect of ST11 treatment on severe rotavirus diarrhea was observed . However , the probiotic treatment did significantly reduce cumulative stool output ( 225 ± 218 vs 381 ± 240 mL/kg ) , stool frequency ( 27.9 ± 17 vs 42.5 ± 26 ) , and oral rehydration solution intake ( 180 ± 207 vs 331 ± 236 mL/kg ) in children with less-severe nonrotavirus diarrhea compared with those receiving placebo treatment . A significantly higher proportion of nonrotavirus children receiving ST11 had their diarrhea resolve within 6 days of therapy ( ST11 versus placebo : 76 % vs 49 % ) . Conclusions . ST11 has a clinical ly significant benefit in the management of children with nonrotavirus-induced diarrhea , but it is ineffective in those with rotavirus diarrhea Objectives . Antimicrobial treatment may disturb the colonization resistance of gastrointestinal microflora , which may induce clinical symptoms , most commonly diarrhea . The severity of antibiotic-associated diarrhea may range from a brief , self-limiting disease to devastating diarrhea with electrolyte disturbances , dehydration , crampy abdominal pain , pseudomembranous colitis , toxic megacolon , or even death . The incidence of diarrhea in children receiving a single antimicrobial treatment is unclear . In addition to more critical use of antimicrobials , adjunctive preventive measures to antibiotic-associated diarrhea are needed . The objective of this study was to evaluate the incidence of diarrhea after antimicrobial treatment in children with no history of antimicrobial use during the previous 3 months . Another aim of this study was to assess the preventive potential of Lactobacillus rhamnosus GG ( Lactobacillus GG ; American Type Culture Collection 53103 ) , a probiotic strain with a documented safety record and a therapeutic effect in viral gastroenteritis on antibiotic-associated diarrhea . Methods . Oral antimicrobial agents were prescribed for the treatment of acute respiratory infections at the clinics of the Health Care Center of the City of Tampere or Tampere University Hospital , Finl and , to 167 patients who were invited to participate in the study . Of the patients , 48 were lost to follow-up ; therefore , the final study population consisted of 119 children from 2 weeks to 12.8 years of age ( mean : 4.5 years ) . All study subjects met the inclusion criteria : they had not received any antimicrobial medication during the previous 3 months , they did not suffer from gastrointestinal disorders , and they did not need intravenous antimicrobial treatment . The patients were r and omized to receive placebo or 2 × 1010 colony-forming units of Lactobacillus GG in capsules given twice daily during the antimicrobial treatment . Lactobacillus GG and placebo capsules were indistinguishable in appearance and taste . The parents kept a daily symptom diary and recorded stool frequency and consistency at home for 3 months . Diarrhea was defined as at least three watery or loose stools per day for a minimum of 2 consecutive days . In the case of diarrhea , viral ( adenovirus , rotavirus , calicivirus and astrovirus ) and bacterial ( Salmonella , Shigella , Yersinia , Campylobacter , Clostridium difficile , Staphylococcus aureus , and yeasts ) analyses were studied in fecal sample s. The metabolic activity of the gut microflora was assessed by analysis of fecal urease , β-glucosidase , and β-glucuronidase activities . The primary outcome measure was diarrhea during the first 2 weeks after the beginning of the antimicrobial treatment , because this period most likely reflects the effects of antimicrobial use . Secondary outcome measures were the activities of fecal urease , β-glucuronidase , and β-glucosidase . Results . On the entire follow-up , 80 % of any gastrointestinal symptoms were reported during the first 2 weeks after the beginning of the antimicrobial treatment . The incidence of diarrhea was 5 % in the  Lactobacillus GG group and 16 % in the placebo group within 2 weeks of antimicrobial therapy ( χ2 = 3.82 ) . The treatment effect ( 95 % confidence interval ) of Lactobacillus GG was −11 % ( −21%–0 % ) . In diarrheal episodes , the viral and bacterial analyses were positive for Clostridium difficile in 2 cases and for Norwalk-like calicivirus in 3 cases . The age of the patients with diarrhea was between 3 months and 5 years in 75 % of cases in both groups .  The severity of diarrhea was comparable in the study groups , as evidence d by similar stool frequency ( mean : 5 per day ; range : 3–6 ) and the duration of diarrhea ( mean : 4 days ; range : 2–8 ) . The activities of fecal urease and β-glucuronidase , but not β-glucosidase , changed significantly after the beginning of the antimicrobial treatment in the Lactobacillus GG group and in the placebo group alike . The decrease in urease and β-glucuronidase activities was reversible in patients with no diarrhea , but in patients with diarrhea , the modifications in gut microflora were more profound and prolonged . The activities of the three enzymes were normalized within 3 weeks , evidence d by stable enzyme activities in sample s collected 3 weeks , 1 month , and 3 months after the beginning of the antimicrobial treatment , compared with those obtained before treatment . Discussion . In the present study , after a single antimicrobial treatment , the incidence of diarrhea was 16 % . The higher incidence of antibiotic-associated diarrhea in previous reports may be attributable to a recent antimicrobial therapy that disturbs intestinal flora and exposes to complications . Also , in the present study , changes in the metabolic activity of the intestinal