Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy.
Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
Adv Exp Med Biol. 2019;1125:109-120. doi: 10.1007/5584_2018_320.
Acute infectious diarrhea (AID) is one of the most common diseases in pediatric age with relevant burden both in high- and in low-income countries.Thanks to their direct action on enterocyte functions and indirect actions on mucosal and systemic immune system and intestinal microenvironment, probiotics are an ideal intervention to manage AID in childhood. However, their efficacy is strictly related to strains and indications, and practitioners should take this information into account in clinical practice.This chapter summarizes the main mechanisms of action of probiotics in AID, with a focus on proof of efficacy supporting their use in prevention and treatment of infant AID.The use of selected strains in appropriate doses is strongly recommended by guidelines of AID, based on large and consistent proofs of efficacy and safety. At present, therapy with probiotics of AID is arguably the strongest indication for probiotics in medicine. Future research should investigate probiotic efficacy in at-risk populations and settings where the evidence is missing.Their role in prevention of AID is however questionable in healthy population, whereas it should be considered in at-risk population. Evidence for prevention of diarrhea in day-care centers and communities is lacking, but consistent evidence supports efficacy in prevention of hospital acquired diarrhea.Overall, AID is the most convincing area for probiotic use in children, and effective strains should be used early after onset of symptoms.
急性感染性腹泻（AID）是儿科最常见的疾病之一，在高收入和低收入国家都有相关负担。由于益生菌对肠细胞功能具有直接作用，对黏膜和全身免疫系统以及肠道微环境具有间接作用，因此是管理儿童 AID 的理想干预措施。然而，其疗效与菌株和适应证密切相关，临床医生在实践中应考虑这些信息。本章总结了益生菌在 AID 中的主要作用机制，重点介绍了支持其在预防和治疗婴儿 AID 中应用的疗效证据。基于大量一致的疗效和安全性证据，AID 指南强烈推荐在适当剂量下使用选定的菌株。目前，益生菌治疗 AID 可以说是医学中益生菌的最强适应证。未来的研究应调查益生菌在高危人群和证据缺失的环境中的疗效。在健康人群中，益生菌预防 AID 的作用尚存在争议，但在高危人群中应考虑使用。在日托中心和社区预防腹泻的证据不足，但一致的证据支持预防医院获得性腹泻的疗效。总的来说，AID 是儿童益生菌应用最有说服力的领域，应在症状出现后尽早使用有效菌株。
