II. Definitions
- Probiotic
- Microorganisms taken as dietary supplements to help improve intestinal microbial balance
- Human Microbiota (esp. Gut Flora)
- Microbes that colonize human body, influenced by vertical transmission, environment (e.g. pets), diet
III. Indications
- Prevention of Antibiotic-Associated Diarrhea
- Unclear if effective for Clostridium difficile, but does appear to decrease Antibiotic Associated Diarrhea (NNT 13)
- Best evidence is for Lactobacillus rhamosus GG (Culturelle) and Saccharomyces boulardii (Florastor)
- Start within 3 days of initiating antibiotic course and continue for 3 days after completing course
- Separate the doses of antibiotic and Probiotic by at least 2 hours
- (2020) Presc Lett 27(9): 49-50
- Irritable Bowel Syndrome
- Atopic Dermatitis in Infants
-
Infectious Diarrhea (Gastroenteritis)
- Lactobacillus does not appear to reduce Diarrhea in Children
- Schnadower (2018) N Engl J Med 379(21):2002-14 [PubMed]
IV. Physiology
- Human Gastrointestinal Microbiota may have an impact on Obesity and human disease
- High fiber diet from various sources encourages a more diverse Gut Flora and may result in improved health
- Resources
- Nature Journal - Microbiota
- References
- Sonnenberg (2018) Healthy Kitchens Conference, Harvard and Culinary Institute, St. Helena, CA
V. Contraindications
- Severe immunompromised state
- Short-Gut Syndrome (relative contraindication)
- Some Probiotic preparations may contain gluten (avoid in Celiac Sprue)
VI. Dosing
- Children: 5-10 Billion Colony Forming Units per day
- Adults: 10-20 Billion Colony Forming Units per day
VII. Components (most brands contain a mixture of multiple Probiotic strains)
- Lactobacillus species
- Lactobacillus acidophilus
- Lactobacillus rhamnosus
- Lactobacillus bulgaricus
- Bifidobacterium species
- Bifidobacterium bifidum
- Bifidobacterium longum
- Saccharomyces species
VIII. Preparations
- Precautions
- Most significant factor affecting efficacy appears to be at least 5-10 Billion CFUs
- Specific organisms appear to have less of an impact on efficacy
- Activa yogurt (5-10 B CFU/container), Align (1 B CFU/cap)
- Bifidobacterium species
- Bio-K Plus (12.5 B CFU/cap), Bacid (1 B CFU/cap), Lactinex (1 M CFU/tab)
- Lactobacillus species
- Culturelle (10 B CFU/cap)
- Lactobacillus rhamosus
- DanActive yogurt drink (1 B CFU/3 oz)
- Lactobacillus species
- Streptococcus species
- Jamieson Probiotic Sticks (3 billion CFU/stick)
- Lactobacillus species
- Bifidobacterium species
- Iflora Multi-Biotic (16 B CFU/cap), Probiotic-10 (25 B CFU/cap)
- Lactobacillus species
- Streptococcus species
- Bifidobacterium species
- Kefir fermented milk drink (7-10 B CFU/8 oz)
- Bifidobacterium species
- Lactobacillus species
- Leuconostoc species
- Saccharomyces florentinus
- Florastor (1 B CFU/cap)
- Saccharomyces boulardii
- Garden of Life Raw Probiotics Ultimate Care (100 B CFU/cap)
- Bifidobacterium species
- Lactobacillus species
- Leuconostoc species
- Saccharomyces species
- Streptococcus species
- Additional 5 Bacteria distinct to this formulation (unknown efficacy)
IX. Adverse Effects
- Flatulence
- Abdominal discomfort
X. Drug Interactions
- None
XI. Efficacy
- See Infantile Colic
- See Necrotizing Enterocolitis
-
Antibiotic Associated Diarrhea significantly reduced if Probiotics started in first 3 days of antibiotics
- Prevents Antibiotic Associated Diarrhea (NNT 12) and Clostridium difficile (NNT 29)
- Probiotic examples: Bio-K+, Culturelle, DanActive, Florajen or Florastor
- Take 2 hours after each antibiotic dose
- Continue for up to 2 weeks after completing antibiotics
- Sazawal (2006) Lancet Infect Dis 6(6): 374-82 [PubMed]
- McFarland (2006) Am J Gastroenterol 101(4): 812-22 [PubMed]
-
Acute Infectious Diarrhea reduced duration with Probiotics
- May shorten Diarrhea course by one day
- May also prevent Traveler's Diarrhea
- Canani (2007) BMJ 335(7615):340 [PubMed]
-
Constipation
- Improves stooling frequency and symptoms in both children and adults with Functional Constipation
- Ford (2014) Am J Gastroenterol 109(10): 1547-61 [PubMed]
- Guerra (2011) World J Gastroenterol 17(34): 3916-21 [PubMed]
- Irritable Bowel Syndrome with reduced symptoms in women on Probiotics
-
Ulcerative Colitis
- Increases remission rates with Ulcerative Colitis flares
- Shen (2014) Inflamm Bowel Dis 20(1): 21-35 [PubMed]
- Atopic Disease development risk may be reduced with Probiotics in infants
- Other conditions with mixed or inconclusive data to support Probiotic use