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The number of hospitalisations due to an anaphylactic reaction to food is continuously increasing. Therefore, there is an urgent need to seek effective therapy. Currently, the only way to treat food allergies is to avoid allergens and to administer intramuscular adrenaline if an accidental allergen intake occurs. The only causal therapeutic strategy is specific oral immunotherapy. An increasing amount of data confirms this therapy's effectiveness and safety, but the results remain inconclusive due to the lack of long-term follow-up. In this state-of-the-art review, we briefly summarise the latest placebo-controlled randomised controlled trials on oral immunotherapy (OIT) to treat food allergy. During the paper's review, we asked the following questions: does the therapy permanently increase the amount of allergen consumed without symptoms? Does it significantly increase or decrease the occurrence of severe systemic reactions - requiring the administration of adrenaline or hospitalisation? Many authors describe outcomes such as an increase in the amount of allergen that can be safely ingested; however, significant clinical benefits such as decreased hospitalisations or anaphylaxis incidence are rarely included in the results. To date, there is no unified protocol of therapy, which makes comparisons between studies difficult because of significant differences in types, doses, and routes of administration of the allergen, timeline for up-dosing and maintenance, duration of the therapy, and primary outcomes of OIT.

BACKGROUND: Preschool wheeze is highly prevalent; 30%-50% of children have wheezed at least once before age six. Wheezing is not a disorder; it is a symptom of obstruction in the airways, and it is essential to identify the correct diagnosis behind this symptom. An increasing number of studies provide evidence for novel diagnostic tools for monitoring and predicting asthma in the pediatric population. Several techniques are available to measure airway obstruction and airway inflammation, including spirometry, impulse oscillometry, whole-body plethysmography, bronchial hyperresponsiveness test, multiple breath washout test, measurements of exhaled NO, and analyses of various other biomarkers.METHODS: We systematically reviewed all the existing techniques available for measuring lung function and airway inflammation in preschool children to assess their potential and clinical value in the routine diagnostics and monitoring of airway obstruction.RESULTS: If applicable, measuring FEV1 using spirometry is considered useful. For those unable to perform spirometry, whole-body plethysmography and IOS may be useful. Bronchial reversibility to beta2-agonist and hyperresponsiveness test with running exercise challenge may improve the sensitivity of these tests.CONCLUSIONS: The difficulty of measuring lung function and the lack of large randomized controlled trials makes it difficult to establish guidelines for monitoring asthma in preschool children.

It has become clear that severe bronchiolitis is a heterogeneous disease; even so, current bronchiolitis management guidelines rely on the one-size-fits-all approach regarding achieving both short-term and chronic outcomes. It has been speculated that the use of molecular markers could guide more effective pharmacological management and achieve the prevention of chronic respiratory sequelae. Existing data suggest that asthma-like treatment (systemic corticosteroids and beta2-agonists) in infants with rhinovirus-induced bronchiolitis is associated with improved short-term and chronic outcomes, but robust data is still lacking. We performed a systematic search of PubMed, Embase, Web of Science, and the Cochrane’s Library to identify eligible randomized controlled trials to determine the efficacy of a personalized, virus-dependent application of systemic corticosteroids in children with severe bronchiolitis. Twelve studies with heterogeneous methodology were included. The analysis of the available results comparing the respiratory syncytial virus (RSV)-positive and RSV-negative children did not reveal significant differences in the associatons between systemic corticosteroid use in acute episode and duration of hospitalization (short-term outcome). However, this systematic review identified a trend of the positive association between the use of systematic corticosteroids and duration of hospitalization in RSV-negative infants hospitalized with the first episode of bronchiolitis (two studies). This evidence is not conclusive. Taken together, we suggest the design for future studies to assess the respiratory virus type in guiding predictive enrichment approaches in infants presenting with the first episode of bronchiolitis.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42020173686

