Альманах клинической медицины. 2018; 46: 118-125
Эффективность пробиотика B. bifidum 1 для профилактики повторных респираторных инфекций у детей 7–11 лет с функциональной и хронической патологией желудочно-кишечного тракта
https://doi.org/10.18786/2072-0505-2018-46-2-118-125Аннотация
Актуальность. Острые респираторные заболевания (ОРЗ) признаны существенной проблемой здравоохранения во всем мире в связи с высокой заболеваемостью и отсутствием специфической профилактики для большинства инфекций. В систематических обзорах показана возможность применения пробиотиков для профилактики ОРЗ у детей. Вместе с тем отдельно не исследовалась профилактическая эффективность штамма B. bifidum 1 у пациентов с повторными ОРЗ на фоне сопутствующей гастроинтестинальной патологии, которая может влиять на эффективность пробиотической терапии.
Цель – оценить эффективность и безопасность применения сорбированного пробиотика B. bifidum 1 для профилактики ОРЗ у детей 7–11 лет с функциональными кишечными расстройствами или гастритом / гастродуоденитом.
Материал и методы. Проведено проспективное рандомизированное открытое исследование. Исследование завершили 44 ребенка, распределенных на две параллельные группы – получавших и не получавших сорбированные B. bifidum 1 в течение 21 дня по 5 × 107 КОЕ трижды в день в составе комплексного санаторного лечения, назначенного по поводу повторных ОРЗ. Дети наблюдались в течение 3 месяцев после окончания лечения в зимнем сезоне с оценкой частоты, тяжести и продолжительности эпизодов ОРЗ.
Результаты. Использование B. bifidum 1 у детей 7–11 лет с функциональной и хронической патологией желудочно-кишечного тракта сокращало частоту инфекций верхних дыхательных путей (сокращение относительного риска 0,48; 95% доверительный интервал 0,15–0,68), среднюю продолжительность респираторных заболеваний на 2,26 дня (95% доверительный интервал 0,23–4,27), уменьшало величину лихорадки, частоту случаев с кашлем и назначения антибактериальной терапии. Эффективность получена за счет уменьшения количества детей, болевших ОРЗ более 1 раза в течение 3 месяцев зимнего сезона.
Заключение. Pезультаты применения пробиотиков целесообразно оценивать с учетом фоновых заболеваний и состояний пациентов, что может более четко обозначить размер эффекта препарата. Применение пробиотиков для профилактики инфекционных заболеваний, включая респираторные инфекции, у детей с функциональной и хронической патологией желудочно-кишечного тракта может быть перспективным направлением снижения общей заболеваемости и заслуживает дальнейших исследований.
Список литературы
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25. Rodiño-Janeiro BK, Vicario M, Alonso-Cotoner C, Pascua-García R, Santos J. A review of microbiota and irritable bowel syndrome: future in therapies. Adv Ther. 2018;35(3): 289–310. doi: 10.1007/s12325-018-0673-5.
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Almanac of Clinical Medicine. 2018; 46: 118-125
Effectiveness of the probiotic B. bifidum 1 for the prevention of recurrent respiratory infections in children of 7–11 years old with functional and chronic disorders of gastrointestinal tract
https://doi.org/10.18786/2072-0505-2018-46-2-118-125Abstract
Background: Acute respiratory infections (ARI) are a significant public health problem worldwide due to their high incidence and lack of specific prevention for most of them. Previous systematic reviews have demonstrated the possibility to use probiotics to prevent ARI in children. The prophylactic efficacy of the B. bifidum 1 strain in patients with recurrent ARI has not been investigated specifically against the background of concomitant gastrointestinal disorders, which may affect the effectiveness of probiotic therapy.
Aim: To evaluate the effectiveness and safety of the sorbed probiotic B. bifidum 1 for prevention of ARI in children of 7 to 11 years of age with functional intestinal disorders or gastritis / gastroduodenitis.
Materials and methods: This prospective, randomized, open-label study was completed by 44 children divided into two parallel groups: with and without administration of the sorbed B. bifidum 1 at 5 × 107 CFU three times daily for 21 days as a component of a comprehensive sanatorium treatment for recurrent ARI. The children were followed up for three months after the end of the treatment in a winter season, with assessment of frequency, severity and duration of ARI episodes.
