Probiotics are a little bit the rage these days. The more we learn about the microbiome (all the bacteria that happily live in and on us to support digestion and immune function), the more we learn we want to preserve them. Probiotics are supplements (not medicines) so the data on their use is in the early stages but taking probiotics while taking antibiotics really does make medical sense. New data out in JAMA Pediatrics makes this more compelling. Taken orally, probiotics re-populate your gastrointestinal tract with “good” bacteria to help aid in digestion — so using them at the time you are taking antibiotics for an infection may help alleviate side effects like diarrhea that result after the “good” bacteria are killed off.

Antibiotics are the most commonly prescribed medication to children yet estimates show that 1 in 3 to half of antibiotics prescribed are unnecessary. Typically that means that antibiotics are prescribed when they won’t do any good for a viral infection or when a child will recover from an infection without intervention. Trouble is, antibiotics kill BOTH the good and bad bacteria in our bodies. Sometimes this is necessary when it comes to treating things like whooping cough, strep throat and urinary tract infections, while others it is not (colds, bronchitis and fluid in the ear). Of course in addition to using antibiotics more than we’d like to, antibiotics also cause side effects like: diarrhea, abdominal cramping, hives and nausea.

The estimated incidence of antibiotic-associated diarrhea among children is 11%  among outpatients and 21% among inpatients — Probiotics and Prevention of Antibiotic Associated Diarrhea in Infants and Children, JAMA Pediatrics

The recent JAMA Pediatrics  clinical synopsis (summary of a larger Cochrane review) provides us new insights on how we can help children who may be struggling with side effects caused by antibiotics. The study found that providing children with probiotics during antibiotic use can reduce both the chance of diarrhea and the number of days it lasts. Probiotics are live bacteria and yeasts that can help replenish the bacteria in our guts that antibiotics kill. Probiotics often come in capsules you can open up in your children’s food or bottle or they come in packets you can sprinkle.

Antibiotic Overview

  • The Centers for Disease Control & Prevention (CDC) states that 1 in 3 antibiotic prescriptions are unnecessary. Health care providers AND patients and families can work to use them only when necessary. You should always ask if you or your child MUST take antibiotics so you can weigh the risks and benefits of doing so.
  • Antibiotic-associated diarrhea is estimated in roughly 10-20% of patients taking antibiotics because the medicines kill off the normal amount of bacteria in your intestines. Ick.
  • Antibiotics do wonders when necessary but they carry common side effects: abdominal cramps, nausea & skin rash and/or hives or allergic reactions. So they aren’t just ALL GOOD but often they cure and/or prevent serious and even life-threatening infections.

What Are Probiotics?

  • Defining probiotics: I like the definition from the JAMA Pediatrics synopsis, “Probiotics are nonpathogenic microbial preparations that may prevent antibiotic-associated diarrhea via normalization of disrupted microbiota and competitive inhibition of pathogens as a result of antibiotic use.” Translated it means they are live bacteria/yeast that don’t cause human infections and yeasts that help prevent the side effects of killing off the bacteria that kept the tissues healthy in the first place.
  • Probiotics are often called “good” bacteria because they help re-populate your intestines with bacteria to keep your gut functioning at baseline.
  • Probiotics are supplements which means they are NOT regulated by the FDA. I translate that to mean they are subject to less rigorous testing to ensure they are what they say they are.
  • Which one should you buy for your child? It’s hard to say. Many pediatricians have their “go-to” recommendations, so ask your child’s doctor or nurse practitioner. Many pharmacists do too. The synopsis I mention here in this post summarized a larger Cochrane review evaluating 23 studies that compared children getting one strain of bacteria, multiple strains or controls (none). The probiotics included: Bacillus, Bifidobacterium, Clostridium, Lactobacilli, Lactococcus, Leuconostoc, Saccharomyces, Streptococcus.

New Data On Probiotics In Kids:

  • Probiotics are associated with lower rates of antibiotic-associated diarrhea in children (aged 1 month to 18 years) in both children given antibiotics outside of the hospital and those who were inpatient. Probiotics were associated with lower rates of antibiotic-associated diarrhea (8%) compared with control groups (19%). Similarly, probiotics were associated with lower rates of antibiotic-associated diarrhea (9%) compared with those children given placebo (20%).
  • Probiotics decreased the duration of diarrhea that started while children were taking antibiotics. probiotics were associated with a lower mean duration of diarrhea (3.5 days) compared with the control group (4.1 days). And although 1 and a half days doesn’t seem all that significant talk to any parent of a young child with diarrhea coming out the sides of a diaper!
  • There were no increased adverse events (side effects) reported in children given probiotics. Yay!

Bottom line: if your child is prescribed antibiotics, talk to your pediatrician or nurse practitioner and/or pharmacist about supplementing your child with probiotics during the time you’re using antibiotics and potentially for a few days after. Less diarrhea in many children and for less days…

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