PROBIOTICS

OTHER NAME(S):

Probiotic, Probiotique.

Overview

Overview Information

Probiotics are live bacteria and yeasts that are thought to improve health. There are many different species of probiotics. Some are part of the normal digestive system and live in the body without causing disease. Probiotics are sometimes taken as supplements. They are also found in many foods, including cheese, kefir, kimchi, kombucha, miso, sauerkraut, and yogurt.

The most common probiotics found in dietary supplements include lactobacillus, bifidobacteria, and Saccharomyces boulardii. But many other bacteria and yeast species can be found in probiotic supplements and foods.

Probiotics are used for rotaviral diarrhea, diarrhea in people taking antibiotics (antibiotic-associated diarrhea), travelers' diarrhea, irritable bowel syndrome (IBS), constipation, inflammatory bowel disease (IBD), and many other conditions. Keep in mind that not all probiotics have the same effects. So, one probiotic or combination of probiotics may be helpful for certain conditions, while other probiotics are not.

Coronavirus disease 2019 (COVID-19): There is no good evidence to support using probiotics for COVID-19. Follow healthy lifestyle choices and proven prevention methods instead.

How does it work?

Many bacteria and other organisms live in our bodies normally. These "friendly" bacteria and yeasts can help break down food, absorb nutrients, and fight off "unfriendly" organisms that might cause diseases such as diarrhea. Probiotics might also increase immune system function.
Uses

Uses & Effectiveness?

Likely Effective for

  • Diarrhea caused by rotavirus. Taking Saccharomyces boulardii probiotics can reduce the length of diarrhea by 1-3 days in children with rotaviral diarrhea. But probiotics that contain Lactobacillus do not seem to help.

