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To enhance immunomodulatory effects of lyophilized probiotics, we screened a new lyophilizing protective agent, that is Wolfiporia cocos polysaccharide (WP). This study demonstrated WP significantly increased the survival rate among seven polysaccharides, with the optimal dosage being 10 % (w/v). The ratio of bacterial suspension to lyophilizing protective agent was 1:2, in the condition, the probiotic survival rate of probiotics reached 83.06 %. Probiotic powder with WP (PWP) showed superior improvement in immune regulation and gut microbiota in antibiotic-associated diarrhea (AAD) mice compared to powder without WP. It notably increased IgM, IgG and IgA contents, and enhanced the activity of macrophage cells in the abdominal cavity. Furthermore, PWP exhibited the combined benefits of both the WP and PP in regulating the gut microbiota homeostasis, inhibiting the dysbiosis of the gut microbiota reflected in a significant increase in Proteobacteria, such as Sutterella, and decrease in Bacteroidetes, such as Muribaculaceae induced by AAD. Additionally, the correlation analysis indicated Sutterella had negative correlations with the immunomodulatory activities, meanwhile Muribaculace had positive correlations with the immunomodulatory activities. Overall, PWP could regulate the abundances of gut microbiota, thereby modulating immune activities and alleviating antibiotic-associated diarrhea, providing valuable insights for the development and application of WP in probiotics., Competing Interests: Declaration of competing interest The authors declared that they have no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Antibiotic associated diarrhea (AAD) is a common complication in childhood in the outpatient and inpatient settings. This review provides up to date information on the use of probiotics in the prevention and treatment of AAD, including that from Clostridium Difficile, in children. The most recently systematic reviews and subsequently published randomized controlleds trials are considered. Different single and multistrain probiotics are described; a specific recommendation for the use of Lactobacillus Rhamnosus GG (LGG) and Saccharomyces boulardii (Sb) emerges. New information on LGG survival under amoxicillin/clavulanate therapy in children is also provided. This information is relevant in view of the frequent use of this molecule in children, its association with AAD, and LGG's sensitivity to penicillin that might make this probiotic ineffective. In spite of a demonstrated positive effect of specific strains of probiotics on AAD, safety issues still remain among which the risk of associated severe infections and of antibiotic resistant gene exchange., (Copyright © 2017 Elsevier Ltd. All rights reserved.)