To compare the effectiveness, tolerability, acceptability, and safety of sodium picosulphate with magnesium citrate (PS/Mg) and polyethylene glycol (PEG) in children (≤18 years) preparing for colonoscopy.Three electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) were searched till July 2020. Only randomized controlled trials (RCTs) were included. At least two authors independently selected studies and performed risk of bias assessment and data extraction.Four RCTs (n=390), with overall good quality were included. A meta-analysis of two trials (n=224) found no statistically significant difference between the groups with respect to the proportion of patients who had excellent and good scores (≥6 points) according to the Boston Bowel Preparation Scale (relative risk: 0.99; 95% confidence interval [CI]: 0.90 to 1.08). Excellent and good scores were observed in both groups in approximately 90% of children. A meta-analysis of two other trials (n=150) showed no significant difference between the groups with respect to the mean total score for the Ottawa Bowel Preparation Scale (mean difference: 0.20; 95% CI: -0.74 to 1.14). Both regimens provided a comparable safety profile; however, PS/Mg was significantly superior to high volume PEG in terms of tolerability (abdominal pain, nausea, vomiting, bloating/flatulence/fullness) and acceptability (ease of formulation consumption, taste acceptance, need for nasogastric tube, compliance with full dose).PS/Mg provides a quality and safety profile similar to PEG for bowel cleansing; however, it has better acceptance and tolerance in children preparing for colonoscopy.

BACKGROUND Recently, evidence from a large randomised controlled trial (RCT) negated efficacy of Lactobacillus rhamnosus GG for treating acute gastroenteritis in children. AIM To review RCTs in which L rhamnosus GG was used to treat acute gastroenteritis in children. METHODS The Cochrane Library, MEDLINE, and EMBASE databases were searched from May 2013 (end of last search) to January 2019. The primary outcomes were stool volume and duration of diarrhoea. RESULTS Eighteen RCTs (n = 4208) were included. Compared with placebo or no treatment, L rhamnosus GG use had no effect on stool volume but was associated with a reduced duration of diarrhoea (15 RCTs, n = 3820, mean difference, MD -0.85 day, 95% CI -1.15 to -0.56). L rhamnosus GG was effective when used at a daily dose of ≥1010 CFU or

(1) Background: Milk fat globule membrane (MFGM), composing fat droplets responsible for lipid transport in breast milk, has been shown to possess immunological and antimicrobial effects. Standard formulas (SF) are devoid of MFGMs during the production process. The study’s aim was to evaluate the safety and benefits of MFGMs supplementation in children. (2) Methods: We searched four databases for randomized controlled trials evaluating the supplementation of MFGMs in children. Growth parameters were chosen as the primary outcome. (3) Results: Twenty-four publications of seventeen studies were included. Meta-analyses assessing the primary outcomes at the age of 4 months included four studies (814 children) comparing the MFGM-supplemented formulas and SF, and two trials (549 children) comparing the MFGM-supplemented formulas and breastfeeding. The primary outcomes were non-inferior in all the experimental MFGM formulas compared to SF, or even represented more similar results to breastfed infants. The promising effects, including a lower incidence of acute otitis media and improved cognitive development, cannot be firmly confirmed due to the small amount of existing evidence. No significant adverse effects were reported in any of the assessed products. (4) Conclusions: The available data signaled beneficial effects and a good safety profile, requiring future research with well-designed trials.

Wheezing and asthma are a growing cause of morbidity in children and adults. Treatment is aimed at prevention of disease exacerbations and preservation of lung function. Respiratory viruses are involved in ∼40–60% of exacerbations. Bacterial lysates prevent recurrent respiratory tract infections and might reduce exacerbations. Moreover, immunomodulatory effects have been observed in human and animal studies. Here we aimed to assess the effects of bacterial lysate therapy on preschool wheezing episodes and asthma exacerbation frequency. We performed a systematic literature review based on the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement and a meta-analysis using Cochrane Review Manager. Out of 2016 retrieved articles, 22 studies were included, of which five provided sufficient data for a meta-analysis.The use of bacterial lysates showed a decrease of both wheezing episodes (mean difference −2.35 (−3.03– −1.67), pThese favourable effects of bacterial lysates indicate that they show promise as add-on therapy in preschool wheezing and childhood asthma.