flora were observed , evidence d by a transient decline in fecal enzyme activities . Different probiotic preparations , including lactobacilli , are recommended frequently to prevent antibiotic-associated diarrhea . Although probiotics have been shown to be efficient in the prevention and the treatment of viral gastroenteritis , their usefulness during antimicrobial therapy in children has not been eluci date d before . We observed that the administration of Lactobacillus GG to children receiving antimicrobial therapy for respiratory infection reduced the incidence of antibiotic-associated diarrhea to one third . The beneficial effect may be mediated by a number of functions of probiotics , ie , production of antimicrobial substances , local competition of adhesion receptors and nutrients , and stimulation of intestinal antigen specific and nonspecific immune responses . Conclusion . A probiotic strain , Lactobacillus GG , is effective in the prevention of diarrhea in children receiving antimicrobial treatment to respiratory infections We conducted a double-blind r and omized placebo-controlled study to evaluate efficacy and tolerability of VSL♯3 ( CD Pharma India ) in the treatment of acute rotavirus diarrhea in children . The patients were r and omly assigned to receive 4 days of oral treatment with VSL♯3 probiotic mixture or placebo in addition to usual care for diarrhea . Results : Out of 230 rotavirus-positive acute diarrhea children , 224 children completed the study , ( 113 in the drug group and 111 in the placebo group ) . At recruitment on Day 1 , there were no significant differences between the 2 groups in terms of frequency of vomiting , mean loose stool frequency , stool consistency , and mean frequency of oral rehydration salts ( ORS ) and intravenous fluids administered . On Day 2 , a lower mean stool frequency and improved stool consistency was noted in the drug group , which achieved statistical significance . This was also reflected in the lower volume of ORS administration in the drug group . Even on Day 3 , mean loose stool frequency and frequency of ORS use and frequency of intravenous fluid use was significantly lower in the drug group . The differences in the frequency of loose stools persisted till 8 hours of Day 4 . After this , as the placebo group also showed spontaneous improvement the difference between the 2 groups in terms of the overall stools frequency became comparable . However , the overall ORS requirement continued to be significantly lower in the drug group even on Day 4 . The overall recovery rates were significantly better in the drug group compared with placebo . No side effects were noted with the use of the probiotic mixture . Use of probiotic mixture VSL♯3 in acute rotavirus diarrhea result ed in earlier recovery and reduced frequency of ORS administration reflecting decreased stool volume losses during diarrhea BACKGROUND Zonulin is a newly discovered protein that has an important role in the regulation of intestinal permeability . Our previous study showed that probiotics can decrease the rate of infectious complications in patients undergoing colectomy for colorectal cancer . OBJECTIVE The objective was to determine the effects of the perioperative administration of probiotics on serum zonulin concentrations and the subsequent effect on postoperative infectious complications in patients undergoing colorectal surgery . DESIGN A total of 150 patients with colorectal carcinoma were r and omly assigned to the control group ( n = 75 ) , which received placebo , or the probiotics group ( n = 75 ) . Both the probiotics and placebo were given orally for 6 d preoperatively and 10 d postoperatively . Outcomes were measured by assessing bacterial translocation , postoperative intestinal permeability , serum zonulin concentrations , duration of postoperative pyrexia , and cumulative duration of antibiotic therapy . The postoperative infection rate , the positive rate of blood microbial DNA , and the incidence of postoperative infectious complications-including septicemia , central line infection , pneumonia , urinary tract infection , and diarrhea-were also assessed . RESULTS The infection rate was lower in the probiotics group than in the control group ( P < 0.05 ) . Probiotics decreased the serum zonulin concentration ( P < 0.001 ) , duration of postoperative pyrexia , duration of antibiotic therapy , and rate of postoperative infectious complications ( all P < 0.05 ) . The p38 mitogen-activated protein kinase signaling pathway was inhibited by probiotics . CONCLUSIONS Perioperative probiotic treatment can reduce the rate of postoperative septicemia and is associated with reduced serum zonulin concentrations in patients undergoing colectomy . We propose a clinical regulatory model that might explain this association . This trial was registered at http://www.chictr.org/en/ as ChiCTR-TRC-00000423
Only Lactobacillus GG showed a consistent effect .
There is evidence of a clinical ly significant benefit of probiotics in the treatment of  acute infectious diarrhea in infants and children , particularly in rotaviral gastroenteritis .
Lactobacillus GG showed the most consistent effect , although other probiotic strains may also be effective .
Clinical and statistical heterogeneity of the prophylactic interventions preclude drawing firm conclusions about the efficacy of probiotics in preventing acute gastroenteritis
BACKGROUND This review was design ed to assess the evidence from r and omized controlled trials on effects of probiotics in the treatment and prevention of acute infectious diarrhea in infants and children .