| Objectives To investigate the preventive effects of saccharomyces boulardii sachets on antibiotic-associated diarrhea(AAD)due to antibiotic application in children with community acquired pneumonia(CAP),and the investigate risk factors of AAD in children.Methods 1.Subjects: Children that were suffering from CAP and therefore intravenously administered antibiotic in both inpatient and outpatient service of Tianjian Hongqiao Hospital from June 2014 to June 2015 were selected.A total of 420 chndren were randomly divided into two groups:200 cases in experimental group,220 cases in control group.All of the patients were given intravenous antibiotic,and supportive treatment including cough suppression,phlegm reduction,asthma relief,abatement of fever,etc.Children from experimental group were administered antibiotic combined with saccharomyces boulardii sachets(Bioflor,282.5 mg lyophilized live saccharomyces boulardii equivalent to 250 mg saccharomyces boulardii/sachet)from the beginning of treatment.Children under 3 years old were dosed one sachet each time,QD;while children above 3 years were dosed one sachet each time,BID,course of treatment was 5-7 days for all the children.Whereas,children from control group were administered antibiotic alone without application of any microecologics.2.Observation items: Frequency and character of stool,as well as presence or absence of emesis,dehydration etc.Diarrhea was defined as stool consistency decline(becoming loose or watery stool)and/or frequency increase(defecating ≥ 3 times within 24-h)2.Children were administered Montmorillonite Powder after occurrence of diarrhea.Stool routine and culture test and rotavirus ELISA,were detected in children diagnosed with AAD to exclude,bacterial diarrhea and rotavirus enteritis.Incidence of AAD,as well as severity and course diarrhea were observed;and incidence of AAD among patients who were breast fed from their birth to 6 months old in both groups were observed.3.Data analysis: Analysis was performed on medical records of patients in both groups,comprising age,gender,dwelling environment,delivery mode,feeding pattern from birth to 6 months,type of pneumonia,class of applied antibiotic,duration of antibiotic application,application of single antibiotic or multi-antibiotics,therapeutic regimen and therapeutic effects.Results 1.With regard to age,gender,dwelling environment,delivery mode,feeding pattern and type of pneumonia,as well as application of antibiotic,there was no statistical significance between experimental and control group(P>0.05),control group was comparable to experimental group.2.Incidence of AAD in experimental group was 13%,while 30.9% in control group.There was statistically significant difference in incidence of AAD between 2 groups(x2=19.342,P<0.001).3.In experimental group,there were 24 out of 26 children having mild diarrhea(92.3%),and 2 out of 26 having severe diarrhea(7.7%);while in control group,there were 45 out of 68 children having mild diarrhea(66.2%),and 23 out of 68 having severe diarrhea(33.8%).There was statistically significant difference in severity of diarrhea between 2 groups(x2=6.579,P<0.01).4.Experimental group was better than control group in terms of duration of AAD and mean anti-diarrhea time.There was statistically significant difference between 2 groups(P<0.05).5.In experimental group,when duration of antibiotic application was >5 d,AAD occurred in 19 children and didn’t in 60 children;when duration of antibiotic application was <5 d,AAD occurred in 7 children and didn’t in 114 children.In control group,when duration of antibiotic application was >5 d,AAD occurred in 48 children and didn’t in 62 children;when duration of antibiotic application was <5 d,AAD occurred in 20 children and didn’t in 90 children.By comparison,we found that children with duration of antibiotic application >5 d were more susceptible to AAD.Experimental and control group both had statistically significant difference(P<0.001).6.In experimental group,when children were administered single antibiotic,AAD occurred in 8 children and didn’t in 112 children;when children were administered multi-antibiotics,AAD occurred in 18 children and didn’t in 62 children.In control group,when children were administered single antibiotic,AAD occurred in 30 children and didn’t in 109 children;when children were administered multi-antibiotics,AAD occurred in 38 children and didn’t in 43 children.By comparison,we found that children that were administered multi-antibiotics were more susceptible to AAD.Experimental and control group both had statistically significant difference(P<0.001).7.In experimental group,incidences of AAD in children that were breast fed,mixed fed and artificial fed were 3.6%,8.0% and 53.6% respectively.Children that were breast fed were compared to children that were mixed fed and children that were artificial fed,and there was statistically significant difference(x2a=3.880,Pa=0.049;x2b=40.05,Pb=0.000;x2c=23.911,Pc=0.000).In control group,incidences of AAD in children that were breast fed,mixed fed and artificial fed were 11.7%,35.3% and 93.8% respectively.Children that were breast fed were compared to children that were mixed fed and children that were artificial fed,and there was statistically significant difference(x2a=15.025,Pa=0.000;x2b=82.758,Pb=0.000;x2c=29.934,Pc=0.000).8.In experimental and control group,incidences of AAD in children from 6 months-3 years old,4-6 years old and 7-14 years old were 28.9%,19.4% and 12% respectively.Children from 6 months-3 years old were compared to children from 4-6 years old and children from 7-14 years old,and there was statistically significant difference(x2a=4.23,Pa=0.04;x2b=8.431,Pb=0.004;X2c=1.942,Pc=0.163).Children from 4-6 years old were compared to children from 7-14 years old,and there was no statistically significant difference.9.Total AAD therapeutic efficiency was 96.2% in experimental group,and 95.5% in control group.There was statistically significant difference between 2 groups(x2=8.924,P=0.012).Conclusion 1.Preventive application of saccharomyces boulardii sachets could reduce incidence of AAD in children,also could reduce severity of diarrhea in children,as well as shorten duration of AAD and mean anti-diarrhea time in children,Improve treatment effect.2.Prolonged duration of antibiotic application and multi-antibiotics both increased probability of AAD in children.and children that were not breast fed and children from 6 months-3 years old had higher risk of developing AAD. |
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