Contents

Search

probiotic

Replacement of intestinal flora. (Opposite of antibiotic). Especially: 1) Lactobacillus 2) Bifidobacterium 3) Saccharomyces Tradenames: Align, Activa, VSL#3, Florastat, Culturelle, Probiotica, Lactinex Indications: 1) acute infectious diarrhea [16] 1) infantile diarrhea [2,3,4] 2) prophylaxis for necrotizing enterocolitis in infants [3,14] 3) may reduce incidence of gastrointestinal disorders in infants resulting in lower healthcare costs [12] 4) prophylaxis for antibiotic-associated diarrhea in the elderly [7] 5) prophylaxis for cold & flu symptoms [8] 6) irritable bowel syndrome [13] 7) exposure to probiotics during the first 28 days of life associated with decreased risk for developing diabetes mellitus type 1 in genetically susceptible infants (RR=0.66) [18] 8) maternal or infant probiotic supplementation reduces risk for eczema in children ages <=4 years (RR=0.78) [20] 9) may reduce respiratory tract infections in nursing home residents (RR=0.65) [21] 10) may reduce risk of ventilator-associated pneumonia [28] - compare with [26] in Contraindications (below) Contraindications: - acute pancreatitis, 2-fold increase in mortality [6] - not useful for preventing eczema &/or asthma [19] - not useful for treatment of acute gastroenteritis in childen [23] - not useful for reducing antibiotic use in nursing homes [24] - not useful for ICU patients on mechanical ventilation (L rhamnosus GG) [26] - may be harmful in the intensive care unit (ICU) [27] - exposure to probiotics in the ICU is associated with an increase in sepsis & sepsis-related mortality due to organisms present in probiotics [27] Benefit/risk: - number needed to treat for irritable bowel syndrome = 7 [13] - shortens duration of acute infectious diarrhea by 1 day [16] - prevention of C difficile colitis - number needed to treat (NNT) = 25 [17] - no harm noted Complications: - bowel ischemia in patients with acute pancreatitis [6] - case of fatal mucormycosis in preterm infant fed supplement contaminated with Rhizopus oryzae [14] Mechanism of action: - probiotics Bacillus subtilis & Bacillus coagulans increase stool bacteria, Faecalibacterium & Roseburia [25]

Specific

Bifidobacterium bifidum powder Culturelle Lactinex Probiotica Saccharomyces cerevisiae

