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2016 ; 5
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English Wikipedia
Probiotics in critically ill children
#MMPMID27081478
Singhi SC
; Kumar S
F1000Res
2016[]; 5
(ä): ä PMID27081478
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Gut microflora contribute greatly to immune and nutritive functions and act as a
physical barrier against pathogenic organisms across the gut mucosa. Critical
illness disrupts the balance between host and gut microflora, facilitating
colonization, overgrowth, and translocation of pathogens and microbial products
across intestinal mucosal barrier and causing systemic inflammatory response
syndrome and sepsis. Commonly used probiotics, which have been developed from
organisms that form gut microbiota, singly or in combination, can restore gut
microflora and offer the benefits similar to those offered by normal gut flora,
namely immune enhancement, improved barrier function of the gastrointestinal
tract (GIT), and prevention of bacterial translocation. Enteral supplementation
of probiotic strains containing either Lactobacillus alone or in combination with
Bifidobacterium reduced the incidence and severity of necrotizing enterocolitis
and all-cause mortality in preterm infants. Orally administered Lactobacillus
casei subspecies rhamnosus, Lactobacillus reuteri, and Lactobacillus rhamnosus
were effective in the prevention of late-onset sepsis and GIT colonization by
Candida in preterm very low birth weight infants. In critically ill children,
probiotics are effective in the prevention and treatment of antibiotic-associated
diarrhea. Oral administration of a mix of probiotics for 1 week to children on
broad-spectrum antibiotics in a pediatric intensive care unit decreased GIT
colonization by Candida, led to a 50% reduction in candiduria, and showed a trend
toward decreased incidence of candidemia. However, routine use of probiotics
cannot be supported on the basis of current scientific evidence. Safety of
probiotics is also a concern; rarely, probiotics may cause bacteremia, fungemia,
and sepsis in immunocompromised critically ill children. More studies are needed
to answer questions on the effectiveness of a mix versus single-strain
probiotics, optimum dosage regimens and duration of treatment, cost
effectiveness, and risk-benefit potential for the prevention and treatment of
various critical illnesses.