Editing Probiotic (section)

=== Antibiotic-associated diarrhea ===
Antibiotics are a common treatment for children, with 11% to 40% of antibiotic-treated children developing [[diarrhea]].<ref name=":0">{{Cite journal |last1=Guo |first1=Qin |last2=Goldenberg |first2=Joshua Z. |last3=Humphrey |first3=Claire |last4=El Dib |first4=Regina |last5=Johnston |first5=Bradley C. |date=30 April 2019 |title=Probiotics for the prevention of pediatric antibiotic-associated diarrhea |journal=The Cochrane Database of Systematic Reviews |volume=4 |issue=4 |pages=CD004827 |doi=10.1002/14651858.CD004827.pub5 |issn=1469-493X |pmc=6490796 |pmid=31039287}}</ref> [[Antibiotic-associated diarrhea]] (AAD) results from an imbalance in the colonic microbiota caused by antibiotic therapy.<ref name=":0" /> These microbial community alterations result in changes in [[carbohydrate metabolism]], with decreased [[short-chain fatty acid]] absorption and osmotic diarrhea as a result. A 2015 [[Cochrane review]] concluded that a protective effect of some probiotics existed for AAD in children.<ref name=":0" /> The known risks of using probiotics for treating ''Clostridioides difficile'' outweighs the uncertain benefits.<ref name="aga2020">{{Cite journal |vauthors=Su GL, Ko CW, Bercik P, Falck-Ytter Y, Sultan S, Weizman AV, Morgan RL |date=June 2020 |title=AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders |journal=Gastroenterology |type=Clinical guideline |volume=159 |issue=2 |pages=697–705 |doi=10.1053/j.gastro.2020.05.059 |pmid=32531291 |doi-access=free}}</ref>

Probiotic treatment might reduce the incidence and severity of AAD as indicated in several [[meta-analyses]].<ref name="pmid16635227">{{Cite journal |last=McFarlandfirst=LV |year=2006 |title=Meta-analysis of probiotics for the prevention of antibiotic-associated diarrhea and the treatment of Clostridium difficile disease |url=https://zenodo.org/record/1230694 |journal=Am. J. Gastroenterol. |volume=101 |issue=4 |pages=812–822 |doi=10.1111/j.1572-0241.2006.00465.x |pmid=16635227 |s2cid=7557917 |access-date=2019-06-30 |archive-date=2020-07-28 |archive-url=https://web.archive.org/web/20200728163339/https://zenodo.org/record/1230694 |url-status=live }}</ref><ref>{{Cite journal |vauthors=Szajewska H, Ruszczyński M, Radzikowski A |date=September 2006 |title=Probiotics in the prevention of antibiotic-associated diarrhea in children: a meta-analysis of randomized controlled trials |journal=J Pediatr |volume=149 |issue=3 |pages=367–372 |doi=10.1016/j.jpeds.2006.04.053 |pmid=16939749 |s2cid=28439228}}</ref><ref>{{Cite journal |vauthors=Sazawal S, Hiremath G, Dhingra U, Malik P, Deb S, Black RE |date=June 2006 |title=Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials |journal=Lancet Infect Dis |volume=6 |issue=6 |pages=374–382 |doi=10.1016/S1473-3099(06)70495-9 |pmid=16728323}}</ref> For example, treatment with probiotic formulations including  ''L. rhamnosus'' may reduce the risk of AAD, improve stool consistency during antibiotic therapy, and enhance the immune response after vaccination.<ref>{{Cite journal |vauthors=Arvola T, Laiho K, Torkkeli S, Mykkänen H, Salminen S, Maunula L, Isolauri E |year=1999 |title=Prophylactic Lactobacillus GG reduces antibiotic-associated diarrhea in children with respiratory infections: A randomized study |journal=Pediatrics |volume=104 |issue=5 |pages=e64 |doi=10.1542/peds.104.5.e64 |pmid=10545590 |doi-access=free}}</ref>

The potential efficacy of probiotics to treat AAD depends on the probiotic strains and dosage.<ref name="Doron">{{Cite journal |vauthors=Doron SI, Hibberd PL, [[Sherwood Gorbach|Gorbach SL]] |date=July 2008 |title=Probiotics for prevention of antibiotic-associated diarrhea |journal=J Clin Gastroenterol |volume=42 |issue=Suppl 2 |pages=S58–63 |doi=10.1097/MCG.0b013e3181618ab7 |pmid=18542041 |s2cid=2070623}}</ref><ref name="Surawicz">{{Cite journal |last=Surawicz |first=CM |date=July 2008 |title=Role of probiotics in antibiotic-associated diarrhea, Clostridium difficile-associated diarrhea, and recurrent Clostridium difficile-associated diarrhea |journal=J Clin Gastroenterol |volume=42 |issue=Suppl 2 |pages=S64–70 |doi=10.1097/MCG.0b013e3181646d09 |pmid=18545161 |s2cid=37993276}}</ref> One review recommended for children ''L. rhamnosus'' or ''[[Saccharomyces boulardii]]'' at 5 to 40 billion colony-forming units/day, given the modest number needed to treat and the likelihood that adverse events are very rare.<ref name=":0" /> The same review stated that probiotic use should be avoided in pediatric populations at risk for [[adverse event]]s, such as severely debilitated or [[immune system|immune-compromised]] children.{{citation needed|date=June 2022}}