General

gastrointestinal agent

References

  1. Prescriber's Letter 8(2):9-10 2001
  2. Prescriber's Letter 2000 Detail-Document#: 160103 (subscription needed) http://www.prescribersletter.com
  3. Journal Watch 25(5):43, 2005 Weizman Z, Asli G, Alsheikh A. Effect of a probiotic infant formula on infections in child care centers: comparison of two probiotic agents. Pediatrics. 2005 Jan;115(1):5-9. PMID: 15629974 - Lin HC, Su BH, Chen AC, Lin TW, Tsai CH, Yeh TF, Oh W. Oral probiotics reduce the incidence and severity of necrotizing enterocolitis in very low birth weight infants. Pediatrics. 2005 Jan;115(1):1-4. PMID: 15629973 - Kliegman RM, Willoughby RE. Prevention of necrotizing enterocolitis with probiotics. Pediatrics. 2005 Jan;115(1):171-2. No abstract available. PMID: 15629995 - Bell EF. Preventing necrotizing enterocolitis: what works and how safe? Pediatrics. 2005 Jan;115(1):173-4. No abstract available. PMID: 15629996 - Van Niel CW. Probiotics: not just for treatment anymore. Pediatrics. 2005 Jan;115(1):174-7. No abstract available. PMID: 15629997 [PubMed - in process]
  4. Van Niel CW, Feudtner C, Garrison MM, Christakis DA. Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics. 2002 Apr;109(4):678-84. PMID: 11927715
  5. Prescriber's Letter 13(7): 2006 Probiotics: Patient Handout, A chart, professional information Detail-Document#: 220704 (subscription needed) http://www.prescribersletter.com
  6. Besselink MG et al, Probiotic prophylaxis in perdicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet Feb 14, 2008 early, online publication PMID: 18279948
  7. Hickson M, D'Souza AL, Muthu N, Rogers TR, Want S, Rajkumar C, Bulpitt CJ. Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial. BMJ. 2007 Jul 14;335(7610):80. Epub 2007 Jun 29. PMID: 17604300
  8. Leyer GJ et al. Probiotic effects on cold and influenza-like symptom incidence and duration in children. Pediatrics 2009 Aug; 124:e172. PMID: 19651563 http://dx.doi.org/10.1542/peds.2008-2666
  9. Prescriber's Letter 16(9): 2009 PATIENT HANDOUT: What I Need to Know About Probiotics CHART: Comparison of Common Probiotic Products COMMENTARY: Probiotics: An Update Detail-Document#: 250902 (subscription needed) http://www.prescribersletter.com
  10. Deshpande G et al. Updated meta-analysis of probiotics for preventing necrotizing enterocolitis in preterm neonates. Pediatrics 2010 May; 125:921. PMID: 20403939 - Soll RF. Probiotics: Are we ready for routine use? Pediatrics 2010 May; 125:1071. PMID: 20421256 - Tarnow-Mordi WO et al. Probiotics reduce all-cause mortality and necrotizing enterocolitis: It is time to change practice. Pediatrics 2010 May; 125:1068. PMID: 20403934
  11. Cuscak S et al How Beneficial is the Use of Probiotic Supplements for the Aging Gut? Aging health. 2011;7(2):179-186 http://www.medscape.com/viewarticle/748579?sssdmh=dm1.733080&src=journalnl
  12. Indrio F et al Prophylactic Use of a Probiotic in the Prevention of Colic, Regurgitation, and Functional Constipation, A Randomized Clinical Trial. JAMA Pediatr. Published online January 13, 2014 PMID: 24424513 http://archpedi.jamanetwork.com/article.aspx?articleid=1812293 - Chumpitazi BP and Shulman RJ Five Probiotic Drops a Day to Keep Infantile Colic Away? JAMA Pediatr. Published online January 13, 2014 PMID: 24424486 http://archpedi.jamanetwork.com/article.aspx?articleid=1812292
  13. Ford AC et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: Systematic review and meta-analysis. Am J Gastroenterol 2014 Oct; 109:1547 PMID: 25070051
  14. AlFaleh K, Anabrees J Probiotics for prevention of necrotizing enterocolitis in preterm infants. The Cochrane Library. 10 APR 2014 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005496.pub4/abstract
  15. Centers for Disease Control and Prevention (CDC) CDC Health Advisory. November 25, 2014, Fatal Gastrointestinal Mucormycosis in an Infant Following Ingestion of Contaminated Dietary Supplement - Connecticut, 2014. http://emergency.cdc.gov/han/han00373.asp
  16. The NNT: Probiotics for Acute Infectious Diarrhea. http://www.thennt.com/nnt/probiotics-for-acute-infectious-diarrhea/ - Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 2010 Nov 10;(11):CD003048 PMID: 21069673
