Probiotics for antibiotic-associated diarrhea--maybe, maybe not!

duced the risk of severe necrotizing enterocolitis and mortality in preterm infants [5, 6] . The potential benefits and safety profile of probiotics for extremely low birth weight infants have not yet been determined. The treatment of gastrointestinal infections continues to be one of the main targets of probiotics use, aimed at the prevention of community-acquired diarrhea as well as an effective therapeutic approach. The mechanisms of action of probiotics against gastrointestinal pathogens include competition on nutrients and adhesion sites and the modulation of the immune and non-immune defense mechanisms of the host intestinal mucosa [7] . The effectiveness of certain probiotics as treatment for diarrhea in children has been supported by clinical studies [1, 2, 8] . The physician must selectively base the choice of bacterial preparations on validated data, since not all commercially available probiotic combinations are effective in children with acute diarrhea [9] . Clinical trials of probiotic treatment for inflammatory bowel disease, however, have yielded conflicting results. Some of them have confirmed the claim that a daily intake of probiotics will delay the first onset of pouchitis and that they are effective in the treatment of active Crohn’s disease [10, 11] while others failed to a show a beneficial affect [12] . Although there is great interest in probiotic supplementation for prevention and treatment of pediatric allergic diseases, the findings of clinical trials have been inconsistent and have suffered from heterogeneity in Probiotic bacteria and non-pathogenic yeast are increasingly being used in pediatric practice because they are believed to have many health benefits [1] . However, it has been suggested that the term ‘probiotic’ be used only for products that meet the scientific criteria for this term, namely products that contain an adequate dose of live microbes that have been documented in target-host studies to confer a health benefit [1] . The clinical conditions for which probiotics are used are highly varied and include prevention and treatment of gastrointestinal diseases as well as atopic dermatitis and even gingivitis [2] . The colonization of the intestinal tract starts at birth and evolves within the first 2 years of life [3] . It depends to some degree upon environmental factors, such as the way of feeding and the level of hygiene, becoming more like an adult flora as the child consumes solid foods [4] . This microflora influences many aspects of nutrition and immune regulation, one of which involves reducing the effects of an imbalance in gut flora on many health functions [2] . This important protective function led to the idea of changing the immunologic response by modifying gut flora through dietary beneficial bacteria. A variety of probiotic combinations has been tested in a wide range of indications over the past 20 years. Many of the clinical trials were performed in pediatric populations. Probiotics appear to be beneficial for premature infants who suffer necrotizing enterocolitis. Several studies showed that enteral supplementation of probiotics rePublished online: August 14, 2008