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Children and antibiotics  

Antibiotics can be used to treat bacterial infections and children receive them more frequently than any other classes of medication. They are most commonly subscribed for a variety of minor infections of the respiratory tract, integument and urinary tract.(2)  


However, antibiotics can determinately affect the balance of the gut microbiome(3) by killing susceptible intestinal flora bacteria.(4) This is because antibiotics not only kill the bad bacteria but also the good ones – their effect is not specific. This can lead to numerous side effects including abdominal pain, flatulence, antibiotic-associated diarrhoea (AAD) and Candida infestation.(4) The incidence of AAD in children ranges from 20-40% in those receiving broad-spectrum antibiotics.(2) Additionally, it has been shown that 14 days after antibiotic treatment, pathogenic bacteria such as Enterobacteriaceae and Staphylococci increase compared to other species naturally present in the intestinal flora.(3) 


Up to 25% of cases of AAD are caused by Clostridioides difficile. Its growth is usually prevented by the gut microbiota however, when the gut microbiota becomes disrupted by antibiotics, other commensal organisms can grow unchecked and produce toxins that cause illness, like diarrhoea. A meta-analysis showed that probiotic administration during antibiotics usage was significantly associated with a lower risk of developing C. difficile-associated disease (CDAD).(6)  


Probiotics can be used during antibiotic therapy to maintain the balance of the gut microbiota and therefore, help prevent the common side effects.(4) This can be achieved by the probiotics competing for adhesion sites, occupying attachment sites and releasing antimicrobial substances which can prevent the colonisation of pathogenic bacteria.(5,6)


Lactobacillus GG has several properties in preventing AAD including; able to survive in gastric and bile secretions, colonies the gastrointestinal tract and can bind to epithelial cells.(2) The efficacy of Lactobacillus in preventing AAD was demonstrated in a study by Vanderhoof et al,. in 1999. 202 children between the ages of 6 months and 10 years who were prescribed a 10-day course of antibiotics were recruited. Children were randomised to receive either LGG or a placebo in capsule form. Children who weighed <12kg were given 10 billion CFU/day and those >12kg were given 20 billion CFU/day. Outcome measures included stool frequency and consistency, presence or absence of visible blood content in the stool, abdominal pain, nausea, vomiting, bloating and appetite suppression.(2)


Of the children who received LGG, 8% had diarrhoea compared to 25% in the placebo group. Mean duration of diarrhoea was 4.7 days in the LGG group compared to 5.88 days in the placebo (P=.05). Additionally, of the children in the LGG group, the stool consistency and frequency were significantly improved compared to the placebo group.(2) This study demonstrates the use of probiotics alongside antibiotics to prevent AAD and help aid recovery.   



SOURCES

  1. Nicolini G, Sperotto F, Esposito S. Combating the rise of antibiotic resistance in children. Minerva Pediatr. 2014 Feb;66(1):31–9. pmid: 24608580
  2. Vanderhoof JA, Whitney DB, Antonson DL, et al. Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children.J Pediatr. 1999;135:564-568. 
  3. Govender M, Choonara Y, Kumar P, du Toit L, van Vuuren S, Pillay V. A Review of the Advancements in Probiotic Delivery: Conventional vs. Non-conventional Formulations for Intestinal Flora Supplementation. AAPS PharmSciTech. 2013;15(1):29-43. 
  4. Kerna NA. Global Health Preventive Medicine Overture: Select Probiotic Use in the Prevention of Antibiotic-Associated Diarrhea and the Treatment of C. Difficile and Distinct Tropical Diseases. SM Prev Med Public Health. 2018; 2(3): 1021. 
  5. Baumler AJ, Sperandio V. Interactions between the microbiota and pathogenic bacteria in the gut. Nature (2016) 535(7610):85–93. doi:10.1038/nature18849 
  6. Ming L, Zhang Q, Yang L, Huang JA. Comparison of antibacterial effects between antimicrobial peptide and bacteriocins isolated from Lactobacillus plantarum on three common pathogenic bacteria. Int J Clin Exp Med (2015) 8(4):5806–11