News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD

CME/CE Released: 08/12/2009; Valid for credit through 08/12/2010

August 12, 2009 — Probiotics may be useful as prophylaxis against cold and influenza-like symptoms in children, according to the results of a double-blind, placebo-controlled study reported in the August issue of Pediatrics.

"Selected strains of probiotics have been tested for human health benefits in a variety of disease conditions, but much less is known regarding prophylactic benefits in healthy populations," write Gregory J. Leyer, PhD, from Danisco in Madison, Wisconsin, and colleagues. "This study adds information supporting the use of the probiotics tested for prophylaxis against cold and influenza-like symptoms and compares the efficacy of 1-strain and 2-strain preparations."

The effects of probiotic intake on incidence and duration of cold and influenza-like symptoms during the winter season were evaluated in healthy children aged 3 to 5 years. Of 326 eligible children, 104 were randomly assigned to receive placebo, 110 to Lactobacillus acidophilus NCFM, and 112 to L acidophilus NCFM in combination with Bifidobacterium animalis subsp lactis Bi-07. Children were treated twice daily for 6 months.

Compared with the placebo group, the groups receiving single and combination probiotics fared significantly better in several outcomes. Fever incidence was 53.0% lower with single probiotics (P = .0085) and 72.7% lower with combination probiotics (P = .0009); coughing incidence, 41.4% (P = .027) and 62.1% (P = .005) lower; and rhinorrhea incidence, 28.2% (P = .68) and 58.8% (P =.03) lower, respectively.

Fever, coughing, and rhinorrhea duration were 32% lower with single strain vs placebo (P = .0023) and 48% lower with the strain combination (P < .001). Antibiotic use incidence was 68.4% lower for single strain vs placebo (P = .0002) and 84.2% lower for strain combination (P < .0001). Days absent from group child care were also 31.8% lower for single strain vs placebo (P =.002) and 27.7% lower for the strain combination (P < .001).

"Daily dietary probiotic supplementation for 6 months was a safe effective way to reduce fever, rhinorrhea, and cough incidence and duration and antibiotic prescription incidence, as well as the number of missed school days attributable to illness, for children 3 to 5 years of age," the study authors write. "No notable adverse events were attributed to study probiotic strains."

Limitations of this study include failure to evaluate mucosal colonization, underlying mechanisms, or the effect of probiotics in an acute response to signs of illness.

"Daily probiotic dietary supplementation during the winter months was a safe effective way to reduce episodes of fever, rhinorrhea, and cough, the cumulative duration of those symptoms, the incidence of antibiotic prescriptions, and the number of missed school days attributable to illness," the study authors conclude. "L acidophilus NCFM alone was effective. There was, however, a trend for a broader protective effect with the combination of L acidophilus NCFM and B lactis Bi-07."

Danisco USA sponsored this study, employs 2 of the study authors, and has contracted 3 other authors regarding this study.

Pediatrics. 2009;124:e172-e179. Abstract

Clinical Context

The use of probiotics for disease prevention in addition to disease treatment is under investigation. In the June 2, 2001, issue of the BMJ, Hatakka and colleagues reported that Lactobacillus use in children in day care centers had no significant effect on the incidence of infection. In the January 2005 issue of Pediatrics, Weizman and colleagues found that L reuteri and B animalis subsp lactis Bb-12 use were linked with a lower incidence of fever, but not of respiratory tract symptoms.

This prospective, double-blind, placebo-controlled study evaluates the effect of L acidophilus NCFM alone or in combination with B animalis subsp lactis Bi-07 on the incidence of fever, rhinorrhea, and cough, the duration of symptoms, the incidence of antibiotic use, school absences, and clinician visits.

Study Highlights

  • 326 healthy children (aged 3 - 5 years) in the People's Republic of China were randomly assigned to receive placebo, L acidophilus NCFM alone, or L acidophilus with B animalis subsp lactis twice daily for 6 months.
  • Inclusion criteria were no known preexisting diseases, anatomic anomalies, contraindications to dairy products, inflammatory disease, intestinal disease, chronic cough, cystic fibrosis, or functional gastrointestinal tract conditions.
  • Exclusion criterion was probiotic use.
  • 104 patients received sucrose placebo.
  • 110 patients received 1.0 x 1010 colony-forming units per gram of L acidophilus total per day added to 1% fat milk.
  • 112 patients received 50% L acidophilus NCFM plus 50% B animalis subsp lactis for a total of 1.0 x 1010 colony-forming units per gram total per day in 1% fat milk.
  • Placebo subjects were 4 to 5 months older than subjects receiving L acidophilus NCFM and those receiving L acidophilus NCFM combined with B animalis subsp lactis (P < .001).
  • Participants were instructed not to use traditional Chinese medicine during the study.
  • Participants did not receive influenza vaccination.
  • Symptom questionnaires were completed by group child care center representatives during weekdays and by patients' guardians during weekends.
  • Fever incidence was reduced with single probiotic vs placebo (decrease, 53.0%; P =.0085; odds ratio [OR], 0.57; 95% confidence interval [CI], 0.44 - 0.90; P = .015).
  • Fever incidence was reduced with combined probiotic vs placebo (decrease, 72.7%; P = .0009; OR, 0.34; 95% CI, 0.22 - 0.63; P = .01).
  • Cough incidence was reduced with single probiotic vs placebo (decrease, 41.4%; P = .027; OR, 0.59; 95% CI, 0.39 - 0.96; P = .028).
  • Cough incidence was reduced with combined probiotic vs placebo (decrease, 62.1%; P = .005; OR, 0.44; 95% CI, 0.28 - 0.78; P = .005).
  • Rhinorrhea incidence was reduced with combined probiotic vs placebo (decrease, 58.8%; P = .03; OR, 0.52; 95% CI, 0.34 - 0.97; P = .04).
  • Rhinorrhea incidence was reduced with single use vs placebo (decrease, 28.2%; P = .68).
  • Age-adjusted duration of symptoms decreased with single probiotic vs placebo (–2.17 days; P = .0023).
  • Age-adjusted duration of symptoms decreased with combined probiotic vs placebo (–3.2 days; P < .001).
  • Antibiotic use incidence decreased with single probiotic use by 68.4% (P = .0002) and with combined probiotic use by 84.2% (P < .0001) vs placebo.
  • Absences from group child care reduced with single probiotic vs placebo (–1.6 days; P = .01) and with combined probiotic vs placebo (–1.4 days; P = .01).
  • Clinician visits were not significantly different between the groups.
  • There were no significant differences in results between single and combined probiotic use.
  • Vomiting and diarrhea incidences were too low to be affected by probiotic use.
  • The number of subjects who withdrew from the study was similar for all groups.

