пробиотики

[internist]

Полный текст статьи – Probiotics and human health, указанной в первом посте. http://mihd.net/pozxm7
Я не хочу показаться занудой, но позволю себе скопировать свои посты с РМС.
Несколько исследований и метаанализ подтверждающий эффективность пробиотиков.

Prophylactic Lactobacillus GG Reduces Antibiotic-Associated Diarrhea in Children With Respiratory Infections: A Randomized Study PEDIATRICS Vol. 104 No. 5 November 1999, p. e64
Conclusion. A probiotic strain, Lactobacillus GG, is effective in the prevention of diarrhea in children receiving antimicrobial treatment to respiratory infections.

Lactobacillus GG in the prevention antibiotic-associated diarrhea in children J Pediatr 1999;135:564-8

Conclusion: Lactobacillus GG reduces the incidence of antibiotic-associated diarrhea in children treated with oral antibiotics for common childhood infections.

PROBIOTICS IN THE PREVENTION OF ANTIBIOTIC-ASSOCIATED DIARRHEA
IN CHILDREN: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS(J Pediatr 2006;149:367-72)

Probiotics reduce the risk of AAD in children. For every 7 patients that would develop diarrhea while being
treated with antibiotics, one fewer will develop AAD if also receiving probiotics.

Полный текст этих трех статей залил сюда - http://mihd.net/9gbj3s (300 КБ)

Кокрановский обзор. Probiotics for treating infectious diarrhoea (Review) 2007Authors' conclusions:
Probiotics appear to be a useful adjunct to rehydration therapy in treating acute, infectious diarrhea research is needed to inform the use of particular probiotic regimens in specific patient groups. Полный текст - http://mihd.net/bhm38x (406.25 KB)

[internist]

По поводу отсутствия пробиотиков в гайдлайнах.
Нашел статью, которая называется -Guideline for the management of acute diarrhea in adults http://www.blackwell-synergy.com/doi/pd ... ookieSet=1 где упоминаются пробиотики.

Probiotics
Probiotics are non-pathogenic organisms, for example Lactobacillus acidophilus and Saccharomyces boulardii, which multiply in the patient’s intestine and produce metabolites, which increase acidity of stool and prohibit the growth of enteropathogens. They prevent the invasion of bacteria in intestine tissue, and produce short chain fatty acids that are beneficial for intestine recovery, and increase the rate of fluid and electrolyte absorption. In children, there are studies which show that the use of probiotics could reduce the clinical course of acute diarrhea.62–64 In adults, they are used mainly in chronic diarrhea and relapse of antibiotic associated enterocolitis.65

Гайдлайны в которых рекомендуются пробиотики - http://guidelines.gov/search/searchresu ... tic&num=20

Evidence-based clinical care guideline for acute gastroenteritis (AGE) in children aged 2 months through 5 years
http://guidelines.gov/summary/summary.a ... =probiotic

It is recommended that probiotics be considered as adjunctive therapy, as they have been shown to reduce the duration of diarrhea (Allen et al., 2004 [M]). Family preference may be central to the decision to use probiotics. Parameters influencing the family's decision may include cost, degree of potential benefit, availability, and unverified effectiveness of commercial products.
Note 1: A Cochrane meta-analysis of 23 randomized controlled trials found mild therapeutic benefit from probiotics that was generally reproducible regardless of organism, quality of study design, or outcome measure (Allen et al., 2004 [M]). The following organisms/combinations showed benefit in one or more study (in alphabetical order):
• Enterococcus LAB strain SF68
• Lactobacillus acidophilus and Lactobacillus bifidus
• Lactobacillus acidophilus LB strain (killed)
• Lactobacillus casei strain GG
• Lactobacillus reuteri
Note 2: Probiotics may be more effective for rotavirus diarrhea, compared to all-cause diarrhea (Allen et al., 2004 [M]).
Note 3: The microorganisms used to culture yogurt, Streptococcus thermophilus and Lactobacillus bulgaricus, are not considered probiotics because they do not survive the acidity of the stomach to colonize the intestines. One study of malnourished infants found that yogurt, compared to milk, was not effective in reducing the duration of diarrhea (Allen et al., 2004 [M]; Bhatnagar et al., 1998 ).

