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Objectives and study: Recommendations for probiotic use for treatment or prevention in of pediatric intestinal diseases have been produced by scientific societies in several continents, but not in Asia- Pacific region. This paper proposes recommendations for probiotic use for prevention and treatment of gastrointestinal diseases for children living in Asia-Pacific region. Recommendations are based on existing guidelines and on trials conducted in Asia-Pacific countries as well as on considerations of local conditions. Method(s): Target intestinal diseases were identified and their epidemiological and clinical pattern in Asia-Pacific countries were discussed by a panel of experts. Current evidence-based recommendations and guidelines and randomized-controlled trials in the region were revised. Cultural aspects, health management issues, and economic factors were also taken into consideration to formulate recommendations. The strength of each recommendation was rated using the GRADE system. Result(s): The probiotic strains Saccharomyces boulardii CNCM I-745 (Sb) and Lactobacillus rhamnosusGG (LGG) were strongly recommended as active treatment of gastroenteritis in adjunct to oral rehydration. Also Lactobacillus reuteri can be considered. Probiotics may be considered based on evaluation of candidate patients and local setting for the following indications (with the indicated strains): prevention of antibiotic associated diarrhea (LGG or Sb); prevention of Clostridium difficileinduced diarrhea (Sb); prevention of nosocomial diarrhea (LGG); prevention of infantile colics (L reuteri); adjunctive treatment of Helicobacter pylori (Sb and others). Finally probiotics may be considered in infants for prevention of necrotizing enterocolitis but the decision should be left to the physician and discussed with the parents of candidate preterm babies in the light of individual conditions. There is insufficient evidence to formulate recommendations for other gastrointestinal disease

Objectives and study: Recommendations for probiotic use for treatment or prevention in of pediatric intestinal diseases have been produced by scientific societies in several continents, but not in Asia- Pacific region. This paper proposes recommendations for probiotic use for prevention and treatment of gastrointestinal diseases for children living in Asia-Pacific region. Recommendations are based on existing guidelines and on trials conducted in Asia-Pacific countries as well as on considerations of local conditions. Method(s): Target intestinal diseases were identified and their epidemiological and clinical pattern in Asia-Pacific countries were discussed by a panel of experts. Current evidence-based recommendations and guidelines and randomized-controlled trials in the region were revised. Cultural aspects, health management issues, and economic factors were also taken into consideration to formulate recommendations. The strength of each recommendation was rated using the GRADE system. Result(s): The probiotic strains Saccharomyces boulardii CNCM I-745 (Sb) and Lactobacillus rhamnosusGG (LGG) were strongly recommended as active treatment of gastroenteritis in adjunct to oral rehydration. Also Lactobacillus reuteri can be considered. Probiotics may be considered based on evaluation of candidate patients and local setting for the following indications (with the indicated strains): prevention of antibiotic associated diarrhea (LGG or Sb); prevention of Clostridium difficileinduced diarrhea (Sb); prevention of nosocomial diarrhea (LGG); prevention of infantile colics (L reuteri); adjunctive treatment of Helicobacter pylori (Sb and others). Finally probiotics may be considered in infants for prevention of necrotizing enterocolitis but the decision should be left to the physician and discussed with the parents of candidate preterm babies in the light of individual conditions. There is insufficient evidence to formulate recommendations for other gastrointestinal disease