BMJ  2007;335:414 (1 September), doi:10.1136/bmj.39317.494549.80

Letters

Probiotics in children

Consider microbial cause

Canani et al enrolled children with acute diarrhoea in their study of probiotics, but the cause of the diarrhoea was not mentioned.¹ I assumed that the cause was infection or food poisoning, as other causes such as food allergy or cystic fibrosis were excluded. However, microbiological examination was performed only when there were specific clinical reasons, so that no complete information was available.¹ Although a Cochrane review showed therapeutic benefit regardless of organism,² microbiological examination might be of additional value. The specific micro-organism might have had an effect on whether or not the probiotic preparations were successful. In other words, microbial causes might interfere with the result. Moreover, probiotics should be used cautiously in children. Sepsis caused by Lactobacillus GG has been reported in two children in hospital who had diarrhoea as a result of antibiotic treatment for other diseases.³

Department of Histology, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia

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Competing interests: None declared.

References

1. Canani RB, Cirillo P, TerrinG, Cesarano L, Spagnuolo MI, de Vincenzo A, et al. Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations. BMJ 2007;335:340-2. (18 August.)[Abstract/Free Full Text]
2. Allen SJ, Okoko B, Martinez E, Gregorio G, Dans LF. Probiotics for treating infectious diarrhoea. Cochrane Database Syst Rev 2004;(2):CD003048.
3. Land MH, Rouster-Stevens K, Woods CR, Cannon ML, Cnota J, Shetty AK. Lactobacillus sepsis associated with probiotic therapy. Pediatrics 2005;115:178-81.[Abstract/Free Full Text]

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Relevant Article

Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations

Roberto Berni Canani, Pia Cirillo, Gianluca Terrin, Luisa Cesarano, Maria Immacolata Spagnuolo, Anna De Vincenzo, Fabio Albano, Annalisa Passariello, Giulio De Marco, Francesco Manguso, and Alfredo Guarino
BMJ 2007 335: 340. [Abstract] [Full Text] [PDF]