Ibero-Latin American clinical practice guideline for the use of biotics in pediatric gastroenterology, hepatology, and nutrition: probiotics chapter.

BACKGROUND: In Ibero-Latin America, the use of probiotics in pediatrics has increased in recent decades; however, clinical practice shows significant variability across countries and specialties. This situation prompted the development of a regional consensus based on the best available evidence and expert experience. OBJECTIVE: To develop an Ibero-Latin American clinical practice guideline on the use of probiotics in pediatric gastroenterology, hepatology, and nutrition. METHODS: A multidisciplinary panel of specialists from 12 countries, including gastroenterologists, hepatologists, nutritionists, and pediatricians, was convened. A systematic literature review was conducted in PubMed, Scopus, and Cochrane Library through December 2023. Evidence was assessed using the GRADE methodology, and key clinical questions were formulated. Recommendations were discussed and refined through a three-round Delphi process until consensus was reached. RESULTS: Specific recommendations were developed for the use of probiotics in acute diarrhea, antibiotic-associated diarrhea, gastrointestinal infections, functional gastrointestinal disorders, and inflammatory diseases. Strains and doses with proven efficacy, such as Lactobacillus rhamnosus GG and Saccharomyces boulardii, were identified, and clinical scenarios where probiotic use is not justified were defined. The final consensus incorporated considerations of safety, applicability, and regional context. CONCLUSIONS: This guideline represents the first Ibero-Latin American collaborative effort to unify criteria for the use of probiotics in pediatrics, providing a practical and evidence-based framework to improve clinical care across the region.