Abstract：
BACKGROUND: Several probiotic species and strains, single or combined, have been evaluated in childhood diarrheal disorders, and recommendations have ever been changing as newer trials are published. Therefore, there is a need to develop a guideline for Indian children describing the current role of probiotics in clinical practice.
OBJECTIVE: To develop a guideline for the use of probiotics in children with diarrhea.
METHODS: A national consultative group (NCG) was constituted by the Indian Academy of Pediatrics (IAP), consisting of subjects experts. Sub-topics were allotted to various experts as paired groups for detailed review. Members reviewed the international and Indian literature for existing guidelines, systematic reviews, meta-analyses and trials. Thereafter, two virtual structured meetings of the group were held on 2nd and 22nd August, 2020. The management guidelines were formulated by the group and circulated to the participants for comments. The final guidelines were approved by all experts, and adopted by the IAP executive board.
CONCLUSIONS: The NCG suggests Lactobacillus GG as a conditional recommendation with low-to-moderate level evidence or Saccharomyces boulardii as a conditional recommendation with very low-to-low level evidence as adjuvant therapy in acute diarrhea. The NCG also recommends the use of combination probiotics in neonatal necrotizing enterocolitis (NEC), as these reduce the risk of NEC stage II and above, late-onset sepsis, mortality and also time to achieve full feeds. The NCG does not recommend the use of any kind of probiotics in the therapy of acute dysentery, persistent diarrhea, Clostridium difficile diarrhea and chronic diarrheal conditions such as celiac disease, diarrhea-predominant irritable bowel syndrome and inflammatory bowel disease in children. Risk of antibiotic-associated diarrhea (AAD) is high with some antibiotics and most of these cases present as mild diarrhea. The NCG recommends probiotics only in special situations of AAD. L. rhamnoses GG or S. boulardii may be used for the prevention of AAD. VSL#3, a combination probiotic, may be used as an adjuvant in active pouchitis, prevention of recurrences and maintenance of remission in pouchitis.
OBJECTIVE: To develop a guideline for the use of probiotics in children with diarrhea.
METHODS: A national consultative group (NCG) was constituted by the Indian Academy of Pediatrics (IAP), consisting of subjects experts. Sub-topics were allotted to various experts as paired groups for detailed review. Members reviewed the international and Indian literature for existing guidelines, systematic reviews, meta-analyses and trials. Thereafter, two virtual structured meetings of the group were held on 2nd and 22nd August, 2020. The management guidelines were formulated by the group and circulated to the participants for comments. The final guidelines were approved by all experts, and adopted by the IAP executive board.
CONCLUSIONS: The NCG suggests Lactobacillus GG as a conditional recommendation with low-to-moderate level evidence or Saccharomyces boulardii as a conditional recommendation with very low-to-low level evidence as adjuvant therapy in acute diarrhea. The NCG also recommends the use of combination probiotics in neonatal necrotizing enterocolitis (NEC), as these reduce the risk of NEC stage II and above, late-onset sepsis, mortality and also time to achieve full feeds. The NCG does not recommend the use of any kind of probiotics in the therapy of acute dysentery, persistent diarrhea, Clostridium difficile diarrhea and chronic diarrheal conditions such as celiac disease, diarrhea-predominant irritable bowel syndrome and inflammatory bowel disease in children. Risk of antibiotic-associated diarrhea (AAD) is high with some antibiotics and most of these cases present as mild diarrhea. The NCG recommends probiotics only in special situations of AAD. L. rhamnoses GG or S. boulardii may be used for the prevention of AAD. VSL#3, a combination probiotic, may be used as an adjuvant in active pouchitis, prevention of recurrences and maintenance of remission in pouchitis.
摘要：
背景：几种益生菌物种和菌株，单个或组合，已经在儿童腹泻疾病中进行了评估，随着新试验的发表，建议一直在变化。因此,有必要为印度儿童制定指南,描述益生菌在临床实践中的当前作用.
目的：为腹泻患儿使用益生菌制定指南。
方法：由印度儿科学会（IAP）组成的国家咨询小组（NCG），由学科专家组成。分主题被分配给各种专家作为配对小组进行详细审查。成员们审查了现有准则的国际和印度文献，系统评价,荟萃分析和试验。此后,该小组于8月2日和22日举行了两次虚拟结构化会议，2020年。管理准则由小组制定，并分发给与会者征求意见。最终指南得到了所有专家的批准，并由IAP执行董事会通过。
结论：NCG建议GG乳杆菌作为有条件的推荐，有低至中等水平的证据，或布拉酵母菌作为有条件的推荐，有非常低至低水平的证据作为急性腹泻的辅助治疗。NCG还建议在新生儿坏死性小肠结肠炎（NEC）中使用联合益生菌，由于这些降低了NEC第二阶段及以上阶段的风险，迟发性败血症,死亡率和实现全食的时间。NCG不建议在急性痢疾的治疗中使用任何类型的益生菌，持续性腹泻,艰难梭菌腹泻和乳糜泻等慢性腹泻，儿童腹泻型肠易激综合征和炎症性肠病。使用某些抗生素时，抗生素相关性腹泻（AAD）的风险很高，大多数病例表现为轻度腹泻。NCG仅在AAD的特殊情况下推荐益生菌。鼠李糖乳杆菌GG或布拉氏链球菌可用于预防AAD。VSL#3，一种组合益生菌，可用作活性囊炎的佐剂，预防囊炎的复发和维持缓解。
目的：为腹泻患儿使用益生菌制定指南。
方法：由印度儿科学会（IAP）组成的国家咨询小组（NCG），由学科专家组成。分主题被分配给各种专家作为配对小组进行详细审查。成员们审查了现有准则的国际和印度文献，系统评价,荟萃分析和试验。此后,该小组于8月2日和22日举行了两次虚拟结构化会议，2020年。管理准则由小组制定，并分发给与会者征求意见。最终指南得到了所有专家的批准，并由IAP执行董事会通过。
结论：NCG建议GG乳杆菌作为有条件的推荐，有低至中等水平的证据，或布拉酵母菌作为有条件的推荐，有非常低至低水平的证据作为急性腹泻的辅助治疗。NCG还建议在新生儿坏死性小肠结肠炎（NEC）中使用联合益生菌，由于这些降低了NEC第二阶段及以上阶段的风险，迟发性败血症,死亡率和实现全食的时间。NCG不建议在急性痢疾的治疗中使用任何类型的益生菌，持续性腹泻,艰难梭菌腹泻和乳糜泻等慢性腹泻，儿童腹泻型肠易激综合征和炎症性肠病。使用某些抗生素时，抗生素相关性腹泻（AAD）的风险很高，大多数病例表现为轻度腹泻。NCG仅在AAD的特殊情况下推荐益生菌。鼠李糖乳杆菌GG或布拉氏链球菌可用于预防AAD。VSL#3，一种组合益生菌，可用作活性囊炎的佐剂，预防囊炎的复发和维持缓解。
