Guidance on the use of probiotics in clinical practice in children with selected clinical conditions and in specific vulnerable groups

Iva Hojsak, Valentina Fabiano, Tudor Lucian Pop, Olivier Goulet, Gian Vincenzo Zuccotti, Fugen Cullu Çokuğraş, Massimo Pettoello-Mantovani, Sanja Kolaček, Iva Hojsak, Valentina Fabiano, Tudor Lucian Pop, Olivier Goulet, Gian Vincenzo Zuccotti, Fugen Cullu Çokuğraş, Massimo Pettoello-Mantovani, Sanja Kolaček

Abstract

Aim: The use of probiotics has been covered by many guidelines, position papers and evidence-based recommendations, but few have referred to specific patient groups or clinical indications. This review summarises recommendations and scientifically credited guidelines on the use of probiotics for children with selected clinical conditions and provides practice points.

Methods: An expert panel was convened by the European Paediatric Association in June 2017 to define the relevant clinical questions for using probiotics in paediatric health care and review and summarise the guidelines, recommendations, position papers and high-quality evidence.

Results: The panel found that specific probiotic strains were effective in preventing antibiotic-associated and nosocomial diarrhoea, treating acute gastroenteritis and treating infantile colic in breastfed infants. However, special caution is indicated for premature infants, immunocompromised and critically ill patients and those with central venous catheters, cardiac valvular disease and short-gut syndrome. This review discusses the safety of using probiotics in selected groups of paediatric patients and the quality of the available products providing practice points based on proved findings.

Conclusion: Efficacy of probiotics is strain specific. Their benefits are currently scientifically proven for their use in selected clinical conditions in children and not recommended for certain patient groups.

Keywords: Bifidobacterium; Children; Lactobacillus; Probiotics; Saccharomyces.

©2018 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.

