From Dynamed:
Probiotics
Updated 2010 May 25 11:13 AM: Lactobacillus GG treatment decreased risk of nosocomial respiratory and gastrointestinal infections in hospitalized children (Pediatrics 2010 May) update
probiotics may reduce risk for necrotizing enterocolitis and all-cause mortality in premature VLBW infants (Pediatrics 2010 May) update
Lactobacillus sakei may reduce severity of atopic eczema-dermatitis in children (Ann Allergy Asthma Immunol 2010 Apr)
Related Summaries:
Probiotics to prevent antibiotic-associated diarrhea
Probiotics for irritable bowel syndrome
Lactobacillus acidophilus
Overview:
prevention of disease
probiotics shown to reduce rate of antibiotic-associated diarrhea (level 1 [likely reliable] evidence)
some probiotics appear effective in prevention of traveler’s diarrhea but nonviable Lactobacillus acidophilus does not appear effective (level 2 [mid-level] evidence)
some oral probiotics reduce incidence of diarrhea and fever in infants attending child care (level 1 [likely reliable] evidence)
Lactobacillus reuteri may reduce reported sick-leave and sick day frequency (level 2 [mid-level] evidence)
enteral probiotic supplementation reduces incidence of severe necrotizing enterocolitis and mortality in preterm infants (level 1 [likely reliable] evidence)
some oral probiotics given prenatally through infancy appear to reduce incidence of atopic dermatitis or eczema in infants at risk for allergic disease (level 2 [mid-level] evidence)
treatment of diarrhea
some probiotics reduce duration of acute infectious diarrhea (level 1 [likely reliable] evidence)
insufficient evidence to evaluate addition of probiotics to antibiotic therapy for treatment of C. difficile colitis
treatment of other gastrointestinal disease
some probiotics or probiotic mixtures may reduce irritable bowel syndrome (IBS) symptoms (level 2 [mid-level] evidence)
ulcerative colitis
addition of probiotic to conventional therapy does not appear to improve remission rates in patients with mild to moderate ulcerative colitis (level 2 [mid-level] evidence)
some probiotics may be as effective as mesalamine in inducing and maintaining remission (level 2 [mid-level] evidence)
no evidence to support probiotics for inducing remission, maintaining remission or preventing postoperative recurrence of Crohn’s disease
VSL#3 appears effective in preventing flare-ups of chronic pouchitis
probiotics may increase Helicobacter pylori eradication rates and reduce side effects (level 2 [mid-level] evidence)
From Up To Date
SUMMARY AND RECOMMENDATIONS — Several probiotic preparations have promise in preventing or treating various conditions. However, most studies have been small and many have important methodologic limitations, making it difficult to make unequivocal conclusions regarding efficacy, especially when compared with proven therapies. Furthermore, considerable differences exist in composition, doses, and biologic activity between various commercial preparations, so that results with one preparation cannot be applied to all probiotic preparations. Finally, costs to the patient may be considerable, since no preparation is FDA approved and hence are not reimbursed by insurers. Enthusiasm for probiotics has outpaced the scientific evidence. Large, well designed multicenter controlled clinical trials are needed to clarify the role of specific probiotics in different patient populations.
Because they are generally safe, the decision to use a probiotic rests mostly upon the degree of anticipated benefit, available alternatives, the clarity of the available data in showing a benefit, costs, and patient preferences. No probiotic strategy is currently considered to represent the standard of care nor primary treatment for any of the conditions described above. The following recommendations are based upon the author’s overall appraisal of the quality and consistency of the available evidence.
Pouchitis — Limited data from small controlled trials suggest a benefit from VSL#3 in the primary and secondary prevention of pouchitis. Thus, it is a reasonable option in addition to standard medical therapy, although long-term efficacy is uncertain. (See ‘Pouchitis’ above.)
Ulcerative colitis — A benefit of probiotics in ulcerative colitis remains unproven, but E. coli Nissle 1917 shows promise in maintaining remission and could be considered as an alternative in patients intolerant or resistant to 5-ASA preparations. No other probiotic preparation has been validated for this indication.
Crohn’s disease — A benefit of probiotics in Crohn’s disease remains unproven.
Antibiotic associated diarrhea — Large, well conducted studies are needed before probiotics can be recommended routinely for antibiotic associated diarrhea.
Infectious diarrhea — It is reasonable to recommend probiotics to adults and children with presumed infectious diarrheal illness with the hope of reducing the duration of symptoms by 17 to 30 hours. Probiotics that were effective in at least one controlled trial included Lactobacillus strain GG, Lactobacillus reuteri, combination Lactobacillus rhamnosus and Lactobacillus reuteri, and combination Lactobacillus acidophilus and Lactobacillus bifidus. The minimal effective dose appears to be 10 billion colony-forming units given within the first 48 hours of symptoms.
Irritable bowel syndrome — A benefit of probiotics for IBS remains unproven but needs to be further investigated in defined patient subsets.
Lactose intolerance — A benefit of probiotics for lactose intolerance remains unproven.
Hepatic encephalopathy — Initial studies in mild hepatic encephalopathy are encouraging. However, the role of probiotics remains unproven.
Allergy — A definitive role of probiotics for allergic conditions remains unproven, although initial results in studies of children with a variety of preparations for atopic dermatitis are promising.
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