Risk and Protective Factors for Gastrointestinal Symptoms associated with Antibiotic Treatment in Children: A Population Study
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
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.
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.
참고문헌 (36)
- Chai G, "Trends of outpatient prescription drug utilization in US children, 2002-2010", Pediatrics, 130, pp.23~31 (2012)
- Goldenberg JZ, "Probiotics for the prevention of pediatric antibiotic-associated diarrhea", Cochrane Database Syst Rev, (12), pp.CD004827~ (2015)
- Videlock EJ, "Meta-analysis : probiotics in antibiotic-associated diarrhoea", Aliment Pharmacol Ther, 35, pp.1355~1369 (2012)
- Reed DE, "Emerging studies of human visceral nociceptors", Am J Physiol Gastrointest Liver Physiol, 312, pp.G201~7 (2017)
- Szajewska H, "Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Children", J Pediatr Gastroenterol Nutr, 62, pp.495~506 (2016)
- "Diarrhoeal Disease Fact Sheet" (2017)[URL]
- McFarland LV, "Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections", World J Gastroenterol, 22, pp.3078~3104 (2016)
- Cai J, "Comparative efficacy and tolerability of probiotics for antibiotic-associated diarrhea : systematic review with network meta-analysis", United European Gastroenterol J, 6, pp.169~180 (2018)
- Reyes H, "Antibiotic noncompliance and waste in upper respiratory infections and acute diarrhea", J Clin Epidemiol, 50, pp.1297~1304 (1997)
- McFarland LV, "Risk factor for antibiotic-associated diarrhea. A review of the literature", Ann Med Interne(Paris), 149, pp.261~266 (1998)
- McFarland LV, "Preventing pediatric antibiotic-associated diarrhea and Clostridium difficile infections with probiotics : a meta-analysis", World J Meta-Anal, 1, pp.102~120 (2013)
- Turck D, "Incidence and risk factors of oral antibiotic-associated diarrhea in an outpatient pediatric population", J Pediatr Gastroenterol Nutr, 37, pp.22~26 (2003)
- Erdeve O, "The probiotic effect of Saccharomyces boulardii in a pediatric age group", J Trop Pediatr, 50, pp.234~236 (2004)
- Murphy JL, "Adverse events in pediatric patients receiving long-term oral and intravenous antibiotics", Hosp Pediatr, 6, pp.330~338 (2016)
- Li N, "Cost-effectiveness analysis of oral probiotics for the prevention of Clostridium difficile-associated diarrhoea in children and adolescents", J Hosp Infect, 99, pp.469~474 (2018)
- Jeffrey S. Hyams, "Childhood Functional Gastrointestinal Disorders: Child", Adolescent, 2016, pp.150(6), 1456~1468.e2[DOI]
- Marc A. Benninga, "Childhood Functional Gastrointestinal Disorders: Neonate", Toddler, 2016, pp.150(6), 1443~1455.e2[DOI]
- Tabbers MM, "Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN", J Pediatr Gastroenterol Nutr, 58, pp.258~274 (2014)
- Patro-Golab B, "Yogurt for treating antibiotic-associated diarrhea : systematic review and meta-analysis", Nutrition, 31, pp.796~800 (2015)
- Akobeng AK, "Communicating the benefits and harms of treatments", Arch Dis Child, 93, pp.710~713 (2008)
- Guo B, "A comparative review of methods for comparing means using partially paired data", Stat Methods Med Res, 26, pp.1323~1340 (2017)
- Johnston BC, "Measurement issues in trials of pediatric acute diarrheal diseases : a systematic review", Pediatrics, 126, pp.e222~31 (2010)
- Castelluzzo MA, "Approccio al bambino con disturbi funzionali gastrointestinali", Prosp in Ped, 46, pp.276~289 (2016)
- Robinson CJ, "Antibiotic administration alters the community structure of the gastrointestinal micobiota", Gut Microbes, 1, pp.279~284 (2010)
- Haran JP, "Factors influencing the development of antibiotic associated diarrhea in ED patients discharged home : risk of administering IV antibiotics", Am J Emerg Med, 32, pp.1195~1199 (2014)
- Szajewska H, "What are the indications for using probiotics in children", Arch Dis Child, 101, pp.398~403 (2016)
- Urbańska M, "Systematic review with meta-analysis : Lactobacillus reuteri DSM 17938 for diarrhoeal diseases in children", Aliment Pharmacol Ther, 43, pp.1025~1034 (2016)
- Uusijärvi A, "Use of antibiotics in infancy and childhood and risk of recurrent abdominal pain--a Swedish birth cohort study", Neurogastroenterol Motil, 26, pp.841~850 (2014)
- Pensabene L, "Postinfectious functional gastrointestinal disorders in children: a multicenter prospective study", J Pediatr, 166, pp.903~907 (2015)
- Saps M, "Post-infectious functional gastrointestinal disorders in children", J Pediatr, 152, pp.812~816 (2008)
- Saps M, "Rotavirus gastroenteritis : precursor of functional gastrointestinal disorders", J Pediatr Gastroenterol Nutr, 49, pp.580~583 (2009)
- Salvatore S, "Mind the gut : probiotics in paediatric neurogastroenterology", Benef Microbes, 9, pp.883~898 (2018)
- Smith JT, "Does a preoperative bowel preparation reduce bowel morbidity and length of stay after scoliosis surgery? A randomized prospective study", J Pediatr Orthop, 33, pp.e69~71 (2013)
- Korterink JJ, "Probiotics for childhood functional gastrointestinal disorders : a systematic review and meta-analysis", Acta Paediatr, 103, pp.365~372 (2014)
- Hojsak I, "Probiotics in functional gastrointestinal disorders", Adv Exp Med Biol, 1125, pp.121~137 (2019)
- Newlove-Delgado T, "Probiotics for children with recurrent abdominal pain", JAMA Pediatr, 173, pp.183~184 (2019)