Probiotics and Antibiotic-Associated Diarrhea in Pediatric Complicated Appendicitis

Introduction An appendectomy is the most common urgent surgical intra-abdominal procedure performed on children. Approximately one third of the population ends up having complicated appendicitis requiring the use of intravenous antibiotics and a prolonged hospital stay. Antibiotic-associated diarrhea (AAD) is a common obstacle seen in both outpatient and inpatient settings. Use of probiotics in a pediatric population exposed to antibiotics and gastrointestinal surgery such as an appendectomy may provide a protective effect and prevent AAD. Methods This study was a prospective randomized controlled trial conducted at a large freestanding pediatric hospital. Patients in the treatment group received a standard dose of Lactobacillus rhamnosus GG capsule twice a day until discharge, and those in the control group received a placebo twice a day until discharge. In this study, we hypothesize that patients given probiotics will decrease the overall length of stay (LOS) by 25% versus the LOS in those patients who do not receive probiotics. Results Ninety-eight patients were randomized, with 93 included in the data analysis, into the probiotic group (n = 57) and the placebo group (n = 41). The LOS for the probiotic group (n = 53; M = 121.55, SD = 59.51) was lower than that for the placebo group (n = 40; M = 131.69, SD = 74.27) but was not found to be statistically different (t(91) = 0.731, p = .467). The average total number of diarrhea counts was higher in the probiotic group (M = 13, SD = 16) than in the placebo group (M = 10, SD = 11) but was not found to be statistically different (t(91) = −1.017, p = .312). Discussion Use of probiotics to reduce AAD has been found to be effective in other patient populations. Because of the small sample size, we were unable to determine if the use of L. rhamnosus in patients with complicated appendicitis was effective in reducing the LOS or average diarrhea counts.