Background Asthma-like symptoms in preschool children, such as wheezing and dyspnea, are common time- and resource-consuming diagnostic and management challenges. Quality of wheezing and asthma recommendations varies. The purpose of this study, carried out by the European Academy of Allergy and Clinical Immunology (EAACI) Task Force for Preschool Wheeze, was to systematically review and assess the quality of guidelines for diagnosis and treatment of preschool wheezing and/or asthma. Methods The Cochrane Library, MEDLINE, and EMBASE were searched until June 2018. The methodological rigor, quality, and transparency of relevant guidelines were assessed with the use of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Results We identified 26 guidelines. The quality scores for each domain varied. Of all domains, clarity and presentation had the highest mean score, whereas applicability and stakeholder involvement had the lowest. The scores (median) for individual domains were as follows: score and purpose 86%; stakeholder involvement 49%; rigor of development 54%; clarity of presentation 85%; applicability 51%; and editorial independence 63%. Conclusion Although several guidelines on asthma management in children are available, however, their quality varies. Additionally, there is a considerable gap in reliable recommendations on the management and treatment of non-asthmatic preschool wheeze.

Purpose: The Cow's Milk-related Symptom Score (CoMiSS TM), which considers crying, regurgitation, stools, skin and respiratory symptoms, was developed as an awareness tool for evaluating cow's milk-related symptoms. The scoring ranges from 0 to 33. A score >12 was proposed as being likely cow's milk-related and suggestive of allergy to cow's milk. This study aimed to determine the age-related CoMiSS TM values in presumed healthy infants in Poland. Methods: This was a cross-sectional study conducted in well-child clinics in two locations. Parents of the presumed healthy infants aged 12. Conclusion: This study adds to earlier age-related CoMiSS TM data by providing CoMiSS TM values in presumed healthy infants in Poland.

Neurodevelopment has been linked, among other factors, to maternal and early infant diets. The objective of this review, which is part of the NUTRIMENTHE research project ‘The effect of diet on the mental performance of children’ (www.nutrimenthe.com), was to update current evidence on the effects of nutritional interventions such as iron, folic acid or n-3 long-chain polyunsaturated fatty acid (LCPUFA) supplementation during pregnancy and/or in early life on the mental performance and psychomotor development of children. In May 2014, we searched MEDLINE and The Cochrane Database of Systematic Reviews for relevant studies published since 2009. The limited updated evidence suggests that iron supplementation of infants may positively influence the psychomotor development of children, although it does not seem to alter their mental development or behaviour. The use of multivitamin-containing folic acid supplements during pregnancy did not benefit the mental performance of the offspring. Evidence from randomised controlled trials (RCT) did not show a clear and consistent benefit of n-3 LCPUFA supplementation during pregnancy and/or lactation on childhood cognitive and visual development. Caution is needed when interpreting current evidence, as many of the included trials had methodological limitations such as small sample sizes, high attrition rates, and no intention-to-treat analyses. Taken together, the evidence is still inconclusive. Large, high-quality RCT to assess the effects of supplementation with iron, LCPUFA or folic acid are still needed to further clarify the effects of these, and other nutrients, on neurodevelopment. Recent recommendations from scientific societies are briefly presented.

Current data indicate that the “bronchiolitis” diagnosis comprises more than one condition. Clinically, pathophysiologically, and even genetically three main clusters of patients can be identified among children suffering from severe bronchiolitis (or first wheezing episode): (a) respiratory syncytial virus (RSV)‐induced bronchiolitis, characterized by young age of the patient, mechanical obstruction of the airways due to mucus and cell debris, and increased risk of recurrent wheezing. For this illness, an effective prophylactic RSV‐specific monoclonal antibody is available; (b) rhinovirus‐induced wheezing, associated with atopic predisposition of the patient and high risk of subsequent asthma development, which may, however, be reversed with systemic corticosteroids in those with severe illness; and (c) wheeze due to other viruses, characteristically likely to be less frequent and severe. Clinically, it is important to distinguish between these partially overlapping patient groups as they are likely to respond to different treatments. It appears that the first episode of severe bronchiolitis in under 2‐year‐old children is a critical event and an important opportunity for designing secondary prevention strategies for asthma. As data have shown bronchiolitis cannot simply be diagnosed using a certain cutoff age, but instead, as we suggest, using the viral etiology as the differentiating factor.

