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Probiotics are big business, but do they deliver for patients? :

June 27, 2019

Editor's note:The 2019 AAP National Conference & Exhibition will take place from Oct. 25-29 in New Orleans.

Probiotics are touted as an antidote for a multitude of health conditions, including gastrointestinal distress, infant colic, acne and depression. But do these “good bacteria” live up to the hype?

Find out during “Controversies in Pediatrics: Probiotics: Friend or Folly?” (S2074) from 8:30-10 a.m. Saturday, Oct. 26 in rooms 217-219 of the convention center. 

James P. Nataro, M.D., Ph.D., M.B.A., FAAP, will lay out evidence supporting the safety and efficacy of probiotics, while James D. Campbell, M.D., M.S., FAAP, will present some caveats to consider.

“There is fairly strong evidence for a benefit of probiotics for necrotizing enterocolitis in premature infants, antibiotic-associated diarrhea, Clostridium difficile enteritis and for common viral diarrhea,” said Dr. Nataro, professor and chair of pediatrics at University of Virginia and a member of the AAP Section on Infectious Diseases. “There’s also some evidence that probiotics may work for infant colic as well.”

Yet, Dr. Campbell cautions against taking all studies at face value. He will discuss publication bias, weaknesses of meta-analyses and pitfalls of extrapolating evidence from the adult literature to the pediatric population.

“It’s well-designed safety and efficacy studies that are the gold standard for determining whether or not we should be using probiotics in various disease states,” said Dr. Campbell, professor of pediatrics at University of Maryland School of Medicine and a member of the AAP Committee on Infectious Diseases.

During the session, Drs. Nataro and Campbell will address four main issues related to probiotics:

  • The biologic plausibility underlying the efficacy of probiotic therapy.
  • Evidence for the safety and efficacy of probiotics from well-designed trials.
  • The importance of recommending probiotics only for the same conditions studied in trials.
  • The growing market for and advertising of probiotics that may influence patients and families.

Data from the 2012 National Health Interview Survey show about 300,000 children ages 4-17 had recently used probiotics or prebiotics.

“The pressure on pediatricians from their patients and families will grow, and there will be increasing opportunities for physicians to use probiotics to assure the health of their patients,” Dr. Nataro said. “With those opportunities, we want to make sure pediatricians can understand the literature that is already in print and also be equipped with the tools to interpret additional studies that are published.”

Added Dr. Campbell: “Probiotics are a class of potential interventions, and it’s not a single product. It’s very likely that as we learn more and more, we will figure out which products for which diseases are the most efficacious and the safest.”

For more coverage of the 2019 AAP National Conference & Exhibition, visit http://bit.ly/AAPNationalConference19.

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