Should pediatric infectious disease physicians be using probiotics? This question is pondered by Joan L Robinson, a physician at University of Alberta and Stollery Children’s Hospital in Canada writing in a recent issue of The Canadian Journal of Infectious Disease and Medical Microbiology.
The author describes the many reasons probiotics are believed to work as well as why effectiveness is still in question.
Among the latter:
- Probiotics are not regulated like drugs therefore clinical trials using various formulas and doses may in fact not be truly accurate.
- There are few clinical trials for probiotics in the United States.
- Required sample sizes are large.
The author includes the reasons probiotics may be indicated:
Prevention of necrotizing enterocolitis (NEC) and decreased mortality in preterm infants with a birth weight >1000 g
Primary prevention of Clostridium difficile-associated diarrhea CDAD)
Robinson states: “My conclusion is that one should consider prophylactic probiotics only in medically fragile children prescribed antibiotics commonly associated with CDAD (quinolones, clindamycin, cephalosporins and carbapenems) while admitted to a hospital with a high incidence of CDAD.”
“Experts are less optimistic that probiotics can prevent recurrent CDAD because GI flora is so disrupted in patients with recurrent CDAD that probiotics may be ineffective.”
Prevention of antibiotic-associated diarrhea
“Because most cases of AAD are brief and do not result in medical visits, it is my opinion that probiotics should not be prescribed for prevention of AAD, although one may consider use in a child with a history of bothersome AAD.”
Treatment of acute diarrhea
“In conclusion, I would not recommend probiotics for treatment of acute diarrhea unless greater benefit is demonstrated in future trials; however, others may interpret the data differently.”
Prevention of viral infections
“My opinion is that probiotics should not be used for prevention of viral infections because there is a need for higher-quality data with closer tracking of adverse events with long-term use.”
Prevention of ventilator-associated pneumonia
For various reasons submitted in the article, Robinson suggests more study is needed.
As for adverse effects of probiotics, the author uncovered no clinically important adverse effects. This doesn’t mean such harm is not possible however as probiotics may increase oxygen demand or may transfer resistance genes to other GI flora according to some research.
Clearly, the youngest among us can be the most fragile. Pediatricians must use caution.