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– Vanderhoof et al (J Pediatr 1999) ? 202 children, 6 mo 10 yr, otitis/pharyngitis, amox/amoxclav ? Oral antibiotics in an outpatient setting for 10 days ? Lactobacillus GG, 10 (12kg) or 20 (12kg) billion cfu’s for 10 d ? Rated stool consistency and frequency ? 26% of controls and 8% of L GG had diarrhea ? Of those with diarrhea, days in placebo, days in L GG Probiotics: the evidence ? Infectious diarrhea: – Van Niel et al (Peds 2022) ? Systematic review of 9 studies (all outside US, 136 months) ? Various probiotics (4 used L GG) ? Mean reduction in diarrhea of days (95% CI: ) ? fewer stools in L GG groups (95% CI: ) ? Dose response curve with higher L GG dose – Two other metaanalyses also showed benefits, particularly with L GG ? Allen et al. Cochrane Database Syst Rev, 2022 ? Szajewska et al. J Pediatr Gastroenterol Nutr, 2022 Probiotics: the evidence ? Prevention of infections in day care: – Weizman et al (Peds 2022) ? Doubleblind, placebocontrolled RCT ? 14 day care centers in Israel, 410 months of age ? Formula with B lactis, L reuteri, or no probiotics (no breastfeeding) ? Mean intake: 1 billion s