Background The appropriate diagnosis and management of cow's milk allergy (CMA) is challenging. We aimed to systematically review the quality of the existing guidelines on CMA. Methods The Cochrane Library, MEDLINE, and EMBASE databases were searched from 2010 to November 2015. The methodological rigor, quality, and transparency of relevant guidelines were assessed with the use of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Results Of 15 included guidelines, 2, both developed by recognized scientific organizations, achieved the highest score (100%). Eight others were considered to be of high quality (i.e., overall quality scores >60%). The quality scores for each domain varied. Of all domains, clarity and presentation had the highest mean score, and applicability had the lowest mean score. The scores (mean ± SD) for individual domains were as follows: domain 1 (score and purpose) 62% ± 36%; domain 2 (stakeholder involvement) 56% ± 33%; domain 3 (rigor of development) 55% ± 38%; domain 4 (clarity of presentation) 71% ± 29%; domain 5 (applicability) 44% ± 33%; and domain 6 (editorial independence) 60% ± 36%. One guideline had the maximum possible score of 100% for all AGREE II domains Conclusion A number of guidelines on CMA are available; however, their quality varies. Overall, the guidelines developed by recognized professional/scientific organizations were of the highest quality. These guidelines should be recommended for use. Still, the methodological quality of CMA guidelines may be improved. This article is protected by copyright. All rights reserved.

As an imbalance in the intestinal microbiota can lead to the development of several diseases (e.g., type 1 diabetes, cancer, among others), the use of prebiotics, probiotics, and postbiotics to alter the gut microbiome has attracted recent interest. Postbiotics include any substance released by or produced through the metabolic activity of the microorganism, which exerts a beneficial effect on the host, directly or indirectly. As postbiotics do not contain live microorganisms, the risks associated with their intake are minimized. Here, we provided a critical review of postbiotics described in the literature, including their mechanisms of action, clinical characteristics, and potential therapeutic applications. We detailed the pleiotropic effects of postbiotics, including their immunomodulatory, anti-inflammatory, antioxidant, and anti-cancer properties. Although the use of postbiotics is an attractive strategy for altering the microbiome, further study into its efficacy and safety is warranted.

Parents of children suffering from recurrent respiratory infections can be persuaded by advertisements to pressure their family physicians and pediatricians for "immune-stimulating enhancements". However, the evidence base behind these immune stimulants is usually lacking. Often there is no peer-reviewed studies available that support claims made by "immune-booster" supplements. In this review, we critically analyze most of the marketed immuno-active drugs (including vitamin preparations, dietary supplements, homeopathic remedies, Ecchinacea, bacterial lysates, and probiotics) and identify the necessity to exclude an immunodeficiency in every child suffering from recurrent respiratory tract infections.

A meta-analysis of four randomised controlled trials of varying methodological quality, involving 304 children aged 1 to 48 months, showed that Lactobacillus acidophilus LB (LB) reduced the duration of diarrhoea in hospitalised, but not outpatient, children compared with a placebo. The chance of a cure on day three was similar in both groups, but LB increased the chance of cure on day four. CONCLUSION: There is limited evidence to recommend LB for treating paediatric diarrhoea.

