Regarding the Editors’ Note relating to “Probiotics Reduce Hospital Stay for Viral Diarrhea” by Tony Delgado in the June 2010 issue of AAP Grand Rounds, we concur that the selection of a probiotic may be a complex decision. In addition to host factors, one must consider the condition for which the probiotic is intended, and whether or not the probiotic is being used as treatment or prevention. It is helpful to consider the selection of a probiotic as a similar process to the selection of an antimicrobial agent. While this may require considerable deliberation, several entities including the National Institutes of Health (NIH), National Center for Complementary and Alternative Medicine (NCCAM; and the International Scientific Association for Probiotics and Prebiotics (ISAPP; have developed guidelines for consumers and healthcare professionals that may assist with product selection and use.

The results of studies generated by recent research pertaining to the application of probiotics in pediatrics were not available at the time of publication of the 2009 AAP Report of the Committee on Infectious Diseases, Red Book. While the use of probiotics is not specifically mentioned or indexed, their use is alluded to in a discussion of treatment modalities for Clostridium difficile infections, “Investigational therapies include other antimicrobial agents (nitazoxanide, rifaximin, tinidazole), immune globulin therapy, toxin binders, and restoring intestinal tract flora.” The Red Book edition slated for publication in 2012 will include discussions of potential applications of probiotics and the term will be referenced in the index.

Several reviews discuss applications of probiotics in children1,2 as well as an AAP Prep Audio presentation.3 These may serve as helpful resources and guidance for pediatricians and families seeking to use probiotics.

We appreciate the letter and Red Book preview. As we stated, prebiotics as well as probiotics and breastfeeding have received considerable coverage in AAP Grand Rounds. Your information certainly provides a timely update.

The Editors

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