Probiotics Tips

Parents may often come across terms such as probiotics, prebiotics, and synbiotics. Perhaps they may wonder: What are these? What are their uses? We often hear or see these things in baby food and medicines. Are they safe for babies to use? How should they be used? So today, please follow me to solve the doubts~

Q1: What are probiotics, prebiotics and synbiotics?

A: Probiotics refer to live microorganisms that are administered in a certain amount and can have a beneficial effect on the health of the host.

Prebiotics: refers to substances that can selectively stimulate the activity or growth and reproduction of one or several beneficial bacteria in the host's intestines, but cannot be digested and absorbed by the host.

Prebiotics mainly refer to non-digestible oligosaccharides (NDO), including inulin, fructooligosaccharides (FOS), galacto-oligosaccharides (GOS), soy oligosaccharides, lactulose, etc. They are currently mainly used in functional foods and health products. Probiotics (such as FOS and GOS) are also added to many formula milk powders. The only drug used clinically is lactulose (for chronic or habitual constipation, regulating the physiological rhythm of the colon, and for the treatment and prevention of hepatic encephalopathy or pre-comatose state).

Synbiotics refers to a compound preparation made of probiotics and prebiotics.

Q2: What are the uses of probiotics?

A: Probiotics have the following applications in pediatrics:

1. Gastrointestinal diseases

Diarrhea in children: The use of probiotics can shorten the course of diarrhea, alleviate symptoms, and reduce hospitalization time. For acute diarrhea, the recommended products are Saccharomyces boulardii powder (A) and Bifidobacterium triple live bacteria powder (A). For persistent and chronic diarrhea, Saccharomyces boulardii powder (B), Bifidobacterium triple live bacteria powder (B), Bifidobacterium triple live bacteria enteric-coated capsules (B), Bifidobacterium quadruple live bacteria tablets (B), Bacillus subtilis dual live bacteria granules (B), and Clostridium butyricum live bacteria powder (B).

Prevention of antibiotic-associated diarrhea: Using probiotics while taking antibiotics can significantly reduce the incidence and severity of diarrhea. The recommended ones are Saccharomyces boulardii (A), Clostridium butyricum combined live bacteria powder (A), Bifidobacterium triple live bacteria powder/capsule (A), and Bifidobacterium and Lactobacillus triple live bacteria tablets (A).

Prevention and treatment of chemotherapy-related diarrhea: The use of probiotics can significantly reduce its incidence. Recommended products include Clostridium butyricum combined live bacteria powder (B), Bifidobacterium quadruple live bacteria tablets (B), Bifidobacterium lactobacillus triple live bacteria tablets (B), and Bacillus licheniformis live bacteria granules (B).

Treatment of lactose intolerance: Probiotics can be used as an auxiliary treatment for infants with lactose intolerance, which can significantly shorten the course of treatment and hospitalization time. Recommended products include Bifidobacterium and Lactobacillus triple live bacteria tablets (B), Bacillus subtilis dual live bacteria granules (B), Bifidobacterium triple live bacteria powder (B) and Clostridium butyricum dual live bacteria powder (B).

Functional constipation: Probiotics can improve the intestinal transit time of stool, increase the frequency of intestinal movement, significantly improve the frequency of bowel movements and stool viscosity, and relieve the symptoms of pain and difficulty in defecation, and reduce the recurrence rate of functional constipation. The recommended level is Bifidobacterium Triple Live Bacteria Powder (A)

Treatment of Helicobacter pylori (Hp) infection: Triple therapy combined with probiotics can improve the eradication rate of Hp in children and reduce the incidence of adverse reactions. Saccharomyces boulardii (B) is recommended.

2. Neonatal diseases

Neonatal necrotizing enterocolitis: Probiotics can reduce the incidence, mortality and severity of the disease in premature infants, and shorten the course of the disease and the duration of abdominal distension in children with the disease. Recommended are Bifidobacterium triple live bacteria powder (B), Bifidobacterium and Lactobacillus triple live bacteria tablets (B), Clostridium butyricum live bacteria powder (B), and Saccharomyces boulardii (B).

Neonatal jaundice: adjuvant probiotic treatment can reduce bilirubin concentration and shorten the duration of jaundice. Bacillus subtilis combined live bacteria granules (A) and Bifidobacterium triple live bacteria powder/capsule (A) are recommended.

Feeding intolerance in premature infants: Probiotics can reduce the incidence of feeding intolerance in premature infants, promote weight gain in premature infants, reduce the occurrence of vomiting, gastric retention, and abdominal distension during feeding, shorten the time to reach full gastrointestinal nutrition, save hospitalization time, and reduce the adverse reactions of intravenous nutrition. The stool characteristics of premature infants supplemented with probiotics are closer to those of breastfed infants. Recommended products include Bifidobacterium and Lactobacillus triple live bacteria tablets (B), Bifidobacterium triple live bacteria powder (B), Bifidobacterium triple live bacteria capsules/enteric-coated capsules (B), Bacillus subtilis dual live bacteria granules (B), Clostridium butyricum live bacteria powder (B), Saccharomyces boulardii powder (B), Clostridium butyricum dual live bacteria powder (B), and Bifidobacterium live bacteria capsules (B).