References

    1. Gibson GR, Hutkins R, Sanders ME, Prescott SL, Reimer RA, Salminen SJ, et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nat Rev Gastroenterol Hepatol 2017; 14: 491–502.
    1. Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 2014; 11: 506–14.
    1. Gerber‐Grote A, Namazova‐Baranova L, Hoey H, Pettoello‐Mantovani M, Vural M, Mestrovic J, et al. European Paediatric Association, the Union of National European Paediatric Societies and Associations Turns 40 Years: What This European Platform Offers to Pediatricians. J Pediatr 2017; 186: 217–8.
    1. Center for Drug Evaluation and Research; Center for Biologics Evaluation and Research . Guidance for industry: providing clinical evidence of effectiveness for human drug and biological products, 1998. Available at: .
    1. Silverstein M, Sales AE, Koepsell TD. Health care utilization and expenditures associated with child care attendance: a nationally representative sample. Pediatrics 2003; 111: 371–5.
    1. Haskins R. Acute illness in day care: how much does it cost? Bull N Y Acad Med 1989; 65: 319–43.
    1. Wang Y, Li X, Ge T, Xiao Y, Liao Y, Cui Y, et al. Probiotics for prevention and treatment of respiratory tract infections in children: a systematic review and meta‐analysis of randomized controlled trials. Medicine (Baltimore) 2016; 95: e4509.
    1. Hatakka K, Savilahti E, Ponka A, Meurman JH, Poussa T, Nase L, et al. Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial. BMJ 2001; 322: 1327.
    1. Lin JS, Chiu YH, Lin NT, Chu CH, Huang KC, Liao KW, et al. Different effects of probiotic species/strains on infections in preschool children: a double‐blind, randomized, controlled study. Vaccine 2009; 27: 1073–9.
    1. Hojsak I, Abdovic S, Szajewska H, Milosevic M, Krznaric Z, Kolacek S. Lactobacillus GG in the prevention of nosocomial gastrointestinal and respiratory tract infections. Pediatrics 2010; 125: 1171–7.
    1. Hojsak I, Snovak N, Abdovic S, Szajewska H, Misak Z, Kolacek S. Lactobacillus GG in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centers: a randomized, double‐blind, placebo‐controlled trial. Clin Nutr 2010; 29: 312–6.
    1. Merenstein D, Murphy M, Fokar A, Hernandez RK, Park H, Nsouli H, et al. Use of a fermented dairy probiotic drink containing Lactobacillus casei (DN‐114 001) to decrease the rate of illness in kids: the DRINK study. A patient‐oriented, double‐blind, cluster‐randomized, placebo‐controlled, clinical trial. Eur J Clin Nutr 2010; 64: 669–77.
    1. Kumpu M, Kekkonen RA, Kautiainen H, Jarvenpaa S, Kristo A, Huovinen P, et al. Milk containing probiotic Lactobacillus rhamnosus GG and respiratory illness in children: a randomized, double‐blind, placebo‐controlled trial. Eur J Clin Nutr 2012; 66: 1020–3.
    1. Leyer GJ, Li S, Mubasher ME, Reifer C, Ouwehand AC. Probiotic effects on cold and influenza‐like symptom incidence and duration in children. Pediatrics 2009; 124: 172–9.
    1. Gutierrez‐Castrellon P, Lopez‐Velazquez G, Diaz‐Garcia L, Jimenez‐Gutierrez C, Mancilla‐Ramirez J, Estevez‐Jimenez J, et al. Diarrhea in preschool children and Lactobacillus reuteri: a randomized controlled trial. Pediatrics 2014; 133: 904–9.
    1. Hojsak I. Probiotics in Children – What is the Evidence? Pediatr Gastroenterol Hepatol Nutr 2017; 20: 139–46.
    1. Weizman Z, Asli G, Alsheikh A. Effect of a probiotic infant formula on infections in child care centers: comparison of two probiotic agents. Pediatrics 2005; 115: 5–9.
    1. Merenstein DJ, Smith KH, Scriven M, Roberts RF, Sanders ME, Petterson S. The study to investigate the potential benefits of probiotics in yogurt, a patient‐oriented, double‐blind, cluster‐randomised, placebo‐controlled, clinical trial. Eur J Clin Nutr 2010; 64: 685–91.
    1. Merenstein D, Gonzalez J, Young AG, Roberts RF, Sanders ME, Petterson S. Study to investigate the potential of probiotics in children attending school. Eur J Clin Nutr 2011; 65: 447–53.
    1. Hojsak I, Mocic Pavic A, Kos T, Dumancic J, Kolacek S. Bifidobacterium animalis subsp. lactis in prevention of common infections in healthy children attending day care centers ‐ Randomized, double blind, placebo‐controlled study. Clin Nutr 2016; 35: 587–91.
