Therapeutic and prophylactic efficacy of a probiotic complex in infections with combined lesions to the respiratory and gastrointestinal tracts

Objective. To evaluate the efficacy of a probiotic complex containing L. plantarum, L. rhamnosus, and Bifidobacterium lactis in the treatment of acute respiratory and intestinal infections with CLRGT in children. Patients and methods. This study included 376 children with clinical manifestations of acute respiratory and/or intestinal infections (ARIs and AIIs respectively) admitted to hospitals in Moscow and Obninsk within the first 24 h after symptom onset. The diagnosis of ARI and AII was based on clinical signs and results of laboratory testing. All study participants were divided into three groups: Group 1 included 204 children (54.3%) with ARI symptoms alone; Group 2 included 105 children (27.9%) with AII symptoms alone; and Group 3 included 67 children (17.8%) with CLRGT. Patients in each group were randomized into two subgroups. We evaluated therapeutic and prophylactic efficacy of the probiotic complex, including such parameters as frequency of CLRGT development in children receiving the probiotic complex, duration of main respiratory and gastrointestinal symptoms, incidence of complications, and length of in-hospital stay. Results. Currently, almost 30% of patients with acute respiratory and gastrointestinal infections have CLRGT. The inclusion of a probiotic complex into the treatment regimen for acute infectious diseases resulted in a decreased duration of most symptoms in both clinical groups; however, statistically significant differences were observed only for length of in-hospital stay in children with CLRGT. Conclusion. We recommend the probiotic complex as a part of initial therapy for ARI, AII, and infections with CLRGT, since it improves the prognosis and reduces treatment duration

Modern approaches to the prevention and rehydration therapy of antibiotic-associated diarrhea affected by ARI in children

The use of antibiotic drugs (ABDs) has significantly reduced the number of severe bacterial infectious diseases and mortality in children, especially in infants. But the widespread and unnecessary use of ABDs, including reserve antibiotics (the use of carbapenems increased by 45%, polymyxins  – by 13%), to treat uncomplicated acute respiratory infections is open to many hazards, such as increased antibiotic resistance of pathogens. Antibiotic-associated diarrhea is one of the common complications of antibiotic therapy. According to various authors, the incidence of antibiotic-associated diarrhea is 6–80% among patients treated with antibiotics, on average 35% of patients (approximately every third patient) receiving antibiotics report symptoms of antibiotic-associated diarrhea. Disruptive changes in the qualitative and quantitative composition of the intestinal microbiota are accompanied by a decrease in the protective functions of the intestinal mucosa and contribute to the growth of pathogenic and opportunistic microorganisms (Clostridium spp., Candida spp., Salmonella spp., Staphyloccus aureus). The findings of most studies obtained on a large sample of paediatric population, as well as the clinical guidelines of the World Association of Gastroenterologists recommend the use of L. rhamnosus GGprobiotic strain (level of evidence 1) to prevent antibiotic-associated diarrhea in children. L. rhamnosus GGpresents chromosomal resistance to a range of antibiotics, which varies with species and strain. They do not contain plasmid DNA, which is dangerous for the spread of antibiotic resistance among other bacteria, which enables their wide therapeutic and prophylactic use. Clinical case studies of the course of antibiotic-associated diarrhea in children are presented to demonstrate the variability of clinical symptoms. Fever in children with ARI, particularly in tender-age infants, requires special attention from parents and doctors, as its main risk lies with a dehydration due to significant water loss during breathing, and especially increased sweating (including sweating induced by antipyretics). Therefore, oral rehydration therapy is an important method for treating infectious diseases in children. Complications that develop in patients, especially in children, after administration of antibiotics, diseases that can lead to water and electrolyte imbalance are life-threatening conditions that require immediate medical attention. Correction of water and electrolyte balance, timely restoration of intestinal microflora improve prognosis in such patients and promote faster recovery