Results: The use of B. bifidum 1 in children of 7–11 years old with functional and chronic gastrointestinal disorders reduced the incidence of upper respiratory tract infections (relative risk reduction 0.48, 95% confidence interval 0.15–0.68) and mean duration of respiratory diseases by 2.26 days (95% confidence interval 0.23–4.27). It also reduced fever, frequency of cases with cough and the need in antibiotic therapy. The efficacy was related mainly to a decrease in the number of children with more than one ARI episode during the three months of the winter season.
Conclusion: The results of probiotics use should be evaluated with consideration of underlying disease, which can more clearly indicate the size of their effect. The use of probiotics for prevention of infectious diseases, including respiratory infections, in children with functional and chronic gastrointestinal disorders can be promising in reduction of the overall morbidity and requires further studies.
References
1. Wishaupt JO, van der Ploeg T, de Groot R, Versteegh FG, Hartwig NG. Single- and multiple viral respiratory infections in children: disease and management cannot be related to a specific pathogen. BMC Infect Dis. 2017;17(1): 62. doi: 10.1186/s12879-016-2118-6.
2. Toivonen L, Karppinen S, Schuez-Havupalo L, Teros-Jaakkola T, Vuononvirta J, Mertsola J, He Q, Waris M, Peltola V. Burden of recurrent respiratory tract infections in children: a prospective cohort study. Pediatr Infect Dis J. 2016;35(12):e362–9. doi: 10.1097/INF.0000000000001304.
3. GBD 2015 LRI Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis. 2017;17(11): 1133–61. doi: 10.1016/S1473-3099(17)30396-1.
4. Nurmatov ZSh. Otsenka raskhodov, svyazannykh s ambulatornym i statsionarnym lecheniem ORVI i grippa i ikh oslozhnenii. Epidemiologiya i vaktsinoprofilaktika. 2015;14(5): 26–30.
5. Santibanez P, Gooch K, Vo P, Lorimer M, Sandino Y. Acute care utilization due to hospitalizations for pediatric lower respiratory tract infections in British Columbia, Canada. BMC Health Serv Res. 2012;12:451. doi: 10.1186/14726963-12-451.
6. Lara-Oliveros CA, De Graeve D, Franco F, Daza SP. Disease burden and medical cost-analysis of Acute Respiratory Infections in a low-income district of Bogotá. Rev Salud Publica (Bogota). 2016;18(4): 568–80. doi: 10.15446/rsap.v18n4.45485.
7. Sarna M, Ware RS, Sloots TP, Nissen MD, Grimwood K, Lambert SB. The burden of community-managed acute respiratory infections in the first 2-years of life. Pediatr Pulmonol. 2016;51(12): 1336–46. doi: 10.1002/ppul.23480.
8. McLean HQ, Peterson SH, King JP, Meece JK, Belongia EA. School absenteeism among schoolaged children with medically attended acute viral respiratory illness during three influenza seasons, 2012–2013 through 2014–2015. Influenza Other Respir Viruses. 2017;11(3): 220–9. doi: 10.1111/irv.12440.
9. Schaad UB, Esposito S, Razi CH. Diagnosis and management of recurrent respiratory tract infections in children: a practical guide. Arch Pediatr Infect Dis. 2016;4(1):e31039. doi: 10.5812/pedinfect.31039.
10. de Martino M, Ballotti S. The child with recurrent respiratory infections: normal or not? Pediatr Allergy Immunol. 2007;18 Suppl 18:13–8. doi: 10.1111/j.1399-3038.2007.00625.x.
11. Gorelov AV, Ploskireva AA, Bondareva AV, Kanner EV. Probiotiki v kompleksnoi profilaktike respiratornykh infektsii. Voprosy prakticheskoi pediatrii. 2014;9(5): 77–83.
12. Araujo GV, Oliveira Junior MH, Peixoto DM, Sarinho ES. Probiotics for the treatment of upper and lower respiratory-tract infections in children: systematic review based on randomized clinical trials. J Pediatr (Rio J). 2015;91(5): 413–27. doi: 10.1016/j.jped.2015.03.002.