3. Allergic diseases

For infantile eczema, in addition to local treatment, probiotics as systemic adjuvant therapy can significantly improve eczema scores, improve efficacy, and reduce recurrence rates. It is recommended to use Bifidobacterium triple live bacteria powder (C), Bifidobacterium and Lactobacillus triple live bacteria tablets (C), Bifidobacterium quadruple live bacteria tablets (C), Clostridium butyricum live bacteria powder (C), Bacillus subtilis dual live bacteria granules (C), Bacillus coagulans live bacteria tablets (C), Saccharomyces boulardii powder (C) and Clostridium butyricum dual live bacteria powder (C). The course of treatment is generally 1 month.

4. Health promotion

Prevention of recurrent respiratory tract infections: Probiotics can significantly reduce the frequency of respiratory tract infections, duration of fever, cough and wheezing, and duration of antibiotic use. Oral Clostridium butyricum live bacteria powder (A) is recommended for a course of 2 to 3 months.

5. There are some clinical applications for which recommendations cannot yet be made in children and will not be discussed in this article.

(Note: ABC refers to the level of medical evidence, A>B>C. When there are many recommended types, this article only lists the probiotics with a higher level of evidence)

Q3: Are probiotics safe?

A: International authoritative organizations have recognized the safety of probiotics. Their products are safe for healthy consumers, but for certain sick individuals, such as those with severe infections or immunodeficiency, they should be used with caution according to the doctor's advice.

Q4: How to take probiotics to be effective?

A: From the definition of probiotics, we can know that the three core characteristics of probiotics are: ① sufficient quantity, ② live bacteria state, and ③ beneficial health functions. The third characteristic has been confirmed before. If you want to achieve the first two core characteristics, you must pay attention to the correct storage and taking methods of probiotics.

1. The probiotics currently used in China and their storage conditions are shown in the following table:

2～8℃, away from light

Probable Bifidobacterium quadruple live bacteria tablets

Bifidobacterium triple live bacteria powder, Bifidobacterium triple live bacteria capsules

Beifeida Bifidobacterium Triple Live Bacteria Enteric-coated Capsules

Golden Bifidobacterium and Lactobacillus Triple Live Bacteria Tablets

Siliankang Bifidobacterium Tetravalent Live Bacteria Tablets

Changlekang Clostridium butyricum combined live bacteria capsules, Clostridium butyricum combined live bacteria powder

≤20℃Avoid light

Livzon Changle Bifidobacterium Live Bacteria Capsules, Bifidobacterium Live Bacteria Powder

Polyke compound lactic acid bacteria capsules

≤25℃Avoid light

Mommy Love Bacillus subtilis combined with live bacteria granules

Meichangan Bacillus subtilis and Live Bacteria Enteric-coated Capsules

Changfukang promotes bacterial growth, Lefukang

Yuanshou Capsule Bacillus cereus Live Bacteria Preparation

Yihuo Saccharomyces boulardii powder, Saccharomyces boulardii capsules

Room temperature

Baolean Clostridium butyricum live bacteria powder

Shiyi Clostridium butyricum saccharifying bacteria Enterococcus live bacteria tablets, Clostridium butyricum saccharifying bacteria Enterococcus live bacteria powder

Miya oral Clostridium butyricum live bacteria powder, oral Clostridium butyricum live bacteria tablets

Intestinal health Bacillus licheniformis live bacteria granules, Bacillus licheniformis live bacteria capsules, Bacillus licheniformis live bacteria tablets

Dry at room temperature

Shuangshubao Bacillus coagulans live bacteria tablets

Ataining Clostridium butyricum Live Bacteria Capsules

Changlining Clostridium butyricum Live Bacteria Tablets

2. Probiotics are living microorganisms and should be avoided when taken with antibiotics.

If antibiotics are required at the same time, the dose of probiotics should be increased or the time of taking the medicine should be staggered, preferably with an interval of more than 2 to 3 hours. Preparations of Saccharomyces boulardii, Clostridium butyricum, and Bacillus are not sensitive to antibiotics and can be used at the same time as antibiotics. It is usually recommended to take antibiotics before meals and probiotics after meals (except for some antibiotics).

3. In addition, do not use liquids above 40°C to prepare probiotic preparations to avoid destroying the activity of the strains.

References:

1. Expert consensus on the application of probiotics in pediatrics

2. Evidence-based guidelines for the clinical use of probiotics in pediatrics

3. Scientific consensus on probiotics (2020)

(Duan Tingting, Qingdao Women and Children's Hospital)