Pediatr Gastroenterol Hepatol Nutr.  2020 Jan;23(1):35-48. 10.5223/pghn.2020.23.1.35.

Risk and Protective Factors for Gastrointestinal Symptoms associated with Antibiotic Treatment in Children: A Population Study

• Baù M
• Moretti A
• Bertoni E
• Vazzoler V
• Luini C
• Agosti M
• Salvatore

• KMID: 2467892
• DOI: http://doi.org/10.5223/pghn.2020.23.1.35

Abstract

PURPOSE
Gastrointestinal symptoms are often related to antibiotic treatment. Their incidence, risk and protective conditions in children are not well defined and represent the aims of this study.
METHODS
We prospectively enrolled inpatient children submitted to antibiotic treatment. Indication, type, dose and duration of treatment, probiotic supplementation and gastrointestinal symptoms were recorded at recruitment, after two and four weeks. Antibiotic-associated diarrhea (AAD) was defined as the presence of at least 3 loose/liquid stools within 14 days from antibiotic onset.
RESULTS
AAD occurred in 59/289 (20.4%) of patients, with increased risk in children younger than 3 years (relative risk [RR]=4.25), in lower respiratory (RR=2.11) and urinary infections (RR=3.67), intravenous administration (RR=1.81) and previous AAD episodes (RR=1.87). Abdominal pain occurred in 27/289 (9.3%), particularly in children >6 years (RR=4.15), with previous abdominal pain (RR=7.2) or constipation (RR=4.06). Constipation was recorded in 23/289 (8.0%), with increased risk in children having surgery (RR=2.56) or previous constipation (RR=7.38). Probiotic supplementation significantly reduced AAD (RR=0.30) and abdominal pain (RR=0.36). Lactobacillus rhamnosus GG (LGG) and L. reuteri significantly reduced AAD (RR=0.37 and 0.35) and abdominal pain (RR=0.37 and 0.24).
CONCLUSION
AAD occurred in 20.4% of children, with increased risk at younger age, lower respiratory and urinary tract infections, intravenous treatment and previous AAD. LGG and L. reuteri reduced both AAD and associated abdominal pain.

Keyword

Abdominal pain; Anti-bacterial agents; Antibiotic-associated diarrhea; Children; Constipation; Diarrhea; Lactobacillus reuteri; Lactobacillus rhamnosus GG; Probiotics

MeSH Terms

Abdominal Pain
Administration, Intravenous
Anti-Bacterial Agents
Child*
Constipation
Diarrhea
Humans
Incidence
Inpatients
Lactobacillus reuteri
Lactobacillus rhamnosus
Probiotics
Prospective Studies
Protective Factors*
Urinary Tract Infections
Anti-Bacterial Agents

Figure

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  Fig. 1 Flow chart of participant enrollment process.

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  Fig. 2 Total probiotic intake in our population by different strains. LGG, Lactobacillus rhamnosus GG; L., Lactobacillus; B., Bifidobacterium.

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