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More research is needed on the use of probiotics for critically ill patients

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READER’S FORUM

More research is needed on the

use of probiotics for critically ill

patients

Dear Editor,

We are grateful to Williams and Kumar Angurana (1) for their comments on our paper (2) in Acta Paediatrica and for providing the references to their own work on the use of probiotics for critically ill patients (3,4).

However, the aim of our paper was to provide guidance to primary care paediatricians and physicians who face daily questions about what probiotic strain to give patients and for what clinical indications. Therefore, we sum-marised the scientifically accredited guidelines and recommendations that were available on the use of probiotics in the paediatric healthcare practice at the time of our study and decided not to mention every randomised controlled trial. The use of probiotics in paediatric intensive care units fell outside the scope of the paper and their use in critically ill patients was only mentioned with regard to safety issues. We did not state that probiotics should not be used for this group of patients, but that they should be

used with caution due to the possible risk of septic dissemination. In general, we do agree with the conclusion reached by Williams and Kumar Angurana that more evidence is needed to guide more specific recommendations for the use of probiotics in critically ill patients.

References

1. Williams V, Angurana SK. Probiotics do have a role to play in treating critically ill children.Acta Paediatr 2019; 108: 180.

2. Hojsak I, Fabiano V, Pop TL, Goulet O, Zuccotti GV, Cokugras FC, et al. Guidance on the use of probiotics in clinical practice in children with selected clinical conditions and in specific vulnerable groups. Acta Paediatr 2018; 107: 927–37.

3. Kumar S, Bansal A, Chakrabarti A, Singhi S. Evaluation of efficacy of probiotics in prevention of candida colonization in a PICU-a randomized controlled trial.Crit Care Med 2013; 41: 565–72. 4. Kumar S, Singhi S, Chakrabarti A, Bansal A, Jayashree M. Probiotic use and prevalence of candidemia and candiduria in a PICU. Pediatr Crit Care Med 2013; 14: e409–15.

DOI:10.1111/apa.14547

Iva Hojsak (ivahojsak@gmail.com)1,2 ,

Valentina Fabiano3, Tudor Lucian Pop4, Olivier

Goulet5, Gian Vincenzo Zuccotti3, Fugen Cullu Cßokugrasß6, Massimo Pettoello-Mantovani7,8 ,

Sanja Kolacek1

1.Children’s Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia

2.School of Medicine, University J.J Strossmayer, Osijek, Croatia

3.Paediatric Department, Vittore Buzzi Children’s Hospital, Universita degli Studi di Milano, Milan, Italy 4.2nd Paediatric Clinic, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania 5.Department of Paediatric Gastroenterology, Hepa-tology and Nutrition, Intestinal Failure Rehabilitation Centre, National Reference Centre for Rare Diges-tive Diseases, APHP Necker-Enfants Malades Hospi-tal, Paris-Descartes University, Paris, France 6.Paediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasßa Medical Faculty, Turkey 7.Department of Paediatrics, Scientific Institute “Casa Sollievo della Sofferenza”, University of Foggia, Foggia, Italy

8.European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany

Correspondence

Iva Hojsak, MD PhD, Referral Centre for Paediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb, Klaiceva 16, 10000 Zagreb, Croatia. Tel: +38514600130|

Fax: +38514600160| Email: ivahojsak@gmail.com

ª2018 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2019 108, p. 181 181 Acta Pædiatrica ISSN 0803-5253

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