Probiotics to help manage occasional diarrhea in infants and children

Content

• High incidence rate
• Dysbiosis and diarrhea
• Acute diarrhea
• Antibiotic-associated diarrhea
• Hospital-acquired diarrhea

Supplementation with probiotic products, such as those containing Lactobacillus rhamnosus, LGG^® (hereafter referred to by its trademark LGG^®) strain, has been associated with alleviation of the symptoms of acute,^{1, 2} antibiotic-associated,^{3, 4} and hospital-acquired diarrhea.⁵

High incidence rate

Diarrhea, whether acute, antibiotic-associated or hospital-acquired, is a major health burden, with a particularly high incidence rate in infants and young children.⁶ Globally, each child under three years of age will have at least one episode of acute diarrhea each year.⁶

Dysbiosis and diarrhea

Simply, diarrhea is an altered movement of ions and water. When healthy and balanced, the gastrointestinal tract has the capacity to absorb fluids and electrolytes.⁷ This is facilitated by beneficial bacteria blocking the actions of pathogenic bacteria, and thus helping to maintain a healthy gastrointestinal tract. However, when infected by pathogenic bacteria or diarrhea-causing virus such as rotavirus, the mucosa is compromised and either there is an excessive secretion or an impaired absorption of fluid and electrolytes across the intestinal epithelium.⁸

Evidence supports the beneficial impact of some probiotic strains at helping to maintain a healthy gastrointestinal tract, via a number of mechanisms.^9,10 Lactobacillus rhamnosus, LGG^®is one such strain; it has been associated with beneficial effects such as enhancing the integrity of the intestinal epithelial barrier,^11,12 modulating immune responses^13,14 and inhibition of pathogens.^15,16

Acute diarrhea

Diarrhea is a common consequence of gastrointestinal infections that are caused by a wide range of pathogens, including bacteria and viruses, with rotavirus being the primary cause.¹⁷ Acute diarrhea is defined as loose or watery stools at least three times per day, or more frequently than is normal for a particular individual,¹⁸ and typically lasting < 7 days and no longer than 14 days.¹⁹ The incidence rate ranges from 0.5 – 1.9 episodes each year in children under 3 years of age.¹⁸

To rebalance fluid and electrolytes, rehydration when possible is key.¹⁹ Further, some probiotic strains have been associated with helping to support a healthy gastrointestinal tract, for instance, shorter duration of^{1, 2} and more rapid improvement in symptoms has been observed¹ when supplementing with the LGG^® strain.

These results have been observed in children with acute diarrhea in children when supplemented with 10 billion CFU/day of the LGG^® strain for 5-7 days.¹⁹

Antibiotic-associated diarrhea

Occurring in up to one third of all patients treated with antibiotics, antibiotic-associated diarrhea (AAD) is common and challenging and is observed in both outpatient clinics and hospital settings.²¹ It is diarrhea that occurs in relation to antibiotic treatment, with the exclusion of any other etiologies.²² Almost any oral and intravenous antibiotic treatment can cause AAD. However, the risk of AAD is higher when aminopenicillins are used (with or without the addition of clavulanate, cephalosporins, or clindamycin) and, in general, the risk is higher with any antibiotic that is active against anaerobes.²³

Since AAD does not necessarily occur immediately, and may instead occur a few weeks or months after treatment, caution is needed in order to differentiate AAD from an episode of infectious gastroenteritis.²² AAD typically presents as mild diarrhea, but it can also present as fulminant pseudomembranous colitis.²⁴ Usually, no specific pathogen is identified, however, in the most severe case of AAD, or when in association with chronic conditions such as cancer and inflammatory bowel disease, the cause is frequently Clostridium difficile.²⁴

By destroying not only the pathological but also the beneficial microbes and the competitive exclusion mechanism (one method by which microbiota eliminate pathological microbes), AAD may be caused by a disruption to the gut microbiota and an overgrowth of pathogens.^{21, 22, 25} Some probiotic strains have been associated with reducing the occurrence of AAD. Specifically, supplementation with the LGG^® strain has been associated with a reduction in the occurrence of antibiotic-associated diarrhea in children.^{3, 4}

Results from clinical studies^{3, 4} suggest that to optimize the potential effect of the LGG^® strain, supplementation at 10-20 billion CFU/day of the LGG^® strain²⁶ should be initiated on the same day as starting antibiotic treatment, resumed for a week longer than the antibiotic treatment, and the probiotic product consumed a few hours after taking the antibiotics.

Hospital-acquired diarrhea

Also known as nosocomial and healthcare-associated infections, hospital-acquired infections develop > 48 hours after hospital admission, and are therefore not present or incubating at the point of hospital admission.²⁶ Depending on factors such as time of year and the ward, the incidence of hospital-acquired infections in children in developed countries is high, ranging from 5.1% - 11.6%,²⁷ with gastrointestinal infection accounting for the majority of infections.^28,29,30 The costs associated with hospital-acquired infections are significant, by prolonging length of hospital stay, worsening treatment outcomes, and increasing microbial antibiotic resistance.⁵

Probiotic products have been associated with alleviating the symptoms of occasional diarrhea resulting from  hospital-acquired infection. In one study, children admitted to pediatric facilities exhibited reduced incidence of hospital-acquired gastrointestinal and respiratory tract infection when supplemented with the LGG^® strain at 10 billion CFU/day for the length of the hospital stay^5,31

LGG^® is a registered trademark of Chr. Hansen A/S.

The article is provided for informational purposes regarding probiotics and is not meant to suggest that any substance referenced in the article is intended to diagnose, cure, mitigate, treat, or prevent any disease.