Use Of Probiotics In Infants With Diarrhea Associated With A

Use of Probiotics in Infants with Diarrhea Associated with Antibiotics

The problem this paper addresses is whether probiotics can be an effective preventative measure for diarrhea when a child is prescribed an antibiotic. The significance of this problem is that diarrhea can lead to serious complications in the very young and the elderly. Based on a six-month prospective cohort study by Vernacchio et al. (2006), diarrhea in infants and young children was reported to be 2.2 episodes per person-year with a median duration of 2 days. More of these were caused by viruses than bacteria. Although recent data are unavailable, a 1991 study by Glass, Lew, Gangarose, and LeBaron indicated that children in the US die of diarrheal disease every year and 2.1 to 3.7 million children are seen by a physician for diarrheal diseases.

C. difficile infections are among the most serious causes of antibiotic-associated diarrhea and their incidence in hospitalized infants has been increasing (American Academy of Pediatrics Committee on Infectious Diseases, 2013). The major pathophysiology of the diarrhea associated with antibiotics is disturbance of the normal flora in the GI tract. The specific clinical question guiding the search for a quantitative research article is: In hospitalized pediatric patients taking antibiotics, does taking probiotics decrease the risk of antibiotic-associated diarrhea? The population is hospitalized pediatric patients; the intervention is taking probiotics; the comparison is not taking probiotics; and the outcome is reduction in diarrhea.

The population for the qualitative question is: parents of children with acute diarrhea; the outcome of interest is the lived experience of these parents. The variable of interest is the parents' lived experience when caring for children with acute diarrhea. Since diarrhea is often short-term, a time component is not relevant to these clinical questions.

The purpose of this paper is to describe the systematic searches for the most relevant evidence related to the use of probiotics in the care of children with antibiotic-associated diarrhea. The levels of evidence most relevant are Level I (multiple randomized controlled trials) and Level II (single well-designed RCT) for prevention studies, and Level IV (descriptive or qualitative studies) for exploring parental experiences.

The search was conducted through CINAHL using keywords, advanced search strategies, and headings. For the quantitative evidence, keywords “probiotics” and “diarrhea” were combined; later, adding “antibiotics” helped refine the search. The expanded search yielded 178 results, which, after applying filters for publication date, language, research type, and age, produced a manageable set of articles. Among these, systematic reviews and clinical trials were selected for relevance. The most pertinent study found an association between specific probiotic strains such as Lactobacillus GG and Saccharomyces boulardii and a reduction in antibiotic-associated diarrhea in children (Jones, 2010).

For the qualitative evidence, the search strategy focused on parents’ experiences, leading to a limited number of studies. After combining “parents” with “diarrhea,” and applying qualitative-specific filters, two studies emerged. One explored how parents decide to seek emergency care for children with GI symptoms, emphasizing factors such as perceived urgency, access to care, and decision-making processes (Graham, Fitzpatrick, & Black, 2010). These studies highlight the complexities faced by parents and the psychosocial factors influencing their response to childhood diarrhea.

Paper For Above instruction

Diarrhea in infants and children remains a significant health concern worldwide, with implications that extend beyond discomfort to severe health risks and increased healthcare costs (Vernacchio et al., 2006). The role of antibiotics in precipitating diarrhea by disrupting normal gastrointestinal flora has garnered considerable attention, particularly regarding the potential of probiotics as a preventive intervention (American Academy of Pediatrics, 2013). The systematic review of recent literature reveals that probiotic strains, such as Lactobacillus GG and Saccharomyces boulardii, have promising evidence supporting their efficacy in reducing the incidence of antibiotic-associated diarrhea among pediatric populations (Jones, 2010). Conversely, understanding parental experiences when managing childhood diarrhea is vital for developing supportive care strategies that are culturally sensitive and accessible (Graham et al., 2010).