[internist]

Чем плох вышеуказанный кокрановский обзор?? В чем неубедительность приведенных исследований и метаанализов?

Интересный феномен наблюдаю. Отрицание диагноза дисбактериоз ведет к отрицанию не только пробиотиков, но и самой возможности нарушения микробного баланса в кишечнике.

Нарушение микробного баланса имеет значение. Antibiotic-Associated Diarrhea - http://content.nejm.org/cgi/content/full/346/5/334 Ниже обсуждаются механизмы развития Antibiotic-Associated Diarrhea не связанные с Клостридиум диффициле -

Multiple laboratories report that only 10 to 20 percent of stool specimens submitted for testing for C. difficile toxin are positive.1,3,4,5,6 Antibiotic-associated diarrhea may also be caused by other enteric pathogens, by the direct effects of antimicrobial agents on the intestinal mucosa, and by the metabolic consequences of reduced concentrations of fecal flora.
Other enteric pathogens that can cause diarrhea include salmonella, C. perfringens type A, Staphylococcus aureus, and possibly Candida albicans. C. perfringens type A produces an enterotoxin known to cause food poisoning; more recently, a different genotype has been implicated in antibiotic-associated diarrhea.7 Infection with either subtype causes a self-limited diarrhea that generally resolves within 24 hours. There is no specific treatment, and few laboratories offer the diagnostic tests necessary to identify this pathogen.
Staph. aureus was implicated as the chief cause of antibiotic-associated pseudomembranous enterocolitis in the 1950s.8 It is unclear whether this finding represented misdiagnosis of C. difficile infection or Staph. aureus caused a different disease — an enterocolitis instead of colitis. The distinction is important because metronidazole is effective for C. difficile infection but not for Staph. aureus infection. The finding of candida species in the stool at a concentration of more than 100,000 organisms per gram and in some patients whose condition has improved after nystatin therapy has suggested that candida species may cause antibiotic-associated diarrhea; however, many authorities question the validity of the evidence.9 Multidrug-resistant Salmonella newport from contaminated beef was implicated in an outbreak of diarrhea among patients who had taken ampicillin.10 Fluoroquinolone-resistant enteric disease caused by salmonella has also been reported; most of the affected patients had previously taken fluoroquinolones.11 Salmonella may also cause pseudomembranous colitis.12
Drugs have multiple effects on the gastrointestinal tract,13 including some that are independent of antimicrobial activity. Erythromycin acts as a motilin-receptor agonist and accelerates the rate of gastric emptying. The clavulanate in amoxicillin–clavulanate appears to stimulate small-bowel motility, and in rare instances, penicillins may cause segmental colitis.14
Antibiotics may substantially reduce the concentration of fecal anaerobes that are normally present. As a consequence, the metabolism of carbohydrates may decrease, which causes osmotic diarrhea, and the rate of breakdown of primary bile acids, which are potent colonic secretory agents, may be reduced. Neither mechanism is clearly established as a cause of antibiotic-associated diarrhea, but the efficacy of enemas with fecal flora in treating this problem suggests that changes in fecal flora are a contributing factor.15
In many suspected cases, nonantibiotic drugs are the cause of diarrhea attributed to antibiotics; these include laxatives, antacids, contrast agents, products containing lactose or sorbitol, nonsteroidal antiinflammatory drugs, antiarrhythmic drugs, and cholinergic agents.13

[Doc Vadik]

Более того, в октябре 2006 на правах гайда появилась следующая северо-американская публикация:

Clinical Practice Guideline
Clinical Efficacy of Probiotics: Review of the Evidence With Focus on Children
Journal of Pediatric Gastroenterology and Nutrition

Всем желающим - на мыло.

