Sources:(1) Arvola T, Laiho K, Torkkeli S, et al. Prophylactic Lactobacillus GG reduces antibiotic-associated diarrhea in children with respiratory infections: a randomized study.
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(2) Vanderhoof JA, Whitney DB, Antonson DL, et al. Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children.
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Antibiotic therapy results in changes in intestinal microflora that may have adverse clinical effects including toxic megacolon, pseudomembranous colitis and diarrhea (particularly from Clostridium difficile).1Lactobacillus casei sps. rhamnosus (LGG) is a probiotic that has been effective in the treatment and prevention of viral gastroenteritis.2,3 In a randomized double-blind trial, Arvola et al examined the effect of the administration of LGG in a group of Finnish children who received oral antibiotics for upper respiratory infections. One hundred nineteen children (aged 2 weeks to 12.8 years, mean age 4.5 years) were randomized to receive placebo or 2 capsules per day of LGG for the duration of antibiotic treatment. Episodes of diarrhea (defined as >3 stools per day for 2 consecutive days) were compared in the 2 groups. Stools were also evaluated for infectious causes of diarrhea using bacterial culture, C. difficile toxin immunoassay, and viral detection methods. The prevalence of antibiotic-associated diarrhea in the placebo group was 16% versus 5% in the LGG group (P<.05). There was 1 patient in each group with C. difficile organism and toxin A elaboration. Norwalk-like calicivirus was present in 3 patients, 1 in the experimental group and 2 in the control group. No other infectious organisms were found. The severity and duration of the diarrhea, when it occurred, was similar in both groups and self-limiting in all cases.

Vanderhoof et al examined the efficacy of LGG in reducing antibiotic-associated diarrhea in 188 previously well children aged 6 months to 10 years (median age 4 years) who were prescribed a 10-day course of antibiotics for a variety of non-serious infections. In this randomized, double-blind, placebo-controlled study, 93 children in the treatment group received a weight-adjusted dose of LGG once daily while the 95 children in the control group received identical-appearing placebo. Investigators, who were blinded, contacted the parents by telephone regularly to assess stool consistency and frequency. Diarrhea, defined as 2 or more liquid stools per day, developed in 8% (7) of the children who received LGG as compared with 26% (25) of the placebo group. Mean duration of diarrhea was also 1.2 days shorter in the treated group (4.7 versus 5.88, P =0.5). Both of these studies suggest that LGG can mitigate both the occurrence and duration of antibiotic-associated diarrhea in children receiving oral antibiotics.

Interest in the use of probiotic substances that favor microbial growth has significantly increased over the last few years.4 The hypothesis is that antibiotic-induced alterations of gut flora and function may be counteracted by introducing nonpathogenic organisms. LGG has previously been shown to reduce both the incidence of traveler’s diarrhea and the duration and severity...

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