Clinical Implications

  • In children, L acidophilus NCFM treatment alone results in a lower incidence of fever and cough, whereas combined L acidophilus NCFM and B animalis subsp lactis results in a lower incidence of fever, cough, or rhinorrhea. L acidophilus NCFM alone or in combination with B animalis subsp lactis results in shorter duration of symptoms.
  • Children who receive L acidophilus NCFM alone or in combination with B animalis subsp lactis have lower incidence of school absences and antibiotic use, but not clinician visits.

CME/CE Test

表單的頂端

 

Questions answered incorrectly will be highlighted.

 

In children, probiotic treatment with L acidophilus NCFM and B animalis subsp lactis is most likely to result in which of the following outcomes?

Lower incidence of fever

Lower incidence of cough

Lower incidence of rhinorrhea

Shorter duration of symptoms

All of the above

 

A 4-year-old healthy child who takes probiotics for 6 months is most likely to have which of the following?

More school absences

Fewer visits to a clinician

Less antibiotic use

None of the above

All of the above

 

想好答案了嗎?

 先看一下那篇文章吧:

August 12, 2009 — 根據發表於8月份小兒科(Pediatrics)期刊的一篇雙盲、安慰劑控制研究,益生菌可以預防孩童的感冒和類流感症狀。
  
  威斯康辛州Danisco公司的Gregory J. Leyer博士等人寫道,已經在多種疾病狀態中,檢測特定益生菌對於促進人類健康的效果,但是有關對於健康族群的預防效果所知有限。本研究提出之報告,支持使用益生菌預防感冒和類流感症狀,且比較兩組不同菌株的效果。
  
  在冬天時,研究者評估使用益生菌對於3到5歲健康孩童之感冒和類流感症狀的發生率和發病期間的效果。在326名符合的孩童中,隨機指定104人使用安慰劑,110人使用嗜酸乳桿菌(Lactobacillus acidophilus)NCFM,112人使用嗜酸乳桿菌NCFM與動物雙歧桿菌(Bifidobacterium animalis)亞種lactis Bi-07。這些小孩每天服用兩次、為期六個月。
  
  相較於安慰劑組,使用單一菌株和複方益生菌這兩組,多種結果均顯著較優。單一益生菌株組之發燒發生率降低53.0% (P = .0085),複方益生菌株組降低72.7%(P = .0009);咳嗽發生率分別降低41.4% (P = .027)和62.1% (P = .005);流鼻水發生率分別降低 28.2% (P = .68)和 58.8% (P =.03)。
  
  發燒、咳嗽、流鼻水的期間,單一益生菌株組比安慰劑組縮短32% (P = .0023),複方益生菌株組縮短48% (P < .001)。使用抗生素比率方面,單一益生菌株組比安慰劑組少68.4% (P = .0002),比複方益生菌株組少84.2% (P < .0001)。因病缺課天數方面,單一益生菌株組比安慰劑組少31.8% (P =.002),比複方益生菌株組少27.7% (P < .001)。
  
  研究作者寫道,對於3到5歲的小孩,每天補充益生菌為期六個月,是減少發燒、咳嗽、流鼻水發生率以及時間、減少抗生素處方、減少因病缺課天數的一個安全有效的方法。研究所用的益生菌株並無引起副作用的報告。
  
  研究限制包括,無法評估黏膜菌株、潛在的機轉、益生菌對於病徵的急性反應效果等。
  
  研究作者結論表示,冬天時,每天在飲食補充益生菌,是減少發燒、咳嗽、流鼻水的發生率、減少這些症狀的發生時間、減少抗生素處方、減少因病缺課天數的一個安全有效的方法。單用嗜酸乳桿菌 NCFM是有效,不過,併用嗜酸乳桿菌 NCFM和動物雙歧桿菌亞種lactis Bi-07,會有更廣泛的保護效果。
  
  Danisco USA公司贊助本研究,雇用其中兩位作者,與其他三位作者有相關合約。

Pediatrics. 2009;124:e172-e179.

 

這樣有方便一點判斷答案了嗎?

In children, probiotic treatment with L acidophilus NCFM and B animalis subsp lactis is most likely to result in which of the following outcomes?

Answer: All of the above
According to the study by Leyer and colleagues, children who took combined
L acidophilus NCFM and B animalis subsp lactis had decreased incidences of fever, cough, and rhinorrhea as well as shorter duration of symptoms.

A 4-year-old healthy child who takes probiotics for 6 months is most likely to have which of the following?

Answer: Less antibiotic use
According to the study by Leyer and colleagues, probiotic use for 6 months in children was associated with fewer school absences and less antibiotic use but no effect on clinician visits.

 

 

 順便一提,如果你想多了解這個菌種的產品,可以提供你商品名:HOWARU® Dophilus

只是給你做健康知識的練習,不要問我去邊可以買到,我自己也沒有用過。

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