益生菌飲品可能無法預防抗生素相關的腹瀉


  August 18, 2009 — 根據一項隨機分派雙盲、隱匿分派的研究結果,Kefir,一個類似優格的發酵乳製品但包括不同發酵微生物,可能無法預防抗生素相關的腹瀉。這項研究結果發表在8月份的兒童青少年醫學誌上。
  
  來自華盛頓特區喬治城大學醫學中心的Daniel J. Merenstein醫師與其來自評估Kefir效果(MILK)研究的同事們表示,使用機能性食品來減輕疾病與促進健康是許多資源被放到這個令人興奮新領域的主要因素之一。Kefir由乳糖發酵菌(Kluyveromyces marxianus)與非乳糖發酵酵母菌(Saccharomyces unisporus、Saccharomyces cerevisia與Saccharomyces exiguus)組成。據稱,這些益生菌運送有益的細菌到腸道,改善腸胃道健康,且可能保護免於發生抗生素相關腹瀉。
  
  這項研究的目的在於評估市面上可取得的Kefir產品(Probugs,Lifeways產品有限公司)用於預防抗生素相關腹瀉的效果,研究收納125位1到5歲於華盛頓特區城區接受初級照護醫師照護的病童。受試者被隨機分派接受Kefir飲品或是加熱滅菌相符安慰劑,主要試驗終點是對病童投予抗生素後14天追蹤期之間腹瀉的發生率。
  
  兩組之間腹瀉機率並無顯著差異(Kefir組為18%,相較於安慰劑組的21.9%;相對風險為0.82;95%信賴區間為0.54-1.43),兩組之間的次級預後也無顯著差異。研究者們表示,收納病患時的起始健康狀況,以及受試者的年齡與性別之間有某些有趣的交互作用,代表這需要更多的研究。
  
  研究作者們表示,在我們的研究中,Kefir並不能預防抗生素相關腹瀉。未來需要針對Kefir的潛力進行獨立的研究。
  
  這項研究的限制包括沒有進行糞便檢驗,或是病原菌培養,沒有有關困難腸梭菌(Clostridium difficile)的數據,收納相對比較健康的族群,以及由父母報告數據的可靠性。
  
  研究作者們的結論是,因為這項研究針對特定品種、特定劑量,所以我們的發現不能外推到其他品種或是預後。這項研究有一些有趣的數據,我們相信這值得未來進一步釐清,且可能有Kefir在預防抗生素相關腹瀉角色潛在有益的角色。當許多產品顯然以萬靈丹自居,但是缺乏病患為主的預後數據時,我們也相信應該繼續對市面上產品進行獨立的研究,且以高品質研究技巧進行。
  
  Lifeway食品有限公司,Probugs製造公司贊助這項研究且提供試驗用飲品。研究作者們表示沒有相關資金上的往來。
  

Probiotic Drink May Not Prevent Antibiotic-Associated Diarrhea

By Laurie Barclay, MD
Medscape Medical News

August 18, 2009 — Kefir, a fermented milk product similar to yogurt but containing different fermentation microbes, may not prevent antibiotic-associated diarrhea, according to the results of a double-blinded, randomized, allocation concealment clinical trial reported in the August issue of the Archives of Pediatric and Adolescent Medicine.

"The promise of using functional foods to mitigate disease and promote health is one of the major reasons so many resources are being placed in this exciting new field," write Daniel J. Merenstein, MD, from Georgetown University Medical Center in Washington, DC, and colleagues from the Measuring the Influence of Kefir (MILK) Study. "Kefir grains constitute both lactose-fermenting yeasts (Kluyveromyces marxianus) and non–lactose-fermenting yeasts (Saccharomyces unisporus, Saccharomyces cerevisiae, and Saccharomyces exiguus). It is believed that these probiotics deliver beneficial bacteria to the gut, improving gastrointestinal health, and may protect against [antibiotic-associated diarrhea]."

The goal of this study was to evaluate the effect of a commercially available kefir product (Probugs, Lifeway Foods, Inc) on the prevention of antibiotic-associated diarrhea among 125 children aged 1 to 5 years and presenting to primary care clinicians in the Washington, DC, metropolitan area. Participants were randomly assigned to receive kefir drink or heat-killed matching placebo, and the main study endpoint was the incidence of diarrhea during the 14-day follow-up period after children were given antibiotics.

Rates of diarrhea did not differ significantly between groups (18% in the kefir group vs 21.9% in the placebo group; relative risk, 0.82; 95% confidence interval, 0.54 – 1.43), nor did secondary outcomes differ between groups. The investigators noted some interesting interactions among initial health at enrollment and participant age and sex, suggesting the need for additional study.

"In our trial, kefir did not prevent [antibiotic-associated diarrhea]," the study authors write. "Further independent research on the potential of kefir needs to be conducted."

Limitations of this study include the lack of stool testing or culture for pathogens, a lack of data regarding the presence of Clostridium difficile, a generally very healthy population, and a reliance on parental reports.

"It is important to recognize that this trial studied specific strains at specific dosages and our findings cannot be extrapolated for other strains or outcomes," the study authors conclude. "There are some intriguing data that we believe deserve further elucidation and may hold promise for kefir's role in [antibiotic-associated diarrhea] prevention. We also believe that it is important that commercial products continue to be independently studied and subjected to high-quality research techniques, as many products appear to present themselves as a panacea while lacking patient-oriented outcome data."

Lifeway Foods, Inc, the maker of Probugs, supported this study and provided study drinks. The study authors have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. 2009;163:750–754.

    
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