The Food and Agriculture Organization (FAO) of the United Nations and the World Health Organization (WHO) define probiotics as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.”1 Probiotics usually include members of the bacteria genera Lactobacillus, Bifidobacterium, Saccharomyces, and Streptococcus.2 The evidence supporting the use of probiotics in pediatrics is variable, with no fully comprehensive guidelines for probiotic use available.3-5
As there is no regulatory framework for the manufacturing of probiotics, preparations differ in the types of bacteria, numbers of strains, and colony-forming units (CFUs) of microorganisms that they contain. Additionally, prescriptions are not needed to obtain probiotics and appropriate dosing recommendations are not well defined for children or adults, illustrating the need for more well-designed clinical studies to support their routine use.
Uses of probiotics
Probiotics have been used for many indications, ranging from prevention of antibiotic-associated diarrhea (AAD) to the treatment of inflammatory bowel disease.6 Based on reviews and guidelines from several key working groups, including the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN), the European Society for Gastroenterology, Hepatology, and Nutrition (ESPGHAN), and the Latin American Expert Group, the efficacy of probiotics is shown in preventing AAD, severe recurrent Clostridium difficile-associated diarrhea (CDAD), and mild-to-moderate acute diarrhea, mainly with Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii (Table).4,5,7,8
Although a recent meta-analysis of 17 randomized controlled trials (RCTs; n=3953) demonstrated that children receiving probiotics (majority of studies evaluated Lactobacillus and Bifidobacterium spp. at ≥108 cfu/mL) had a 29% risk reduction (95% confidence interval [CI]: 0.54-0.94) of being prescribed antibiotics compared with those who received placebo,9 additional studies are needed to substantiate these findings.
Some other uses of probiotics in children include the treatment of travelers’ diarrhea and acute infectious diarrhea; irritable bowel syndrome (IBS); constipation; infantile colic; necrotizing enterocolitis (NEC); and Helicobacter pylori infection.6 Probiotics may be beneficial in maintaining remission in ulcerative colitis (UC), reducing the risk of NEC in premature infants, and improving symptoms of IBS.5,8