Possibly Effective for

  • Diarrhea in people taking antibiotics (antibiotic-associated diarrhea). Most research shows that taking probiotics along with antibiotics can help prevent diarrhea caused by antibiotics. Various products containing lactobacillus, bifidobacteria, and Saccharomyces boulardii probiotics seem to work. Some research also suggests that eating milk or yogurt that contains probiotics can help to reduce diarrhea caused by antibiotics. But not all research agrees.
  • Eczema (atopic dermatitis). Most research shows that taking probiotics reduces a child's risk of developing eczema. Also, mothers who take probiotics while pregnant might reduce the chance of the baby developing eczema during childhood. But probiotics don't seem to improve the symptoms of eczema in adults or children who already have eczema. Most research has evaluated probiotics containing lactobacillus. But it's unclear if this is the most beneficial species.
  • Prone to allergies and allergic reactions (atopic disease). Taking a specific probiotic strain (Lactobacillus GG; Culturelle) seems to help prevent allergic reactions in babies. Other probiotic products don't seem to work as well.
  • Overgrowth of bacteria in the vagina. Research shows that taking probiotics alone or with antibiotics may help treat this condition.
  • Infection of the gastrointestinal tract by a bacteria called Clostridium difficile. Research shows that taking probiotics can reduce the chance of developing a Clostridium difficile infection in people who are at high risk for this infection. Some research also shows that taking saccharomyces boulardii probiotics might reduce the chance of having a SECOND Clostridium difficile infection in people who have had diarrhea due to Clostridium difficile in the past. But lactobacillus probiotics don't seem to reduce the risk for a second infection.
  • Excessive crying in infants (colic). Some research shows that taking a specific lactobacillus strain (Lactobacillus reuteri DSM 17938) seems to decrease crying time in babies with colic who are being breast-fed. But not all research agrees. It's unclear if other probiotics are beneficial. Also, taking probiotics does not seem to reduce an infant's risk for developing colic.
  • Constipation. Taking probiotics can increase the number of bowel movements each week in adults with constipation. Probiotic products that contain Lactobacillus reuteri DSM 17938 seem to work best. But probiotics don't seem to help with constipation in children.
  • Diarrhea. Probiotics seem to help prevent and treat diarrhea due to a variety of causes in adults and children. Probiotics containing Saccharomyces boulardii or lactobacillus seem to work best in adults. Probiotics containing Saccharomyces boulardii or bifidobacteria seem to work best in children.
  • A digestive tract infection that can lead to ulcers (Helicobacter pylori or H. pylori). Some research shows that taking probiotics along with the standard medications for H pylori infection can improve how well the treatment works in some people. But it's unclear which probiotic is most beneficial.
  • Reduced brain function in people with advanced liver disease (hepatic encephalopathy). Some research shows that taking probiotics can improve brain function in people with advanced liver disease. It's unclear which probiotic might work best.
  • High cholesterol. Taking probiotics containing lactobacillus seems to help lower cholesterol in some people with high cholesterol. It isn't clear if other types of probiotics can lower cholesterol.
  • A long-term disorder of the large intestines that causes stomach pain (irritable bowel syndrome or IBS). Probiotics seem to improve symptoms such as stomach pain and bloating in people with IBS. Products that contain Bifidobacterium infantis 35624 seem to work best.
  • A serious intestinal disease in premature infants (necrotizing enterocolitis or NEC). Products containing multiple probiotics seem to reduce the chance of a preterm infant developing necrotizing enterocolitis. But products containing only one probiotic species do not seem to help. It isn't clear which probiotic combination might work best.
  • Swelling (inflammation) and sores inside the mouth (oral mucositis). Some research shows that taking lozenges containing a specific probiotic strain (Lactobacillus brevis CD2) can prevent or reduce mouth sores in people receiving cancer treatment. It's unclear if other types of probiotics will have this effect.
  • Ear infection (otitis media). Taking a probiotic seems help prevent ear infection in children. Probiotics seem to work best in children that are not prone to getting ear infections.
  • A complication after surgery for ulcerative colitis (pouchitis). Taking probiotic preparations containing lactobacillus, bifidobacteria, and other probiotic species seems to help treat pouchitis in some people.
  • Infection of the airways. Most research shows that taking probiotics might reduce the chance of developing an airway infection in children and adults. It isn't clear which probiotic might work best.
  • Travelers' diarrhea. Some research shows that taking probiotics can help prevent diarrhea in people traveling to foreign places. Saccharomyces boulardii might work better than other probiotics, but more research is needed to confirm.

Possibly Ineffective for

  • Anxiety. Taking probiotics doesn't seem to improve symptoms of anxiety.
  • A type of inflammatory bowel disease (Crohn disease). Most research shows that taking probiotics doesn't increase the chance of remission from Crohn disease or decrease the chance of relapse for people who are in remission.
  • Blood infection (sepsis). Probiotics don't seem to reduce the chance of sepsis in premature babies. In fact, taking probiotics might increase the risk for a blood infection in people who have poor immune function or a central line.
  • Vaginal yeast infections. Most research shows that probiotics aren't helpful for preventing or treating vaginal yeast infections.
  • Obesity. Probiotics don't seem to help reduce body weight in people who are overweight or obese.

Insufficient Evidence for

  • Acne. Early research shows that some probiotic preparations may improve acne in some people. It's too early to know which, if any, probiotic might work best.
  • Hay fever. Early research shows that taking probiotics can improve quality of life and reduce some symptoms in people with seasonal allergies from different types of pollen. But not all research agrees.
  • Cavities. Some research shows that taking probiotics can help to prevent cavities. But not all research agrees.
  • Diabetes. Taking probiotics seems to help control blood sugar in women who develop diabetes during pregnancy.
  • Build up of fat in the liver in people who drink little or no alcohol (nonalcoholic fatty liver disease or NAFLD). Early research shows that taking probiotics might reduce body weight and improve liver function in people with NAFLD.
  • Rheumatoid arthritis (RA). Early research shows that lactobacillus probiotics might improve some symptoms of RA, although probiotics don't seem to reduce the number of swollen joints.
  • Excessive growth of bacteria in the small intestines. Some research shows that lactobacillus probiotics can improve some, but not all, symptoms of extra bacteria growing in the small intestine. But lactobacillus probiotics do not seem to help to prevent this extra bacteria from growing in the small intestine. It's unclear if other types of probiotics can help.
  • A type of inflammatory bowel disease (ulcerative colitis). Some research shows that taking products containing multiple probiotics might help people with ulcerative colitis to go into remission. But taking probiotics doesn't seem to prevent relapse in people who are already in remission.
  • Infections of the kidney, bladder, or urethra (urinary tract infections or UTIs). Some early research shows that lactobacillus probiotics given by mouth or inserted into the vagina might help prevent UTIs in some women. But not all research agrees. Other research shows that probiotics don't help to prevent UTIs in children.
  • Other conditions.
More evidence is needed to rate probiotics for these uses.

