Antibiotic therapy may have important side effects. Guidelines recommend the administration of specific probiotics to reduce the risk of antibiotic-associated diarrhoea (AAD). The rates and determinants of antibiotics and co-prescription of probiotics in children remain poorly known in Asia-Pacific countries, which are very heterogenous in terms of economic development, health care organization and health policies. A survey among general practitioners (GPs) and paediatricians was performed in seven countries of the Asia-Pacific area (Australia, Japan, Indonesia, India, China, Singapore, and South Korea). Physicians completed an online questionnaire that explored their current habits and the determinants for prescribing antibiotics and probiotics. For the 731 physicians who completed the questionnaire (390 paediatricians and 341 GPs), 37% of all consultations for a child led to the prescription of antibiotics (ranging from 17% in Australia to 47% in India). A large majority of physicians (84%) agreed that antibiotics disrupted gut microbiota and considered probiotics an effective intervention to prevent AAD (68%). However, only 33% co-prescribed probiotics with antibiotics (ranging from 13% in Japan to 60% in South Korea). The main reasons for prescribing probiotics were previous episodes of AAD (61%), presence of diarrhoea (55%), prolonged antibiotic treatment (54%) or amoxicillin-clavulanic acid therapy (54%). Although current local guidelines recommend the use of selected probiotics in children receiving antibiotics in Asia-Pacific area, the rates of antibiotics and probiotics prescription significantly vary among countries and are deeply affected by country-related cultural and organisational issues.
Blaser, M.J., 2016. Antibiotic use and its consequences for the normal microbiome. Science 352: 544-545. 10.1126/science.aad9358
'Antibiotic use and its consequences for the normal microbiome ' () 352 Science : 544 -545.
Cameron, D., Hock, Q.S., Kadim, M., Mohan, N., Ryoo, E., Sandhu, B., Yamashiro, Y., Jie, C., Hoekstra, H. and Guarino, A., 2017. Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region. World Journal of Gastroenterology 23: 7952-7964. 10.3748/wjg.v23.i45.7952
'Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region ' () 23 World Journal of Gastroenterology : 7952 -7964.
Center for Disease Control and Prevention, 2019a. Antibiotic prescribing and use in doctor’s offices. Available at: https://www.cdc.gov/antibiotic-use/community/about/index.html.
Centers for Disease Control and Prevention, 2019b. Antibiotic/antimicrobial resistance. Available at: https://www.cdc.gov/drugresistance/.
Chen, J., Wan, C.M., Gong, S.T., Fang, F., Sun, M., Qian, Y., Huang, Y., Wang, B.X., Xu, C.D., Ye, L.Y., Dong, M., Jin, Y., Huang, Z.H., Wu, Q.B., Zhu, C.M., Fang, Y.H., Zhu, Q.R. and Dong, Y.S., 2018. Chinese clinical practice guidelines for acute infectious diarrhea in children. World Journal of Pediatrics 14: 429-436. https://doi.org/10.1007/s12519-018-0190-2
Cruchet, S., Furnes, R., Maruy, A., Hebel, E., Palacios, J., Medina, F., Ramirez, N., Orsi, M., Rondon, L., Sdepanian, V., Xochihua, L., Ybarra, M. and Zablah, R.A., 2015. The use of probiotics in pediatric gastroenterology: a review of the literature and recommendations by Latin-American experts. 17: 199-216. https://doi.org/10.1007/s40272-015-0124-6
Dominguez-Bello, M.G., Godoy-Vitorino, F., Knight, R. and Blaser, M.J., 2019. Role of the microbiome in human development. Gut 68: 1108-1114. https://doi.org/10.1136/gutjnl-2018-317503
Doron, S. and Davidson, L.E., 2011. Antimicrobial stewardship. Mayo Clinic Proceedings 86: 1113-1123. https://doi.org/10.4065/mcp.2011.0358
Food and Agriculture Organization of the United Nations/World Health Organization (FAO/WHO), 2002. Guidelines for the evaluation of probiotics in food. Report of a Joint FAO/WHO working group on drafting guidelines for the evaluation of probiotics in food. Available at: http://tinyurl.com/zdbrkeg.
Frieri, M., Kumar, K. and Boutin, A., 2017. Antibiotic resistance. Journal of Infection and Public Health 10: 369-378. https://doi.org/10.1016/j.jiph.2016.08.007
Gibson, G.R., Hutkins, R., Sanders, M.E., Prescott, S.L., Reimer, R.A., Salminen, S.J., Scott, K., Stanton, C., Swanson, K.S., Cani, P.D., Verbeke, K. and Reid, G., 2017. Expert consensus document: the International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nature Reviews. Gastroenterology and Hepatology 14: 491-502. https://doi.org/10.1038/nrgastro.2017.75
Guarino, A., Guandalini, S. and Lo Vecchio, A., 2015. Probiotics for prevention and treatment of diarrhea. Journal of Clinical Gastroenterology 49 Suppl. 1: S37-S45. https://doi.org/10.1097/MCG.0000000000000349
Guo, Q., Goldenberg, J.Z., Humphrey, C., El Dib, R. and Johnston, B.C., 2019. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database of Systematic Reviews 4: CD004827. https://doi.org/10.1002/14651858.CD004827.pub5
International Vaccine Access Center (IVAC). 2008. Pneumonia & diarrhea progress report 2018. Available at: https://tinyurl.com/tnq7tuu.