  17. The NNT: Co-Administration of Probiotics with Prescribed Antibiotics for Preventing C. Difficile Diarrhea. http://www.thennt.com/nnt/probiotics-for-preventing-c-difficile-diarrhea/ - McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol 2006; 101:812 PMID: 16635227 - Johnston BC, Ma SS, Goldenberg JZ et al Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta-analysis. Ann Intern Med. 2012 Dec 18;157(12):878-88. PMID: 23362517
  18. Uusitalo U et al. Association of early exposure of probiotics and islet autoimmunity in the TEDDY study. JAMA Pediatr 2015 Nov 9;1-9 [e-pub] PMID: 26552054 http://archpedi.jamanetwork.com/article.aspx?articleid=2469199 - Weinstock GM. A glimpse of microbial power in preventive medicine. JAMA Pediatr 2015 Nov 9; [e-pub] PMID: 26551837 http://archpedi.jamanetwork.com/article.aspx?articleid=2469197
  19. Cabana MD, McKean M, Caughey AB et al. Early probiotic supplementation for eczema and asthma prevention: A randomized controlled trial. Pediatrics 2017 Aug 7 PMID: 28784701 http://pediatrics.aappublications.org/content/140/3/e20163000
  20. Garcia-Larsen V, Ierodiakonou D, Jarrold K et al Diet during pregnancy and infancy and risk of allergic or autoimmune disease: A systematic review and meta-analysis. PLOS Medicine. February 28, 2018 PMID: 29489823 http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002507
  21. Wang B, Hylwka T, Smieja M et al Probiotics to Prevent Respiratory Infections in Nursing Homes: A Pilot Randomized Controlled Trial. J Am Geriatr Soc. 2018 May 9 PMID: 29741754
  22. Zmora N, Zilberman-Schapira G, Suez J et al. Personalized gut mucosal colonization resistance to empiric probiotics is associated with unique host and microbiome features. Cell 2018 Sep 6; 174:1388. PMID: 30193112 - Suez J, Zmora N, Zilberman-Schapira G et al. Post-antibiotic gut mucosal microbiome reconstitution is impaired by probiotics and improved by autologous FMT. Cell 2018 Sep 6; 174:1406. PMID: 30193113 - Severyn CJ, Bhatt AS. With probiotics, resistance is not always futile. Cell Host Microbe 2018 Sep 12; 24:334. PMID: 30212646
  23. Orciari Herman A. Fairchild DG, Di Francesco L Physician's First Watch, June 9, 2020 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society (subscription needed) http://www.jwatch.org - Szymanski H, Szajewska H. Lack of efficacy of Lactobacillus reuteri DSM 17938 for the treatment of acute gastroenteritis: A randomized controlled trial. Pediatr Infect Dis J 2019 Apr 25; [e-pub] PMID: 28060791 https://journals.lww.com/pidj/Abstract/2019/10000/Lack_of_Efficacy_of_Lactobacillus_reuteri_DSM.1.aspx
  24. Butler CC et al. Effect of probiotic use on antibiotic administration among care home residents: A randomized clinical trial. JAMA. 2020;324(1):47-56 Jul 7 PMID: 32633801 https://jamanetwork.com/journals/jama/fullarticle/2767862
  25. Hamza Z Probiotics Show Promise for Symptoms of Functional GI Disorders. Small pilot study suggested clinical benefit, acceptable safety profile. https://www.medpagetoday.com/gastroenterology/generalgastroenterology/93951 - Wauters L, Slaets H, De Paepe K et al Efficacy and safety of spore-forming probiotics in the treatment of functional dyspepsia: a pilot randomised, double-blind, placebo-controlled trial. Lancet Gastroenterol Hepatol 2021; Aug 3. PMID: 34358486 https://www.thelancet.com/journals/langas/article/PIIS2468-1253(21)00226-0/fulltext - Burns GL, Hoedt EC, Keely S Spore-forming probiotics for functional dyspepsia. Lancet Gastroenterol Hepatol 2021; Aug 3. PMID: 34358485 https://www.thelancet.com/journals/langas/article/PIIS2468-1253(21)00260-0/fulltext
  26. Johnstone J, Meade M, Lauzier F et al. Effect of probiotics on incident ventilator-associated pneumonia in critically ill patients: A randomized clinical trial. JAMA 2021 Sep 21; 326:1024. PMID: 34546300 https://jamanetwork.com/journals/jama/article-abstract/2784358
  27. Bosworth T Study Supports Banning Probiotics From the ICU. Medscape. Nov 22, 2022 https://www.medscape.com/viewarticle/984456
  28. Rapid Review Quiz: Hospital-Acquired Pneumonia Medscape. Sept 15, 2022 https://reference.medscape.com/viewarticle/980567