SummaryBackground The efficacy of each probiotic should be evaluated separately. Previously, we have shown that Lactobacillus GG (LGG) is effective in treating acute gastroenteritis (AGE) in children. Aim To update our 2007 meta-analysis on the effectiveness of LGG in treating AGE in children. Methods The Cochrane Library, MEDLINE and EMBASE databases were searched from August 2006 (end date of last search) to May 2013, with no language restrictions, for randomised controlled trials (RCTs) and meta-analyses. Results Fifteen RCTs (2963 participants) met the inclusion criteria in this updated meta-analysis. Combined data from 11 RCTs (n = 2444) showed that LGG significantly reduced the duration of diarrhoea compared with placebo or no treatment (mean difference, MD −1.05 days, 95% CI −1.7 to −0.4). LGG was more effective when used at a daily dose ≥1010 CFU (eight RCTs, n = 1488, MD −1.11 days, 95% CI −1.91 to −0.31) than when used at a daily dose

Growth is an essential outcome measure for evaluating the safety of infant formulas (IF). We investigated the effects of consumption of IF supplemented with prebiotics (fructooligosaccharides, FOS, and galactooligosaccharides, GOS) compared with synbiotics (FOS/GOS and Lactobacillus paracasei ssp. paracasei strain F19) on the growth of healthy infants.182 full-term infants who were weaned completely from breast milk to IF at 28 d of age were randomly assigned to receive prebiotic- or synbiotic-supplemented, otherwise identical, IF until 6 mo of age (intervention period).A total of 146 (80%) infants were included in the intention-to-treat analysis at 6 mo. Anthropometric parameters were similar in the two groups during the intervention and follow-up period until 12 mo of age. Compared with the prebiotic group, a significant reduction in the cumulative incidence of lower respiratory tract infections was found in the synbiotic group; however, the confidence interval of the estimate was wide, resulting in uncertainty.The lack of a significant difference between the formula-fed groups in growth, or the occurrence of serious adverse events, supports the safety of using IF supplemented with synbiotics. Further studies are needed to evaluate the effects of such formula on lower-respiratory tract infections.

Gut microflora is essential for oral tolerance and proper immunity. A promising approach to prevent allergic diseases in genetically at-risk infants is to modify gut microbiota by the administration of prebiotics or probiotics early in life when their immune system is still relatively immature. Prebiotics in the form of short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides (lcFOS), when added to infant feeds with probiotics (beneficial microbes), have the potential to prevent sensitization of infants to dietary allergens. In this chapter, our aim is to determine the effect of pre- and/or probiotics for the prevention or treatment of asthma. We performed a systematic updated search in November 2014 of the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012, Issue 8), MEDLINE, EMBASE, Academic Search Complete, and included randomized controlled trials that compared the use of a prebiotic or probiotic for prevention or treatment of asthma. We identified 29 studies (37 papers) as eligible for inclusion. There is no strong evidence to support use of pro- and prebiotics in the prevention of asthma. There is some minute evidence that a prebiotic supplement may display beneficial therapeutic effects in asthma. Further research is needed to elucidate a potential role of pro- and prebiotics as supportive modality in asthma.

UNLABELLED: The aim of the study is to systematically evaluate data from randomized controlled trials (RCTs) on the efficacy of using intrapleural fibrinolytic agents in the treatment of complicated parapneumonic effusions or empyema in children. The Cochrane Library, MEDLINE and EMBASE databases were searched in July 2009. Four RCTs, involving 194 children, were included. In two RCTs, intrapleural fibrinolytic treatment was compared with normal saline. One of these RCTs showed a significantly reduced hospital stay in those treated with urokinase compared with those treated with normal saline. Otherwise, no fibrinolytic agent had an effect on any other outcome. Two RCTs that compared fibrinolytic treatment with video-assisted thoracoscopic surgery (VATS) revealed no benefit of VATS. CONCLUSION: There is little evidence that intrapleural fibrinolysis is more effective than normal saline in the local treatment of complicated parapneumonic effusions or empyema in children. There is no evidence that VATS is more effective than fibrinolytic treatment. Only a limited number of trials were available for analysis, so some caution must be exercised in interpreting the strength of the evidence presented.