Jernberg, C., Lofmark, S., Edlund, C. and Jansson, J.K., 2010. Long-term impacts of antibiotic exposure on the human intestinal microbiota. Microbiology 156: 3216-3223. https://doi.org/10.1099/mic.0.040618-0
Johnston, B.C., Lytvyn, L., Lo, C.K., Allen, S.J., Wang, D., Szajewska, H., Miller, M., Ehrhardt, S., Sampalis, J., Duman, D.G., Pozzoni, P., Colli, A., Lonnermark, E., Selinger, C.P., Wong, S., Plummer, S., Hickson, M., Pancheva, R., Hirsch, S., Klarin, B., Goldenberg, J.Z., Wang, L., Mbuagbaw, L., Foster, G., Maw, A., Sadeghirad, B., Thabane, L. and Mertz, D., 2018. Microbial preparations (probiotics) for the prevention of clostridium difficile infection in adults and children: an individual patient data meta-analysis of 6,851 participants. Infection Control and Hospital Epidemiology 39: 771-781. https://doi.org/10.1017/ice.2018.84
Kim, S., Covington, A. and Pamer, E.G. 2017. The intestinal microbiota: antibiotics, colonization resistance, and enteric pathogens. Immunological Reviews 279: 90-105. https://doi.org/10.1111/imr.12563
Lo Vecchio, A., Lancella, L., Tagliabue, C., De Giacomo, C., Garazzino, S., Mainetti, M., Cursi, L., Borali, E., De Vita, M.V., Boccuzzi, E., Castellazzi, L., Esposito, S. and Guarino, A., 2017. Clostridium difficile infection in children: epidemiology and risk of recurrence in a low-prevalence country. European Journal of Clinical Microbiology and Infectious Diseases 36: 177-185. https://doi.org/10.1007/s10096-016-2793-7
McFarland, L.V., 2006. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. American Journal of Gastroenterology 101: 812-822. https://doi.org/10.1111/j.1572-0241.2006.00465.x
McFarland, L.V., 2015. Deciphering meta-analytic results: a mini-review of probiotics for the prevention of paediatric antibiotic-associated diarrhoea and Clostridium difficile infections. Beneficial Microbes 6: 189-194. https://doi.org/10.3920/BM2014.0034
McFarland, L.V., Ozen, M., Dinleyici, E.C. and Goh, S., 2016. Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections. World Journal of Gastroenterology 22: 3078-3104. https://doi.org/10.3748/wjg.v22.i11.3078
Na, J.Y., Park, J.M., Lee, K.S., Kang, J.O., Oh, S.H. and Kim, Y.J., 2014. Clinical characteristics of symptomatic Clostridium difficile infection in children: conditions as infection risks and whether probiotics is effective. Pediatric Gastroenterology, Hepatology and Nutrition 17: 232-238. https://doi.org/10.5223/pghn.2014.17.4.232
Ohl, C.A. and Luther, V.P., 2011. Antimicrobial stewardship for inpatient facilities. Journal of Hospital Medicine 6 Suppl. 1: S4-S15. https://doi.org/10.1002/jhm.881
Pattani, R., Palda, V.A., Hwang, S.W. and Shah, P.S., 2013. Probiotics for the prevention of antibiotic-associated diarrhea and Clostridium difficile infection among hospitalized patients: systematic review and meta-analysis. Open Medicine 7: e56-67.
'Probiotics for the prevention of antibiotic-associated diarrhea and Clostridium difficile infection among hospitalized patients: systematic review and meta-analysis ' () 7 Open Medicine : e56 -67.
