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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.

Program Overview

Learning Objectives

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.

Faculty Information

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.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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.

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.

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.

Lactobacillus reuteri Supplementation for 3 Months Reduces the Number and Duration of Diarrhea Episodes in Children Attending Child Care
Reference: Pediatrics 2014 Apr;133(4):e904 (level 1 [likely reliable] evidence)

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.

Earn CME Credit for reading this e-Newsletter. For more information on this educational activity, see the CME sidebar.

DynaMed Events
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.

KidsCareEverywhere Blogging from Vietnam

EBSCO Information Services along with PEMSoft and DynaMed are proud sponsors of KidsCareEverywhere. KidsCareEverywhere is a public charity dedicated to transforming pediatric care in under-resourced communities by donating state-of-the-art medical software to public hospitals and training physicians and medical providers in software utilization.

Read about an ongoing initiative in Vietnam at KidsCareEverywhere

Call for Peer Reviews

We are currently seeking subspecialty reviewers for our Patient Education Resource Center (PERC). PERC provides fact sheets and discharge instructions for patients leaving the hospital or emergency room. These hand-outs fulfill the meaningful use requirements for the Medicare & Medicare Services Incentive Programs.

Click here to speak with us about becoming a peer reviewer.

DynaMed Careers

Looking for a change? The DynaMed editorial team is expanding and looking for talented and driven individuals. Visit the links below to learn about these exciting opportunities.

Deputy Editor of Oncology
Section Editor of Specialty Content

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