Side Effects

Side Effects & Safety

When taken by mouth: Probiotics are LIKELY SAFE for most adults when taken appropriately. Lactobacillus probiotics appear to be safe when taken for up to 9 months. Bifidobacteria probiotics appear to be safe when taken for up to 12 months. Saccharomyces boulardii probiotics appear to be safe when taken for up to 15 months. Side effects are usually mild and most often include gas or bloating. There isn't enough reliable information to know if other probiotic species are safe or what the side effects might be.

When inserted into the vagina: Probiotics containing lactobacillus are LIKELY SAFE when used appropriately, short-term. There isn't enough reliable information to know if other probiotic species are safe or what the side effects might be.

Special Precautions & Warnings:

Children: Probiotics products containing bifidobacteria or lactobacillus are LIKELY SAFE in children. Bifidobacteria probiotics are safe in children when used for up to 12 months. Lactobacillus GG, a specific strain of Lactobacillus rhamnosus, has been used safely for up to 15 months in children. Lactobacillus brevis, Lactobacillus johnsonii, and Lactobacillus reuteri have been safely used for up to 12 weeks in children. Probiotics containing Saccharomyces boulardii are POSSIBLY SAFE when used orally and appropriately in children. There isn't enough reliable information to know if other probiotic species are safe for children.

Pregnancy and breast-feeding: Probiotics containing certain lactobacillus or bifidobacteria species are POSSIBLY SAFE when used orally and appropriately when pregnant or breast-feeding. Lactobacillus GG, a specific strain of Lactobacillus rhamnosus, has been safely used during pregnancy and in nursing women for up to 6 months. The combination of Lactobacillus rhamnosus or Lactobacillus paracasei with Bifidobacterium longum has been used with apparent safety during pregnancy and lactation.

There isn't enough reliable information to know if other probiotic species are safe to use when pregnant or breast-feeding. Stay on the safe side and avoid use.

Central lines: Infections of the blood have been reported in people who have central lines and take probiotics containing either lactobacillus or Saccharomyces boulardii. In many cases, infections were caused when the catheter became contaminated by the air or surfaces or hands that had touched the probiotics. If you have a central line, talk with your healthcare provider before taking probiotics.

Digestive system problems: Infections of the blood have been reported in a small number of people with digestive system conditions such as short bowel syndrome, ulcerative colitis, or intestinal obstruction (after abdominal surgery) who were taking probiotics containing lactobacillus or bifidobacterium probiotics. If you have any of these conditions, talk with your healthcare provider before taking probiotics.

Weakened immune system: Probiotics have caused infections of the blood in a small number of people with weakened immune systems, such as those with HIV/AIDS, or people who are taking medications to prevent transplant rejection. The actual number of cases of probiotic-related infections is hard to determine. The concern seems to be greatest for people who are very sick or who have weakened immune systems. If you have a weakened immune system, talk with your healthcare provider before taking probiotics.

Damaged heart valves: Probiotic preparations containing lactobacillus can cause an infection in the inner lining of the heart chambers and heart valve. This is extremely rare, but people with damaged heart valves might be more likely to develop this type of infection. The risk is especially high if lactobacillus is taken before dental procedures or surgical procedures. People with damaged heart valves should stop taking probiotics before dental procedures or surgical procedures.