From a clinical perspective, the evidence indicates that probiotics can serve as a safe and effective adjunct to antibiotic therapy to prevent diarrhea. Randomized controlled trials (RCTs) at Level I provide robust evidence supporting this claim (Goldenberg et al., 2017). These studies consistently demonstrate a significant reduction—often up to 75%—in the occurrence of diarrhea among children receiving specific probiotic strains during antibiotic treatment (Hempel et al., 2012). The mechanisms involve the re-establishment and stabilization of the gut microbiome, which otherwise becomes imbalanced due to antibiotic therapy (Vanderhoof et al., 1999). The importance of strain specificity and appropriate dosing cannot be overstated; for example, Lactobacillus rhamnosus GG has been extensively studied and shown to reduce diarrhea duration and severity (Allen et al., 2014).

Qualitative research offers insights into the parental lens of childhood diarrhea management. The experiences of parents are influenced heavily by factors such as access to healthcare, perceived severity of symptoms, and cultural beliefs regarding illness and treatment (Graham et al., 2010). These studies, classified as Level IV evidence, underscore that parents often face dilemmas in deciding when and where to seek care, a process compounded by health literacy levels and previous healthcare experiences. The emotional burden, including anxiety and uncertainty, can influence their decision-making process. Understanding these lived experiences is crucial for healthcare providers to tailor communication, education, and intervention strategies effectively.

In practical terms, integrating probiotic use into pediatric care protocols offers a preventative measure that is supported by a high level of evidence and can be easily incorporated into clinical practice. This involves selecting appropriate strains, establishing dosing guidelines, and providing education to both healthcare professionals and caregivers (Goldenberg et al., 2017). Additionally, recognizing parental perspectives facilitates the development of supportive educational materials that foster timely healthcare seeking behaviors. Future research should focus on long-term safety, cost-effectiveness analyses, and exploring barriers to probiotic use across diverse populations (Hempel et al., 2012). Enhancing our understanding of parental experiences will also aid in designing interventions that improve adherence and satisfaction with care (Graham et al., 2010).

In conclusion, the evidence supports the use of probiotics as an effective preventative strategy for antibiotic-associated diarrhea in children. Health practitioners should consider incorporating probiotic supplementation into treatment protocols, especially strains like Lactobacillus GG that have demonstrated consistent benefits. Simultaneously, understanding parental decision-making processes provides an essential dimension for improving management approaches and health education. Collectively, these strategies can contribute significantly to reducing childhood morbidity associated with diarrhea, thereby improving overall pediatric health outcomes.

References

• Allen SJ, Dawson E, Walsh LJ, et al. (2014). Probiotics for treating acute infectious diarrhea. Cochrane Database of Systematic Reviews, (11), CD003048.
• American Academy of Pediatrics Committee on Infectious Diseases. (2013). Clostridium difficile infection in infants and children. Pediatrics, 131(1), e23-e29. https://doi.org/10.1542/peds.2012-2450
• Goldenberg JZ, Lytvyn L, Lo C, et al. (2017). Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database of Systematic Reviews, (12), CD004827.
• Graham, J. M., Fitzpatrick, E. A., & Black, K. J. (2010). My child can’t keep anything down! Interviewing parents who bring their preschoolers to the emergency department for diarrhea, vomiting, and dehydration. Pediatric Emergency Care, 26(4), 245-251.
• Hempel S, Newberry S, Maher AR, et al. (2012). Probiotics for the prevention and treatment of diarrhea. Annals of Internal Medicine, 157(9), 634–644.
• Jones, K. (2010). Probiotics: Preventing antibiotic-associated diarrhea. Journal for Specialists in Pediatric Nursing, 15(2), 12-18.
• Vanderhoof JA, Blake ME, Singsen B, et al. (1999). Effect of Lactobacillus GG on antibiotic-associated diarrhea in children. The Journal of Pediatrics, 135(2), 156-160.
• Vernacchio L, Vezina R. M., Mitchell A. A., Lesko S. M., Plaut A. G., & Acheson D. W. (2006). Diarrhea in American infants and young children in the community setting: Incidence, clinical presentation and microbiology. The Pediatric Infectious Disease Journal, 25(1), 2-7. https://doi.org/10.1097/01.inf.0000192288.07285.09