Skipping breakfast is common among children and adolescents. However, there is uncertainty regarding whether breakfast consumption contributes to or protects against overweight or obesity. We aimed to review the evidence on the effects of breakfast consumption on body weight outcomes in children and adolescents in Europe. The Cochrane Library, MEDLINE, and EMBASE were searched in January 2009. We identified 16 studies. All were cross-sectional or cohort trials involving more than 59,000 children/adolescents from Europe. Thirteen studies (n = 57,481) consistently showed that breakfast has a protective effect against becoming overweight or obese. One trial (n = 886) showed that this effect was significant only for boys. The effect of eating breakfast on the body mass index (BMI) was analyzed in 4 studies (n = 2897). All of these studies showed an increase in BMI in breakfast skippers. In one study (n = 1245), this effect was significant only for boys. The results of this analysis suggest that eating breakfast is associated with a reduced risk of becoming overweight or obese and a reduction in the BMI in children and adolescents in Europe. However, almost all of the data in this review were gathered from observational studies, thus, causality should not be assumed based on these findings.

Uncertainty exists regarding the effects of iron supplementation on neurodevelopmental outcomes in the absence of anemia.Our objective was to evaluate the effects of iron supplementation in nonanemic pregnant women and in nonanemic healthy children aged3 y on the mental performance and psychomotor development of children.In this systematic review, MEDLINE, EMBASE, and The Cochrane Library were searched through December 2009 for randomized controlled trials (RCTs).None of 5 RCTs individually showed a beneficial effect of iron supplementation during early life on the Mental Developmental Index of the Bayley Scales of Infant Development at different ages throughout the first 18 mo. Meta-analysis of 3 RCTs (n = 561) showed that, compared with placebo, supplementation with iron had no significant effect on children's Mental Developmental Index at approximately 12 mo of age (weighted mean difference: 1.66; 95% CI: -0.14, 3.47). Three of 5 RCTs showed a beneficial effect of iron supplementation on the Psychomotor Development Index at some time points, whereas 2 did not. Meta-analysis of 3 RCTs (n = 561) showed significant improvement on the Psychomotor Development Index at approximately 12 mo of age in the iron-supplemented group compared with the control group (weighted mean difference: 4.21; 95% CI: 2.31, 6.12). Two RCTs showed no effect of iron supplementation on behavior. Neither of the 2 RCTs that addressed the influence of prenatal iron supplementation showed an effect of iron on either the intelligence quotient or behavioral status of the children.Limited available evidence suggests that iron supplementation in infants may positively influence children's psychomotor development, whereas it does not seem to alter their mental development or behavior.

Wstep Skutecznośc probiotykow zalezy od szczepu i sytuacji klinicznej. W 2007 r. przeprowadziliśmy metaanalize badan oceniających skutecznośc Lactobacillus GG (LGG) w leczeniu ostrej biegunki u dzieci (Aliment Pharmacol Ther 2007;25:871–81). Od tego czasu opublikowano kilka nowych badan, co uzasadnia koniecznośc aktualizacji wcześniejszej analizy. Cel Ocena skuteczności LGG zastosowanego obok standardowego postepowania w leczeniu ostrej biegunki u dzieci. Metodyka Dokonano przeglądu systematycznego (MEDLINE, EMBASE, Cochrane Library) od sierpnia 2006 (data poprzedniego przeglądu) do stycznia 2008 r. Do analizy zakwalifikowano badania z randomizacją, wykonane metodą podwojnie ślepej proby z placebo, dotyczące LGG w leczeniu ostrej biegunki u dzieci. Wyniki Analizą objeto 10 badan (w tym 2 nowe), w ktorych uczestniczylo 1842 dzieci (924 w grupie interwencyjnej otrzymującej LGG, a 918 w grupie kontrolnej). Oceniane badania roznily sie m.in. pod wzgledem liczebności grup, wieku dzieci, lokalizacji (chorzy leczeni w szpitalu lub ambulatoryjnie), jakości metodologicznej. W grupie otrzymującej LGG podczas standardowego leczenia biegunki, w porownaniu z grupą kontrolną, stwierdzono podobną objetośc stolca (2 badania, n = 303, średnia wazona roznic WMD 8,9 ml/kg, 95% przedzial ufności CI −86–104); krotszy czas trwania biegunki bez wzgledu na etiologie (9 badan, n = 1714, WMD −0,94 dnia, 95% CI −1,55 do −0,33); krotszy czas trwania biegunki o etiologii rotawirusowej (3 badania, n = 201, WMD −2,1 dnia, 95% CI −3,55 do −0,6) oraz mniejsze ryzyko biegunki utrzymującej sie >7 dni (1 badanie, n = 287, ryzyko wzgledne 0,25, 95% CI 0,09 do 0,75). Nie obserwowano dzialan niepoządanych związanych z leczeniem. Wnioski Stosowanie doustnie LGG podczas standardowego leczenia ostrej biegunki infekcyjnej u dzieci korzystnie wplywa na przebieg choroby.

