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Physicians: .25 AMA PRA Category I CreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours
Release Date: April 9, 2014
Expiration Date: April 9, 2015
Estimated Completion Time: 15 minutes
There is no fee for this activity.
To Receive Credit
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.
Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA
Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company
Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
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AAFP: Enduring Material activity, DynaMed EBM Focus, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each EBM Focus is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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Program ID: 1304159U
Last week 546 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 262 articles were added to DynaMed content.
Based on criteria for selecting "articles most likely to change clinical practice," one article was selected by the DynaMed Editorial Team.
Children attending child care have an increased risk of acute diarrhea compared to children in home care (J Pediatr 1997 Sep;131(3):476). Probiotic supplementation has been evaluated for prevention of acute diarrhea in children, but the setting and choice of live bacterial supplement has varied widely. A recent randomized trial evaluated Lactobacillus reuteri DSM 17938 in 332 healthy children aged 6-36 months attending child care in Mexico.
Children were randomized to Lactobacillus reuteri DSM 17938 1 x 108 colony-forming units vs. placebo for 3 months and followed to 6 months. All children were born at term and were at least 2.5 kg at birth. Children with chronic disease, failure to thrive, allergy or atopic disease, or exposure to probiotics, prebiotics, or antibiotics in previous 4 weeks were excluded. Both interventions were administered once daily as 5 drops of oil formulation from dropper bottle directly in the mouth during the first feed at home. Antibiotic use was allowed for febrile episodes that persisted for > 72 hours.
The mean number of diarrhea episodes (passage of ≥ 3 watery stools within 24 hours) per child over the first 3 months was 0.2 with L. reuteri vs. 0.4 with placebo (p = 0.02). The mean duration of diarrhea episodes per child at 3 months was 0.32 days with L. reuteri vs. 0.96 days with placebo (p = 0.03). L. reuteri was also associated with reductions in the number and duration of febrile episodes per child (mean number 0.4 vs. 1.1, p = 0.03; mean duration 1.2 days vs. 2.8 days, p = 0.03), and the number and duration of respiratory tract infections per child (mean number 0.6 vs. 1.2, p = 0.01; mean duration 1.5 days vs. 4.6 days, p = 0.01). The mean duration of antibiotic use per child was 2.7 days with L. reuteri vs. 4.1 with placebo (p = 0.04). The outcomes above were also significantly reduced with L. reuteri compared to placebo from 3-6 months. No treatment-related adverse events were reported. In addition, L. reuteri was associated with significantly reduced costs in a cost-benefit analysis that included the cost of the intervention, estimated costs of school or work absenteeism, and estimated medical costs for an episode of diarrhea or respiratory infection.
This trial demonstrates that supplementation with Lactobacillus reuteri DSM 17938 reduces both the number and duration of diarrhea episodes in children attending child care. These results are consistent with a previous trial from Israel, which found that Bifidobacterium lactis BB-12 and Lactobacillus reuteri ATCC 55730 each reduced the number and duration of diarrhea episodes in infants aged 4-10 months attending child care (Pediatrics 2005 Jan;115(1):5). These probiotics are commercially available without a prescription, and are available in a variety of formats for young children, including oil drops, powders for mixing with infant formula, and chewable tablets. Further studies will help develop specific recommendations on what bacterial strains and methods of administration will optimize supplementation for acute diarrhea prophylaxis.
For more information see the Prevention of acute diarrhea and Probiotics topics in DynaMed.
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May 3-7, 2014
Deputy Editor Thomas Hilts, DO, will be attending the Society of Teachers of Family Medicine (STFM) 47th Annual Spring Conference, held at the Grand Hyatt San Antonio Riverwalk in San Antonio, Texas. Representatives will be available to discuss peer review, mobile access, and free trial information.
Visit the Society of Teachers of Family Medicine website to learn more about the event and for registration information.
If you would like to meet with a DynaMed representative at any of our conferences, please contact us at DynaMedCommunity@ebscohost.com.