Roque, F., Herdeiro, M.T., Soares, S., Teixeira Rodrigues, A., Breitenfeld, L. and Figueiras, A., 2014. Educational interventions to improve prescription and dispensing of antibiotics: a systematic review. BMC Public Health 14: 1276. https://doi.org/10.1186/1471-2458-14-1276
Shan, L.S., Hou, P., Wang, Z.J., Liu, F.R., Chen, N., Shu, L.H., Zhang, H., Han, X.H., Han, X.X., Cai, X.X., Shang, Y.X. and Vandenplas, Y., 2013. Prevention and treatment of diarrhoea with Saccharomyces boulardii in children with acute lower respiratory tract infections. Beneficial Microbes 4: 329-334. https://doi.org/10.3920/BM2013.0008
Sheehan, D. and Shanahan, F., 2017. The gut microbiota in inflammatory bowel disease. Gastroenterology Clinics of North America 46: 143-154. https://doi.org/10.1016/j.gtc.2016.09.011
Stephen-Victor, E. and Chatila, T.A., 2019. Regulation of oral immune tolerance by the microbiome in food allergy. Current Opinion in Immunology 60: 141-147. https://doi.org/10.1016/j.coi.2019.06.001
Surawicz, C.M., Brandt, L.J., Binion, D.G., Ananthakrishnan, A.N., Curry, S.R., Gilligan, P.H., McFarland, L.V., Mellow, M. and Zuckerbraun, B.S., 2013. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. American Journal of Gastroenterology 108: 478-498. https://doi.org/10.1038/ajg.2013.4
Szajewska, H., Canani, R.B., Guarino, A., Hojsak, I., Indrio, F., Kolacek, S., Orel, R., Shamir, R., Vandenplas, Y., van Goudoever, J.B. and Weizman, Z., 2016. Probiotics for the prevention of antibiotic-associated diarrhea in children. Journal of Pediatric Gastroenterology and Nutrition 62: 495-506. https://doi.org/10.1097/mpg.0000000000001081
Szajewska, H. and Kolodziej, M., 2015. Systematic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Alimentary Pharmacology and Therapeutics 42: 793-801. https://doi.org/10.1111/apt.13344
Torres-Fuentes, C., Schellekens, H., Dinan, T.G. and Cryan, J.F., 2017. The microbiota-gut-brain axis in obesity. The Lancet Gastroenterology and Hepatology 2: 747-756. https://doi.org/10.1016/S2468-1253(17)30147-4
Van Boeckel, T.P., Gandra, S., Ashok, A., Caudron, Q., Grenfell, B.T., Levin, S.A. and Laxminarayan, R., 2014. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. The Lancet Infectious Diseases 14: 742-750. https://doi.org/10.1016/S1473-3099(14)70780-7
Wistrom, J., Norrby, S.R., Myhre, E.B., Eriksson, S., Granstrom, G., Lagergren, L., Englund, G., Nord, C.E. and Svenungsson, B., 2001. Frequency of antibiotic-associated diarrhoea in 2462 antibiotic-treated hospitalized patients: a prospective study. Journal of Antimicrobial Chemotherapy 47: 43-50. https://doi.org/10.1093/jac/47.1.43
World Health Organization (WHO), 2008. Health in Asia and the Pacific. WHO Regional Office for South-East Asia. Available at: http://www.who.int/iris/handle/10665/205227.
World Health Organization (WHO), 2014. Antimicrobial resistance. Global report on surveillance. 2014 Summary. Available at: https://tinyurl.com/sunftkd.
Yassin, S.F., Young-Fadok, T.M., Zein, N.N. and Pardi, D.S., 2001. Clostridium difficile-associated diarrhea and colitis. Mayo Clinic Proceedings 76: 725-730. https://doi.org/10.4065/76.7.725
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Antibiotic therapy may have important side effects. Guidelines recommend the administration of specific probiotics to reduce the risk of antibiotic-associated diarrhoea (AAD). The rates and determinants of antibiotics and co-prescription of probiotics in children remain poorly known in Asia-Pacific countries, which are very heterogenous in terms of economic development, health care organization and health policies. A survey among general practitioners (GPs) and paediatricians was performed in seven countries of the Asia-Pacific area (Australia, Japan, Indonesia, India, China, Singapore, and South Korea). Physicians completed an online questionnaire that explored their current habits and the determinants for prescribing antibiotics and probiotics. For the 731 physicians who completed the questionnaire (390 paediatricians and 341 GPs), 37% of all consultations for a child led to the prescription of antibiotics (ranging from 17% in Australia to 47% in India). A large majority of physicians (84%) agreed that antibiotics disrupted gut microbiota and considered probiotics an effective intervention to prevent AAD (68%). However, only 33% co-prescribed probiotics with antibiotics (ranging from 13% in Japan to 60% in South Korea). The main reasons for prescribing probiotics were previous episodes of AAD (61%), presence of diarrhoea (55%), prolonged antibiotic treatment (54%) or amoxicillin-clavulanic acid therapy (54%). Although current local guidelines recommend the use of selected probiotics in children receiving antibiotics in Asia-Pacific area, the rates of antibiotics and probiotics prescription significantly vary among countries and are deeply affected by country-related cultural and organisational issues.
| All Time | Past 365 days | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 0 | 0 | 0 |
| Full Text Views | 532 | 142 | 16 |
| PDF Views & Downloads | 502 | 110 | 12 |