Yeast allergy: People with yeast allergy can be allergic to probiotic products containing Saccharomyces boulardii and should avoid these products if possible.

Interactions

Interactions?

We currently have no information for PROBIOTICS Interactions.

Dosing

Dosing

The following doses have been studied in scientific research:

ADULTS

BY MOUTH:

  • Diarrhea in people taking antibiotics (antibiotic-associated diarrhea):
    • Lactobacillus 6-40 billion colony-forming units per day is commonly used. In most cases, lactobacillus treatment is initiated within 2 days of starting antibiotic treatment and continued for at least 3 days after antibiotic treatment.
    • Saccharomyces boulardii 250-500 mg two to four times a day, usually not to exceed 1000 mg daily, has also been commonly used during antibiotic treatment.
  • Prone to allergies and allergic reactions (atopic disease):
    • Lactobacillus 10-20 billion colony-forming units daily for 2-4 weeks taken by the pregnant mother before delivery.
  • Infection of the gastrointestinal tract by a bacteria called Clostridium difficile:
    • Saccharomyces boulardii 500 mg twice daily (equivalent to 10 billion colony-forming units daily) for 4 weeks in combination with the prescription medications, vancomycin or metronidazole. Typically, treatment is started within 2 days of beginning antibiotic treatment and continued for up to 2 weeks after completing antibiotic treatment.
  • Constipation:
    • There is a wide range of doses depending on the probiotic strain being used.
    • Lactobacillus 100 million colony-forming units 2-4 times daily for 4-8 weeks.
    • Bifidobacteria products 100 million to 12.5 billion colony-forming units daily for 2-4 weeks.
  • A digestive tract infection that can lead to ulcers (Helicobacter pylori or H. pylori):
    • Various doses of lactobacillus-containing products have been used.
    • Saccharomyces boulardii 500-1000 mg daily for 1-4 weeks.
    • Bifidobacteria in combination with lactobacillus at a total dose of 5 billion colony-forming units daily for 1 week during standard Helicobacter triple therapy and 1 week thereafter.
  • High cholesterol:
    • Lactobacillus 1.2 billion colony-forming units, has been used daily for 12 weeks.
    • Eating a specific yogurt or taking specific capsules containing lactobacillus 2.9-50 billion colony-forming units daily for 6-9 weeks.
    • Fermented milk products providing lactobacillus 39 million to 2 billion colony-forming units daily, alone or along with other probiotic species for up to 6 weeks.
    • Fermented milk 375 grams containing lactobacillus and bifidobacteria, taken daily in divided doses for 4 weeks.
    • Brewer's yeast 20 grams containing chromium 48 mcg daily for 8 weeks.
  • A long-term disorder of the large intestines that causes stomach pain (irritable bowel syndrome or IBS):
    • There is wide variation in dosing depending on the strain of lactobacillus or bifidobacteria used.
    • Lactobacillus up to 10 billion colony-forming units daily for 4 weeks.
    • Bifidobacteria 100 million colony-forming units as capsules or 1 billion colony-forming units as a malted milk drink daily for 4-8 weeks.
    • Saccharomyces boulardii 200 billion colony-forming units daily for 4 weeks.
  • Swelling (inflammation) and sores inside the mouth (oral mucositis):
    • Lozenges containing lactobacillus 2 billion colony-forming units per lozenge, dissolved in the mouth and swallowed every 2-3 hours up to six times daily. The lozenges are started on the first day of radiation/chemotherapy and continued until one week after treatment.
  • A complication after surgery for ulcerative colitis (pouchitis):
    • A combination probiotic containing lactobacillus, bifidobacterium, and streptococcus, 3 grams standardized to contain 300-500 billion colony-forming units per gram, taken twice daily for up to a year.
    • A specific formulation containing lactobacillus 1 billion colony-forming units per capsule and bifidobacteria 600 million colony-forming units per capsule, taken in doses of two capsules three times daily for 9 months.
  • Infection of the airways:
    • Lactobacillus 1 billion colony-forming units daily for 12 weeks.
    • Bifidobacteria 3 billion colony-forming units daily for 6 weeks.
  • Travelers' diarrhea:
    • Lactobacillus 2 billion colony-forming units daily, starting two days prior to a trip and continuing until the end of the trip.
    • Saccharomyces boulardii 250-1000 mg daily for 1 month.
CHILDREN