[Ren_Yumi]

"Probiotics may be used safely in patients with antibiotic-associated diarrhea and recurrent Clostridium difficile colitis. The level 1, 2, and 3 data are inconclusive, with the weight of evidence favoring demonstrable benefit (Grade C). Chronic pouchitis flare-ups apparently are prevented by a mixed-organism probiotic, as reported in recent, conclusive level 2 studies (Grade B)." www.guideline.gov

Grade C
No conclusive level 1 or 2 publication
>1 conclusive level 3 publications demonstrating benefit >> risk
OR
No risk at all and no benefit at all
Recommended for indications reflected by the publications if the patient refuses or fails to respond to conventional therapy, provided there are no significant adverse effects; "no objection" to recommending their use
OR
"no objection" to continuing their use

Grade B
No conclusive level 1 publication
>1 conclusive level 2 publications demonstrating benefit >> risk
Recommended for indications reflected by the publications if the patient refuses or fails to respond to conventional therapy; must monitor for adverse effects, if any; can be recommended as "second-line" therapy.


There are some evidence-based and rational uses for dietary supplements, but profiteering and quackery must be avoided at all costs.

[Bella]

Более того, в октябре 2006 на правах гайда появилась следующая северо-американская публикация:

Clinical Practice Guideline
Clinical Efficacy of Probiotics: Review of the Evidence With Focus on Children
Journal of Pediatric Gastroenterology and Nutrition

Всем желающим - на мыло.

Желающие - желают.
Мыло ты знаешь )))

[Ren_Yumi]

Probiotics for treating infectious diarrhoea
Allen SJ, Okoko B, Martinez E, Gregorio G, Dans LF
Cochrane Database of Systematic Reviews 2007
Authors' conclusions
Probiotics appear to be a useful adjunct to rehydration therapy in treating acute, infectious diarrhoea in adults and children. More research is needed to inform the use of particular probiotic regimens in specific patient groups.
http://www.mrw.interscience.wiley.com/c ... frame.html

[Ren_Yumi]

Использование/неиспользование пробиотиков представляется такой же серьезной и запутанной проблемой как обьем шитовидной железы у детей. От ее решения зависит судьба, жизнь, здоровье, счастье нескольких поколений, исход войны в Ираке и глобальное потепление.

[AOkhotin]

... и глобальное потепление.

Ну да. Эти же бактерии, которых на самом деле в кишечнике нет, делают CO2, а это вызывает парниковый эффект.

[Маша]

Хорошо, поставим вопрос иначе. Есть антибиотик-ассоциированная диаррея. Как известно для ее лечения применяется сильный антибиотик. Есть ли данные, что пробиотики могут вылечит антибиотик-ассоциированную диаррею, без использования антибиотика ?

[AOkhotin]

Хорошо, поставим вопрос иначе. Есть антибиотик-ассоциированная диаррея. Как известно для ее лечения применяется сильный антибиотик. Есть ли данные, что пробиотики могут вылечит антибиотик-ассоциированную диаррею, без использования антибиотика ?

Почему обязательно БЕЗ? Может быть улучшают результаты при использовании этого антибиотика?

[Doc Vadik]

Мне кажется, следует подразделять проблему на диарею, вызванную Cl. difficile, (которая имеет опред. диагностику и лечение, включая АБ) и неспецифич. ААД, для лечения или профилактики которой и используются пробиотики, вот еще рекомендации из США ( J Clin Gastroenterol. 2006 Mar;40(3):275-8. Recommendations for probiotic use. Floch MH, и соавт):

[Rodionov]

Или я совсем запутался, или мне тоже кажется, что псевдомембранозный колит, требующий ванкомицина, и просто антибиотик-ассоциированная диаррея - суть разные вещи.

Кстати тема интересна в методологическом аспекте. Похоже, что за 5 лет обсуждения темы пробиотиков на РМС, действительно появились новые данные, которые позволяют в чем-то пересмотреть отношение к этой группе препаратов... без крайних эмоций как в одну, так и в другую сторону.

[Ren_Yumi]

А Зайцев вдругорядь поднял тему про озон на Солвей всвязи с появлением новых данных.

[Mikhail]

А Зайцев вдругорядь поднял тему про озон на Солвей всвязи с появлением новых данных.

Надо радоваться, что его здесь нет.