    1. World Health Organization DoCD, Surveillance and Response . Prevention of hospital‐acquired infections. Geneva, Switzerland: World Health Organization, 2002. Publication WHO/ CDS/CSR/EPH/2002.12.
    1. World Health Organisation/Patient Safety . Report on the burden of endemic health care‐associated infection worldwide. Geneva, Switzerland: World Health Organization, 2011.
    1. Posfay‐Barbe KM, Zerr DM, Pittet D. Infection control in paediatrics. Lancet Infect Dis 2008; 8: 19–31.
    1. Ejemot‐Nwadiaro RI, Ehiri JE, Arikpo D, Meremikwu MM, Critchley JA. Hand washing promotion for preventing diarrhoea. Cochrane Database Syst Rev 2015; 9: CD004265.
    1. Hojsak I, Szajewska H, Canani RB, Guarino A, Indrio F, Kolacek S, et al. Probiotics for the prevention of Nosocomial diarrhea in children. J Pediatr Gastroenterol Nutr 2018; 66: 3–9.
    1. Wanke M, Szajewska H. Lack of an effect of Lactobacillus reuteri DSM 17938 in preventing nosocomial diarrhea in children: a randomized, double‐blind, placebo‐controlled trial. J Pediatr 2012; 161: 40–3.
    1. Urbanska M, Gieruszczak‐Bialek D, Szymanski H, Szajewska H. Effectiveness of Lactobacillus reuteri DSM 17938 for the prevention of Nosocomial diarrhea in children: a randomized, double‐blind. placebo‐controlled trial. Pediatr Infect Dis J 2016; 35: 142–5.
    1. Hojsak I, Tokic Pivac V, Mocic Pavic A, Pasini AM, Kolacek S. Bifidobacterium animalis subsp. lactis fails to prevent common infections in hospitalized children: a randomized, double‐blind, placebo‐controlled study. Am J Clin Nutr 2015; 101: 680–4.
    1. Prescott SL, Pawankar R, Allen KJ, Campbell DE, Sinn J, Fiocchi A, et al. A global survey of changing patterns of food allergy burden in children. World Allergy Organ J 2013; 6: 21.
    1. Pawankar R, Walkter Canonica G, Holgate ST, Lockey RF. World Health Organization. White Book on Allergy, 2011–2012. Executive Summary.
    1. Centers for Disease Control and Prevention . Allergies, 2011. Available at: .
    1. Gupta R, Sheikh A, Strachan DP, Anderson HR. Time trends in allergic disorders in the UK. Thorax 2007; 62: 91–6.
    1. Turner PJ, Gowland MH, Sharma V, Ierodiakonou D, Harper N, Garcez T, et al. Increase in anaphylaxis‐related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992–2012. J Allergy Clin Immunol 2015; 135: 956–63.
    1. Fiocchi A, Pawankar R, Cuello‐Garcia C, Ahn K, Al‐Hammadi S, Agarwal A, et al. World Allergy Organization‐McMaster University Guidelines for Allergic Disease Prevention (GLAD‐P): Probiotics. World Allergy Organ J 2015; 8: 4.
    1. Schafer T, Bauer CP, Beyer K, Bufe A, Friedrichs F, Gieler U, et al. S3‐Guideline on allergy prevention: 2014 update: guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Society for Pediatric and Adolescent Medicine (DGKJ). Allergo J Int 2014; 23: 186–99.
    1. ASCIA Guidelines . Infant feeding and allergy prevention, 2016. Available at: .
    1. Muraro A, Halken S, Arshad SH, Beyer K, Dubois AE, Du Toit G, et al. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy 2014; 69: 590–601.
    1. Ou CY, Kuo HC, Wang L, Hsu TY, Chuang H, Liu CA, et al. Prenatal and postnatal probiotics reduces maternal but not childhood allergic diseases: a randomized, double‐blind, placebo‐controlled trial. Clin Exp Allergy 2012; 42: 1386–96.
    1. Boyle RJ, Ismail IH, Kivivuori S, Licciardi PV, Robins‐Browne RM, Mah LJ, et al. Lactobacillus GG treatment during pregnancy for the prevention of eczema: a randomized controlled trial. Allergy 2011; 66: 509–16.
    1. Huurre A, Laitinen K, Rautava S, Korkeamaki M, Isolauri E. Impact of maternal atopy and probiotic supplementation during pregnancy on infant sensitization: a double‐blind placebo‐controlled study. Clin Exp Allergy 2008; 38: 1342–8.
    1. Dotterud CK, Storro O, Johnsen R, Oien T. Probiotics in pregnant women to prevent allergic disease: a randomized, double‐blind trial. Br J Dermatol 2010; 163: 616–23.
