Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region

Table 1 Recommendations for use of probiotics in childhood intestinal diseases by geographic region

Diseases		Europe[14,40]	United States[36]	Latin America[50]	World[51]
Acute gastroenteritis	T	L. rhamnosus GG, S. boulardii, L reuteri	L. rhamnosus GG, S. boulardii	L. rhamnosus GG, S. boulardii, L. reuteri	S. boulardii, L. rhamnosus GG, Indian Dahi
AAD	P	L. rhamnosus GG, S. boulardii	L. rhamnosus GG, S. boulardii	L. rhamnosus GG, S. boulardii	S. boulardii; L. rhamnosus GG, , B. lactis Bb12 + S. thermophilus, L. rhamnosus strains E/N, Oxy and Pen
CDAD	P	S. boulardii
Nosocomial diarrhea	P	L. rhamnosus GG	L. rhamnosus GG	L. rhamnosus GG, B. lactis Bb12, S. thermophilus, B. bifidum	L. rhamnosus GG, B. lactis Bb12 + S. Thermophilus
Traveler’s diarrhea	P			S. boulardii
Functional intestinal disorders (IBS)	T	Insufficient evidence		L. rhamnosus GG, VSL#3	L. rhamnosus GG, L. reuteri DSM 17938
Infant colic	T	L. reuteri DSM 17938		L. reuteri DSM 17938	L. reuteri DSM 17938
IBD (CD, UC, pouchitis)	T	E. coli Nissle 1917, VSL#31		VSL#31	VSL#32
Helicobacter pylori infection	T			Not recommended	L. casei DN-114 001

¹Available evidence supports use in UC but not CD or pouchitis;

²For mildly active UC. T: Treatment; P: Prevention; AAD: Antibiotic-associated diarrhea; CDAD: Clostridium difficile-associated diarrhea; CD: Crohn’s disease; IBD: Inflammatory bowel disease; IBS: Irritable bowel syndrome; UC: Ulcerative colitis; VSL#3: Proprietary mixture of eight probiotic strains.

Table 2 Proposed recommendations for the Asia-Pacific region with grade and strength of recommendations

Disease		Recommendation	Strains	Grade	Weak
Acute gastroenteritis	T	Should be considered1	S. boulardii,	Moderate quality	Strong
			L. rhamnosus GG		Strong
			L reuteri		Weak
AAD	P	May be considered	L. rhamnosus GG	Moderate quality	Strong
			S. boulardii		Strong
CDAD	P	May be considered	S. boulardii	Low quality	Weak
Nosocomial diarrhea	P	Can be considered	L. rhamnosus GG	Moderate quality	Weak
Traveler’s diarrhea	P	Not recommended		Very low quality	Weak
Functional intestinal disorders	T	Not recommended		Very low quality	Weak
Infant colics	T	May be considered	L. reuteri	Moderate quality	Weak
IBD (Crohn’s disease, ulcerative colitis)	T	Not recommended		Low quality	Weak
Helicobacter pylori infection	T	May be considered	S. boulardii,	Very low quality	Weak2
			others		Weak
Necrotizing enterocolitis		Decision to be discussed with parents	Various (Bifidobacterium, Lactobacillus species)

¹In adjunct to oral rehydration therapy and with the exclusion of malnourished children;

²For prevention of antibiotic-induced side effects and possible increase in eradication rates. T: Treatment; P: Prevention; AAD: Antibiotic-associated diarrhea; CDAD: Clostridium difficile-associated diarrhea; IBD: Inflammatory bowel disease.