13. Hao Q, Dong BR, Wu T. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev. 2015;(2):CD006895. doi: 10.1002/14651858.CD006895.pub3.
14. Wang Y, Li X, Ge T, Xiao Y, Liao Y, Cui Y, Zhang Y, Ho W, Yu G, Zhang T. Probiotics for prevention and treatment of respiratory tract infections in children: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2016;95(31):e4509. doi: 10.1097/MD.0000000000004509.
15. King S, Glanville J, Sanders ME, Fitzgerald A, Varley D. Effectiveness of probiotics on the duration of illness in healthy children and adults who develop common acute respiratory infectious conditions: a systematic review and meta-analysis. Br J Nutr. 2014;112(1): 41–54. doi: 10.1017/S0007114514000075.
16. Esposito S, Rigante D, Principi N. Do children's upper respiratory tract infections benefit from probiotics? BMC Infect Dis. 2014;14:194. doi: 10.1186/1471-2334-14-194.
17. Laursen RP, Larnkjær A, Ritz C, Hauger H, Michaelsen KF, Mølgaard C. Probiotics and child care absence due to infections: a randomized controlled trial. Pediatrics. 2017;140(2). pii: e20170735. doi: 10.1542/peds.2017-0735.
18. Hojsak I, Močić Pavić A, Kos T, Dumančić J, Kolaček S. Bifidobacterium animalis subsp. lactis in prevention of common infections in healthy children attending day care centers – randomized, double blind, placebo-controlled study. Clin Nutr. 2016;35(3): 587–91. doi: 10.1016/j.clnu.2015.05.004.
19. Guarino A, Canani RB. Probiotics in childhood diseases: from basic science to guidelines in 20 years of research and development. J Pediatr Gastroenterol Nutr. 2016;63 Suppl 1:S1–2. doi: 10.1097/MPG.0000000000001220.
20. Hojsak I. Probiotics in children: what is the evidence? Pediatr Gastroenterol Hepatol Nutr. 2017;20(3): 139–46. doi: 10.5223/pghn.2017.20.3.139.
21. Amaral MA, Guedes GHBF, Epifanio M, Wagner MB, Jones MH, Mattiello R. Network meta-analysis of probiotics to prevent respiratory infections in children and adolescents. Pediatr Pulmonol. 2017;52(6): 833–43. doi: 10.1002/ppul.23643.
22. González-Rodríguez I, Ruiz L, Gueimonde M, Margolles A, Sánchez B. Factors involved in the colonization and survival of bifidobacteria in the gastrointestinal tract. FEMS Microbiol Lett. 2013;340(1): 1–10. doi: 10.1111/15746968.12056.
23. Vecchione A, Celandroni F, Mazzantini D, Senesi S, Lupetti A, Ghelardi E. Compositional quality and potential gastrointestinal behavior of probiotic products commercialized in Italy. Front Med (Lausanne). 2018;5:59. doi: 10.3389/fmed.2018.00059.
24. Piano MD, Carmagnola S, Ballarè M, Balzarini M, Montino F, Pagliarulo M, Anderloni A, Orsello M, Tari R, Sforza F, Mogna L, Mogna G. Comparison of the kinetics of intestinal colonization by associating 5 probiotic bacteria assumed either in a microencapsulated or in a traditional, uncoated form. J Clin Gastroenterol. 2012;46 Suppl:S85–92. doi: 10.1097/MCG.0b013e3182672796.
25. Rodiño-Janeiro BK, Vicario M, Alonso-Cotoner C, Pascua-García R, Santos J. A review of microbiota and irritable bowel syndrome: future in therapies. Adv Ther. 2018;35(3): 289–310. doi: 10.1007/s12325-018-0673-5.
26. Alarcón T, Llorca L, Perez-Perez G. Impact of the Microbiota and Gastric Disease Development by Helicobacter pylori. Curr Top Microbiol Immunol. 2017;400:253–75. doi: 10.1007/978-3319-50520-6_11.
