Gastrointestinal illnesses are a key contributor to child morbidity and mortality in developing countries, and diarrhoeal diseases are among the top five causes of death in children below the age of five.
Malnutrition in both developed and developing countries — over-nutrition in the former and under-nutrition in the latter — has given rise to intestinal diseases by disrupting gut microbiota, and geographic variations (including diet, culture and genetics) in gut microbiota composition could influence the risk of developing certain illnesses.
As such, several paediatric experts from the region, as well as from the UK, Netherlands and Italy, discussed over two meetings sponsored by pharmaceutical firm Biocodex suitable recommendations for probiotics for children in APAC.
The clinical patterns and epidemiology of intestinal diseases, as well as evidence-based recommendations and RCTS in in APAC countries were discussed, with factors such as culture, health management and economy also taken into account.
After using the Likert scale and GRADE system to approve final recommendations, the experts strongly recommended Saccharomyces boulardii CNCM I-745 (Sb) and Lactobacillus rhamnosus GG (LGG) as "adjunct treatment to oral rehydration therapy for gastroenteritis", adding that Lactobacillus reuteri (L reuteri) was also an option.
They also said probiotics could be used for preventing antibiotic-related diarrhoea (LGG or Sb), diarrhoea triggered by Clostridium difficile (Sb), nosocomial diarrhoea (LGG), and infantile colic (L reuteri), as well as in the form of adjunct treatment of Helicobacter pylori (Sb, among others).
Furthermore, they wrote: "Specific probiotics with a history of safe use in preterm and term infants may be considered in infants for prevention of necrotising enterocolitis."
However, they added that they lacked the necessary evidence to propose recommendations for other conditions.
Still, they said, similar recommendations could apply in APAC across a variety of socioeconomic, epidemiological and health system conditions, though these must be validated via local RCTs.
Factors to consider
They wrote that factors such as "the availability of specific probiotic strains in local markets, costs, patient and physician access to probiotic products, and personal / cultural beliefs" must be considered when assessing the applicability of probiotic guidelines for the region.
In addition, existing APAC regulations on probiotics differ from country to country, leading the experts to suggest a standardised regulatory framework for probiotics, which they said would aid both research and application.
They concluded: "Given this complex scenario and the need for supporting evidence, the recommendations are provided as 'proposed', and their potential benefits need to be confirmed at the local level with well-conducted RCTs."
Source: World Journal of Gastroenterology
"Probiotics for gastrointestinal disorders: proposed recommendations for children of the Asia-Pacific region"
Authors: Donald Cameron, et al.