Probiotics: sorting the evidence from the myths

Abstract

Probiotics consist of yeast or bacteria, especially lactic acid bacteria. They are available as capsules, powder, fermented milks or yoghurts. Probiotics exhibit strain‐specific differences in their resistance to acid and bile, ability to colonise the gastrointestinal tract, clinical efficacy, and benefits to the health of the host. There is level I evidence for the use of probiotics in treating acute infectious diarrhoea and preventing antibiotic‐associated diarrhoea, with Lactobacillus rhamnosus GG and Saccharomyces boulardii having the most evidence to support their use for these conditions. There is level II evidence that S. boulardii combined with high‐dose vancomycin is more effective than the antibiotic alone in preventing recurrent Clostridium difficile diarrhoea. There is level I evidence that probiotics prevent traveller's diarrhoea. There is level I evidence for use of the high‐potency probiotic VSL#3 in preventing pouchitis, and level II evidence for this agent in preventing relapse in patients with ulcerative colitis. Probiotics are generally regarded as safe and well tolerated. Some probiotics may be contraindicated in patients who are immunocompromised or have severe underlying illness, as they have been reported to cause fungaemia and bacteraemia.

Probiotics in the treatment of acute rotavirus diarrhoea. A randomized, double-blind, controlled trial using two different probiotic preparations in Bolivian children

“…Children receiving the multiple species product tended to have less time with diarrhoea and no patients vomited after the treatment was started. In previous studies that administered multiple species products similar to the one we used, other authors found a rather more pronounced effect, 30 hours [14,19] and 30-36 hours reduction in diarrhoeal duration [20-23], in comparison with the 26 hours reduction we found. Infants hospitalized in our study were admitted with severe diarrhoea and had intense clinical manifestations in comparison to outpatients with rotavirus diarrhoea; this could explain the less intense results obtained.…”

Antimicrobial-resistant Klebsiella species isolated from free-range chicken samples in an informal settlement

“…This can be achieved by improving methods of animal husbandry, the eradication of diseases in animals, the optimal use of existing vaccines and the development of new vaccines [18, 19]. Generally, these interventions are aimed at reducing the development and incidence of resistant bacterial infections, thereby prolonging or restoring the effectiveness of existing antibiotics [20]. Importantly, a good programme for prevention of antibiotic resistance also includes an active system of surveillance for resistance, an active and effective infection control programme to minimize secondary spread of resistance, and the sensible use of antimicrobials in animal production systems [21].…”

Intestinal microbiota in human health and disease: the impact of probiotics

“…Since modulation of the composition of intestinal microbiota by probiotics was demonstrated to be possible, probiotic intervention has the potential to counterbalance intestinal dysbiosis and thus restore health. The effectiveness of probiotic intervention has been studied in a number of human diseases, including IBD (CD, UC and pouchitis), IBS, constipation, diarrhoea (including AAD), colon cancer, cardiovascular disease, NEC, allergic diseases, obesity and metabolic disorders and these have been the subject of systematic reviews as well as Cochrane reviews (Gareau et al 2010; Iannitti and Palmieri 2010; Pham et al 2008; Sanz et al 2010; Weichselbaum 2010). With the possible exception of NEC and pouchitis, variable clinical effects are found.…”