    1. Rautava S, Kainonen E, Salminen S, Isolauri E. Maternal probiotic supplementation during pregnancy and breast‐feeding reduces the risk of eczema in the infant. J Allergy Clin Immunol 2012; 130: 1355–60.
    1. Abrahamsson TR, Jakobsson T, Bottcher MF, Fredrikson M, Jenmalm MC, Bjorksten B, et al. Probiotics in prevention of IgE‐associated eczema: a double‐blind, randomized, placebo‐controlled trial. J Allergy Clin Immunol 2007; 119: 1174–80.
    1. Abrahamsson TR, Jakobsson T, Bjorksten B, Oldaeus G, Jenmalm MC. No effect of probiotics on respiratory allergies: a seven‐year follow‐up of a randomized controlled trial in infancy. Pediatr Allergy Immunol 2013; 24: 556–61.
    1. Allen SJ, Jordan S, Storey M, Thornton CA, Gravenor MB, Garaiova I, et al. Probiotics in the prevention of eczema: a randomised controlled trial. Arch Dis Child 2014; 99: 1014–9.
    1. Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomised placebo‐controlled trial. Lancet 2001; 357: 1076–9.
    1. Kalliomaki M, Salminen S, Poussa T, Isolauri E. Probiotics during the first 7 years of life: a cumulative risk reduction of eczema in a randomized, placebo‐controlled trial. J Allergy Clin Immunol 2007; 119: 1019–21.
    1. Kalliomaki M, Salminen S, Poussa T, Arvilommi H, Isolauri E. Probiotics and prevention of atopic disease: 4‐year follow‐up of a randomised placebo‐controlled trial. Lancet 2003; 361: 1869–71.
    1. Kopp MV, Hennemuth I, Heinzmann A, Urbanek R. Randomized, double‐blind, placebo‐controlled trial of probiotics for primary prevention: no clinical effects of Lactobacillus GG supplementation. Pediatrics 2008; 121: 850–6.
    1. Kim JY, Kwon JH, Ahn SH, Lee SI, Han YS, Choi YO, et al. Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: a double‐blind, randomized, placebo‐controlled trial. Pediatr Allergy Immunol 2010; 21: 386–93.
    1. Niers L, Martin R, Rijkers G, Sengers F, Timmerman H, van Uden N, et al. The effects of selected probiotic strains on the development of eczema (the PandA study). Allergy 2009; 64: 1349–58.
    1. Wickens K, Black PN, Stanley TV, Mitchell E, Fitzharris P, Tannock GW, et al. A differential effect of 2 probiotics in the prevention of eczema and atopy: a double‐blind, randomized, placebo‐controlled trial. J Allergy Clin Immunol 2008; 122: 788–94.
    1. Wickens K, Black P, Stanley TV, Mitchell E, Barthow C, Fitzharris P, et al. A protective effect of Lactobacillus rhamnosus HN001 against eczema in the first 2 years of life persists to age 4 years. Clin Exp Allergy 2012; 42: 1071–9.
    1. Wickens K, Stanley TV, Mitchell EA, Barthow C, Fitzharris P, Purdie G, et al. Early supplementation with Lactobacillus rhamnosus HN001 reduces eczema prevalence to 6 years: does it also reduce atopic sensitization? Clin Exp Allergy 2013; 43: 1048–57.
    1. Soh SE, Aw M, Gerez I, Chong YS, Rauff M, Ng YP, et al. Probiotic supplementation in the first 6 months of life in at risk Asian infants–effects on eczema and atopic sensitization at the age of 1 year. Clin Exp Allergy 2009; 39: 571–8.
    1. West CE, Hammarstrom ML, Hernell O. Probiotics during weaning reduce the incidence of eczema. Pediatr Allergy Immunol 2009; 20: 430–7.
    1. Prescott SL, Wiltschut J, Taylor A, Westcott L, Jung W, Currie H, et al. Early markers of allergic disease in a primary prevention study using probiotics: 2.5‐year follow‐up phase. Allergy 2008; 63: 1481–90.
    1. Taylor AL, Dunstan JA, Prescott SL. Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high‐risk children: a randomized controlled trial. J Allergy Clin Immunol 2007; 119: 184–91.
    1. Zuccotti G, Meneghin F, Aceti A, Barone G, Callegari ML, Di Mauro A, et al. Probiotics for prevention of atopic diseases in infants: systematic review and meta‐analysis. Allergy 2015; 70: 1356–71.
    1. Zhang GQ, Hu HJ, Liu CY, Zhang Q, Shakya S, Li ZY. Probiotics for prevention of atopy and food hypersensitivity in early childhood: a PRISMA‐compliant systematic review and meta‐analysis of randomized controlled trials. Medicine (Baltimore) 2016; 95: 2562.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit