Probiotics and Antimicrobial Proteins

, Volume 10, Issue 2, pp 323–328 | Cite as

Frequency of Antibiotic-Associated Diarrhea and Related Complications in Pediatric Patients Who Underwent Hypospadias Repair: a Comparative Study Using Probiotics vs Placebo

  • Ciro EspositoEmail author
  • Agnese Roberti
  • Francesco Turrà
  • Mariapina Cerulo
  • Giovanni Severino
  • Alessandro Settimi
  • Maria Escolino


This study aimed to evaluate the effectiveness of probiotics (Lactobacillus rhamnosus GG), as a preventive measure of antibiotic-associated diarrhea (AAD) in children who underwent hypospadias repair and its clinical consequences on postoperative outcome, comparing the group treated with probiotics + antibiotics with two control groups (only antibiotics and antibiotics + placebo). We performed a prospective, randomized, placebo-controlled study with three groups of patients (30 boys for each group) who underwent hypospadias repair in our unit from March 2016 to December 2016. G1 received antibiotics + probiotics (L. rhamnosus GG), while G2 and G3 respectively received only antibiotics or antibiotics + placebo (glucose solution at 5%) for the same period. The patients were evaluated in regard to the number of evacuations/day, stool consistency, and the number of dressings/day. The overall incidence of postoperative AAD was 33.3% (30/90), and it was statistically lower in G1 patients compared to G2 and G3 ones (p = 0.002). The duration of AAD was significantly longer in G2 and G3 compared to G1 (p = 0.001). In G1, the frequency of dressing change was significantly lower compared to G2 and G3 (p = 0.001).The incidence of postoperative complications (fistula and dehiscence) was significantly higher in G2 and G3 compared to G1 (p = 0.001). Our study confirmed that the use of probiotic L. rhamnosus GG associated with antibiotics significantly reduced the incidence and the duration of postoperative AAD. In addition, the use of probiotics LGG reduced the frequency of dressing changes and the incidence of postoperative complications, such as urethral fistula and foreskin dehiscence.


Probiotics Diarrhea Children Antibiotics Placebo Hypospadias 


Compliance with Ethical Standards

All procedures followed were in accordance with the ethical standards of the institutional and national research committee and with the Helsinki Declaration of 1975, as revised in 2008.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Wistrom J, Norrby S, Myhre E, Erikson S, Grandström G, Lagergren L (2001) Frequency of antibiotic-associated diarrhoea in 2462 antibiotic-treated hospitalized patients: a prospective study. J Antimicrob Chemother 47:43–50CrossRefPubMedGoogle Scholar
  2. 2.
    Turck D, Bernet JP, Marx J, Kempf H, Giard P, Walbaum O, Lacombe A, Rembert F, Toursel F, Bernasconi P, Gottrand F, McFarland LV, Bloch K (2003) Incidence and risk factors of oral antibiotic-associated diarrhea in an outpatient pediatric population. J Pediatr Gastroenterol Nutr 37(1):22–26CrossRefPubMedGoogle Scholar
  3. 3.
    Heaton KW, Radvan J, Cripps H, Mountford RA, Braddon FE, Hughes AO (1992) Defecation frequency and timing, and stool form in the general population: a prospective study. Gut 33(6):818–824CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Owens RC Jr, Donskey CJ, Gaynes RP, Loo VG, Muto CA (2008) Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis 46(Suppl 1):S19–S31CrossRefPubMedGoogle Scholar
  5. 5.
    McFarland LV (2008) Antibiotic-associated diarrhea: epidemiology, trends and treatment. Future Microbiol 3(5):563–578CrossRefPubMedGoogle Scholar
  6. 6.
    Hempel S, Newberry SJ, Maher AR et al (2012) Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA 307:1959–1969CrossRefPubMedGoogle Scholar
  7. 7.
    Guarino A, Guandalini S, Lo Vecchio A (2015) Probiotics for prevention and treatment of diarrhea. J Clin Gastroenterol 49(Suppl 1):S37–S45CrossRefPubMedGoogle Scholar
  8. 8.
    Lemberg DA, Ooi CY, Day AS (2007) Probiotics in paediatric gastrointestinal diseases. J Paediatr Child Health 43:331–336CrossRefPubMedGoogle Scholar
  9. 9.
    Videlock EJ, Cremonini F (2012) Meta-analysis: probiotics in antibiotic-associated diarrhoea. Aliment Pharmacol Ther 35:1355–1369CrossRefPubMedGoogle Scholar
  10. 10.
    Johnston BC, Supina AL, Vohra S (2006) Probiotics for pediatric antibiotic-associated diarrhea: a meta-analysis of randomized placebo-controlled trials. CMAJ 175(4):377–383 Erratum in: CMAJ 175(7):777CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Szajewska H, Ruszczyński M, Radzikowski A (2006) Probiotics in the prevention of antibiotic-associated diarrhea in children: a meta-analysis of randomized controlled trials. J Pediatr 149(3):367–372CrossRefPubMedGoogle Scholar
  12. 12.
    Hawrelak JA, Whitten DL, Myers SP (2005) Is Lactobacillus rhamnosus GG effective in preventing the onset of antibiotic-associated diarrhoea: a systematic review. Digestion 72:51–56CrossRefPubMedGoogle Scholar
  13. 13.
    Erdeve O, Tiras U, Dallar Y (2004) The probiotic effect of Saccharomyces boulardii in a pediatric age group. J Trop Pediatr 50:234–236CrossRefPubMedGoogle Scholar
  14. 14.
    Vandenplas Y, Huys G, Daube G (2015) Probiotics: an update. J Pediatr 91(1):6–21CrossRefGoogle Scholar
  15. 15.
    Naber KG, Bergman B, Bishop MC, Bjerklund-Johansen TE, Botto H, Lobel B, Jinenez Cruz F, Selvaggi FP, Urinary Tract Infection (UTI) Working Group of the Health Care Office (HCO) of the European Association of Urology (EAU) (2001) EAU guidelines for the management of urinary and male genital tract infections. Urinary Tract Infection (UTI) Working Group of the Health Care Office (HCO) of the European Association of Urology (EAU). Eur Urol 40(5):576–588CrossRefPubMedGoogle Scholar
  16. 16.
    Kanamaru S, Terai A, Ishitoya S, Kunishima Y, Nishiyama H, Segawa T, Nakamura E, Kinoshita H, Moroi S, Ito N, Kamoto T, Okuno H, Habuchi T, Senda K, Ichiyama S, Ogawa O, Yamamoto S (2004) Assessment of a protocol for prophylactic antibiotics to prevent perioperative infection in urological surgery: a preliminary study. Int J Urol 11(6):355–363CrossRefPubMedGoogle Scholar
  17. 17.
    Hayes SR, Vargas AJ (2016) Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Explore (NY) 12(6):463–466CrossRefGoogle Scholar
  18. 18.
    Yan F, Polk DB (2012) Lactobacillus rhamnosus GG: an updated strategy to use microbial products to promote health. Funct Foods Rev 4(2):77–84Google Scholar
  19. 19.
    Gogineni VK, Morrow LE, Malesker MA (2013) Probiotics: mechanisms of action and clinical applications. J Prob Health 1:101CrossRefGoogle Scholar
  20. 20.
    Bermudez-Brito M, Plaza-Díaz J, Muñoz-Quezada S, Gómez-Llorente C, Gil A (2012) Probiotic mechanisms of action. Ann Nutr Metab 61:160–174CrossRefPubMedGoogle Scholar
  21. 21.
    Snodgrass W, Bush N (2016) TIP hypospadias repair: a pediatric urology indicator operation. J Pediatr Urol 12(1):11–18CrossRefPubMedGoogle Scholar
  22. 22.
    Schneuer FJ, Holland AJ, Pereira G, Bower C, Nassar N (2015) Prevalence, repairs and complications of hypospadias: an Australian population-based study. Arch Dis Child 100(11):1038–1043CrossRefPubMedGoogle Scholar
  23. 23.
    Esposito C, Savanelli A, Escolino M, Giurin I, Iaquinto M, Alicchio F, Roberti A, Settimi A (2014) Preputioplasty associated with urethroplasty for correction of distal hypospadias: a prospective study and proposition of a new objective scoring system for evaluation of esthetic and functional outcome. J Pediatr Urol 10(2):294–299CrossRefPubMedGoogle Scholar
  24. 24.
    Goldenberg JZ, Lytvyn L, Steurich J, Parkin P, Mahant S, Johnston BC (2015) Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev 12:CD004827Google Scholar
  25. 25.
    Johnston BC, Goldenberg JZ, Vandvik PO, Sun X, Guyatt GH (2011) Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev 11:CD004827Google Scholar
  26. 26.
    Szajewska H, Kołodziej M (2015) Systematic review with meta-analysis: Lactobacillus rhamnosus GG in the prevention of antibiotic-associated diarrhoea in children and adults. Aliment Pharmacol Ther 42(10):1149–1157CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Ciro Esposito
    • 1
    Email author
  • Agnese Roberti
    • 1
  • Francesco Turrà
    • 1
  • Mariapina Cerulo
    • 1
  • Giovanni Severino
    • 1
  • Alessandro Settimi
    • 1
  • Maria Escolino
    • 1
  1. 1.Pediatric Surgery Unit, Department of Translational Medical SciencesFederico II University of NaplesNaplesItaly

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