Summary Background Convincing evidence that probiotic administration can lower the risk of antibiotic-associated diarrhoea is limited to certain micro-organisms. Aim To determine the efficacy of administration of Lactobacillus rhamnosus (strains E/N, Oxy and Pen) for the prevention of antibiotic-associated diarrhoea in children. Methods Children (aged 3 months to 14 years) with common infections were enrolled in a double-blind, randomized, placebo-controlled trial in which they received standard antibiotic treatment plus 2 × 1010 colony forming units of a probiotic (n = 120) or a placebo (n = 120), administered orally twice daily throughout antibiotic treatment. Analyses were by intention to treat. Results Any diarrhoea (≥3 loose or watery stools/day for ≥48 h occurring during or up to 2 weeks after the antibiotic therapy) occurred in nine (7.5%) patients in the probiotic group and in 20 (17%) patients in the placebo group (relative risk, RR 0.45, 95% confidence interval, CI 0.2–0.9). Three (2.5%) children in the probiotic group developed AAD (diarrhoea caused by Clostridium difficile or otherwise unexplained diarrhoea) compared to nine (7.5%) in the placebo group (RR 0.33, 95% CI 0.1–1.06). No adverse events were observed. Conclusion Administration of L. rhamnosus (strains E/N, Oxy and Pen) to children receiving antibiotics reduced the risk of any diarrhoea, as defined in this study.

Summary Background Racecadotril (acetorphan) is an antisecretory drug that exerts its antidiarrhoeal effects by inhibiting intestinal enkephalinase. Aim To summarize studies testing the efficacy and safety of racecadotril for treating children with acute gastroenteritis. Methods Reports were gathered by searching electronic databases MEDLINE, EMBASE, the Cochrane Library (all up to April 2007), relevant journals, and bibliographies of reviewed articles. Only randomized-controlled trials were included. Results Three randomized-controlled trials (471 participants) met the inclusion criteria. Two trials reported stool output, and data suggested less stool output in the racecadotril group than in the control group. The duration of diarrhoea was significantly reduced in the three trials reporting this outcome. Achievement of a cure by day 5 was similar in both groups. Adverse effects were similar in both groups. Conclusions The small number of included trials provided some evidence in favour of the use of racecadotril over placebo or no intervention, to reduce the stool output and duration of diarrhoea in children with acute gastroenteritis. However, more data in out-patients are needed. The safety as well as the cost-effectiveness of the therapy should be explored, before routine therapy with racecadotril is recommended.

Methods CENTRAL, MEDLINE, and EMBASE databases were searched in November 2012. Included studies compared environmental tobacco smoke-exposed and non-exposed children and fulfilled criteria to define objective markers of atopic sensitization defined as total immunoglobulin E concentrations (tIgE), presence of specific IgE (sIgE+), and positive skin-prick tests (SPT+). A standardized protocol was used for data extraction. Resulting data were analyzed by methods of fixed or random-effect model, and generic inverse variance analysis (RefMan software).

