Experts resolution on the topic “Probiotics in pediatric surgery: Challenges and opportunities”

Abstract

Experts resolution assess the role of probiotics in pediatric surgery and address a practical question: should probiotics be prescribed concomitantly with antibiotics? The paper examines how surgical stress, limited enteral feeding, and antibiotic therapy in children disrupt the gut microbiota and increase the risk of antibiotic-associated diarrhea, including Clostridioides difficile , nosocomial diarrhea, and postoperative infections. Based on data from systematic reviews and clinical observations, the authors emphasize the principle of strain specificity: clinically meaningful effects are expected when using strains supported by evidence, primarily Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp . Lactis . It is noted that multi-strain combinations may provide a more pronounced reduction in the incidence of infectious complications. The experts propose a practical approach: initiate probiotics from day 1 of antibiotic therapy in the preoperative period and continue for at least 2 weeks after surgery, with duration individualized. The Expert Council considers probiotics a promising component of perioperative support in children, potentially reducing the risk of antibiotic-associated dysbiosis and nosocomial diarrhea, including C. difficile -associated complications (e.g., pseudomembranous colitis), accelerating microbiota recovery after perioperative antibiotic prophylaxis, and lowering the likelihood of inflammatory, infectious, and nosocomial complications, including hospital-acquired intestinal infections. Additional potential benefits include support of local and systemic immune responses, reduced perioperative stress burden, and earlier mobilization, which may contribute to shorter rehabilitation.