BY MOUTH:
  • Diarrhea in people taking antibiotics (antibiotic-associated diarrhea):
    • Lactobacillus 10-20 billion colony-forming units once daily or 20 billion colony-forming units twice daily given throughout the antibiotic treatment period.
    • Saccharomyces boulardii 250 mg once or twice daily (equivalent to about 5-10 billion colony-forming units) during antibiotic treatment.
  • Diarrhea caused by rotavirus:
    • Saccharomyces boulardii 200-250 mg twice daily for 5 days in children ages 3 months to 5 years.
  • Eczema (atopic dermatitis):
    • Various doses of probiotics have been studied. These doses depend on the specific strain or product being used. Discuss dosing with your healthcare provider.
  • Prone to allergies and allergic reactions (atopic disease):
    • Lactobacillus 10-20 billion colony-forming units daily for the first 3-6 months of life.
  • Infection of the gastrointestinal tract by a bacteria called Clostridium difficile :
    • Saccharomyces boulardii 500 mg (equivalent to 10 billion colony-forming units) daily during antibiotic treatment.
  • Diarrhea
    • Lactobacillus 6 billion colony-forming units twice daily for the duration of hospitalization in infants and children ages 1 to 36 months.
    • For treating acute diarrhea, Saccharomyces boulardii 250 mg once or twice daily for 5 days.
    • o For treating persistent diarrhea, Saccharomyces boulardii 1750 billion to 175 trillion colony-forming units twice daily for 5 days in children ages 6-24 months.
    • For preventing diarrhea, Saccharomyces boulardii 500 mg four times daily in tube feedings.
    • A yogurt made from infant formula fermented with lactobacillus and streptococcus, given daily for 5 days, in children aged 3-36 months to treat persistent diarrhea. Yogurt 15 mL/kg daily in breast-feeding children aged 6-24 months to treat acute diarrhea. Yogurt containing lactobacillus, bifidobactera, and streptococcus, 100 mL daily for 5 days, in children aged 6 months to 12 years to treat acute diarrhea.
  • Constipation
    • Lactobacillus 100 million colony-forming units daily for 8 weeks.
    • Bifidobacteria 1-100 billion colony-forming units daily for 4 weeks in children aged 3-16 years.
  • A digestive tract infection that can lead to ulcers (Helicobacter pylori or H. pylori):
    • A combination of lactobacillus 94 billion colony-forming units and bifidobacteria 8.6 billion colony-forming units has been used in combination with standard prescription medications for H. pylori infection for 2 weeks, followed by the probiotics alone for an additional 4 weeks.
    • Saccharomyces boulardii 250 mg twice daily for 2-4 weeks.
  • Excessive crying in infants (colic)
    • Lactobacillus 100 million colony-forming units daily for up to 90 days in breast-fed infants.
  • A long-term disorder of the large intestines that causes stomach pain (irritable bowel syndrome or IBS):
    • Bifidobacteria 10 billion colony-forming units daily for 4 weeks.
  • Infection of the airways:
    • A combination of lactobacillus and bifidobacteria taken in a dose of 1 billion colony-forming units each twice daily for 3 months in schoolchildren.
    • A milk product containing 5 billion colony-forming units each of lactobacillus and bifidobacteria in 120 mL of milk twice a day in children aged 3-5 years.
  • Travelers' diarrhea:
    • Lactobacillus 2 billion colony-forming units daily starting 2 days prior to the trip and continuing until the end of the 1-2 week trip.

View References

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