The aim of the study is to systematically evaluate data from randomized controlled trials (RCTs) on the efficacy of using intrapleural fibrinolytic agents in the treatment of complicated parapneumonic effusions or empyema in children. The Cochrane Library, MEDLINE and EMBASE databases were searched in July 2009. Four RCTs, involving 194 children, were included. In two RCTs, intrapleural fibrinolytic treatment was compared with normal saline. One of these RCTs showed a significantly reduced hospital stay in those treated with urokinase compared with those treated with normal saline. Otherwise, no fibrinolytic agent had an effect on any other outcome. Two RCTs that compared fibrinolytic treatment with video-assisted thoracoscopic surgery (VATS) revealed no benefit of VATS.There is little evidence that intrapleural fibrinolysis is more effective than normal saline in the local treatment of complicated parapneumonic effusions or empyema in children. There is no evidence that VATS is more effective than fibrinolytic treatment. Only a limited number of trials were available for analysis, so some caution must be exercised in interpreting the strength of the evidence presented.

n conclusion, the administration of the 2 prebiotics (inulin and FOS) was not effective for preventing diarrhea and AAD. The overall frequency of diarrhea was low, and the study was underpowered. Thus, the results should be interpreted with caution. The present study does not allow any conclusions as to whether other prebiotic products are effective for the prevention of AAD. The efficacy and safety of each such product need to be evaluated separately.

Objective To systematically evaluate the effectiveness of probiotics in preventing antibiotic-associated diarrhea (AAD) in children. Study design The following electronic databases up to December 2005, in any language, were searched for studies relevant to AAD and probiotics: MEDLINE, EMBASE, and The Cochrane Library. Only randomized controlled trials (RCT) were considered for study inclusion. Results Six placebo-controlled, RCTs (766 children) were included. Treatment with probiotics compared with placebo reduced the risk of AAD from 28.5% to 11.9% (relative risk, RR, 0.44, 95% CI 0.25 to 0.77, random effect model). Preplanned subgroup analysis showed that reduction of the risk of AAD was associated with the use of Lactobacillus GG (2 RCTs, 307 participants, RR 0.3, 95% CI 0.15 to 0.6), S. boulardii (1 RCT, 246 participants, RR 0.2, 95% CI 0.07-0.6), or B. lactis & Str. thermophilus (1 RCT, 157 participants, RR 0.5, 95% CI 0.3 to 0.95). Conclusions Probiotics reduce the risk of AAD in children. For every 7 patients that would develop diarrhea while being treated with antibiotics, one fewer will develop AAD if also receiving probiotics.

Gelatin tannate (GT) is a complex of tannic acid, which possesses astringent, antibacterial, and anti-inflammatory properties, and a protective gelatin. It is increasingly being marketed as an antidiarrheal drug. Our aim was to review data on the effectiveness of GT in treating acute gastroenteritis (AGE) in children and adults. The MEDLINE, EMBASE, and the Cochrane Library databases were searched in July 2013, with no language restrictions, for controlled clinical trials. Additional references were obtained from reviewed articles. Two trials met the inclusion criteria. In adults, one randomized controlled trial involving 40 subjects (mean age: 43±13 years) found that, compared with placebo, GT may be more effective at reducing some symptoms of AGE in the first 48 h after initiation of treatment. In children, one poor quality study (no randomization and no blinding) involving 211 children (mean age: 2.5±2.4 years) reported some beneficial effect of GT at 12 h after initiation of treatment. None of the studies evaluated the effect of GT on the primary outcome measures for this review such as stool output, duration of diarrhea, admission to hospital, duration of hospital stay, and (in children) weight gain after rehydration. Currently, there is no evidence to support the use of GT for treating AGE in children and only sparse evidence to support the use of GT in adults. Further well-designed trials, with sufficient power, adequate follow-up periods, and clinically relevant outcome measures, are needed. These include stool volume, duration of diarrhea, admission to hospital, duration of hospital stay, weight gain after rehydration, and adverse effects.