Inulin and Fructo‐oligosaccharides for the Prevention of Antibiotic‐associated Diarrhea in Children

Abstract

T o the Editor: We provided care to a 10-year-old girl who had placed 2 Buckyballs magnets in her mouth as a makeshift tongue ring, and accidentally swallowed both magnets. An emergent esophagogastroduodenoscopy revealed that the magnets had passed beyond the duodenum. After 48 hours of conservative management, the magnets appeared to remain in a static position in the right lower quadrant. A limited noncontrast computed tomography scan of the abdomen showed both magnets attached to each other in the appendix. A diagnostic laparotomy was performed and under direct visualization, the magnets were manipulated into the appendix and retrieved via an appendectomy (Fig. 1). Her postoperative course was uneventful. After discharge from the hospital, this case received wide media coverage and was published on the front page of The Washington Post (1). During the same time, 2 other preteens were hospitalized at Inova Fairfax Hospital for Children with similar complaints. Both of them passed the objects spontaneously.Between 10% and 20% of cases require endoscopic retrieval, and approximately 1% of cases require operative management for intestinal obstruction or perforation (2,3) Reports from the Centers for Disease Control and Prevention and the US Consumer Product Safety Commission have described the risks of multiple magnet ingestion and have highlighted the dangers of using magnets as simulated jewelry, particularly around the lips and tongue (4,5). We urge the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition to assume a leadership role and take the initiative in educating and creating awareness among pediatricians, pediatric gastroenterologists, and other subspecialists about this emerging pediatric health concern.

Health Care Provider's Knowledge, Perceptions, and Use of Probiotics and Prebiotics

“…9 Evidence for the benefit of prebiotics for these conditions is more limited, and of these conditions, prebiotics may benefit those with IBS the most. [10][11][12][13][14] While some research supports the use of probiotics and prebiotics for these conditions, not all data support use of these dietary supplements. 15 More randomized controlled trials should be conducted to determine optimal dosage, strain (probiotics), and composition (prebiotics) for each condition, as well as determine the effectiveness of these dietary compounds on additional conditions such as metabolic diseases including cardiovascular disease and diabetes.…”

Biotics and Children’s and Adolescents’ Health: A Narrative Review

“…The Global Recommendations of the World Gastroenterology Organization (2017) align with the above regarding the types of probiotics to be used. Finally, an ESPGHAN report on the use of inulin and fructo-oligosaccharides in 2012 showed that they were not effective treatments [ 60 ].…”

“…Regarding current trends on the different uses of biotics in diseases, the present review highlighted a variety of important fields, such as the administration of probiotics in the context of acute infectious diarrhea [ 17 , 51 , 52 ], nosocomial diarrhea [ 20 , 21 , 52 , 57 ], diarrhea associated with antibiotics [ 22 , 23 , 51 , 53 , 59 , 60 ], functional abdominal pain [ 53 , 64 ], pouchitis [ 53 ], and necrotizing enterocolitis in infants [ 53 ], as well as their role as adjuncts in ulcerative colitis [ 52 ], in the improvement in the eradication rate of H. pylori [ 24 , 25 , 26 ], and as prevention tools for allergic disease in infants [ 34 , 37 ]. Emerging fields include neurodevelopmental disorders [ 36 , 37 , 38 ], obesity [ 40 ], otitis media [ 42 ], and viral respiratory infections [ 75 ].…”

Clinical Uses of Fructooligosaccharides for Gastrointestinal health in the Pediatric Population

“…However, an ESPGHAN study conducted among infants and children aged 6 months-11 years who were given antibiotics with 5 g per day of FOS and inulin failed to show any significant effect on AAD when compared to the placebo group. There is a need for further large-scale systematic studies to clearly elucidate the role of FOS in preventing AAD in infants and children [27].…”