Reappraisal of probiotics’ safety in human
Abstract
Contrary to the safe usage of probiotics for years, their threat is still worthy of attention. Several risks have been explained or mentioned in the case reports, clinical trials and experimental studies. Due to a large number of probiotic products worldwide, the certainty of the safety of such products is a matter of concern. Current review appraises all the available information about a range of adverse effects by probiotics in different populations of consumers and almost all qualified investigations and reports, relevant to the adverse effects of probiotics. Furthermore, the effects of basic or original sources of probiotics were studied. The principally noticed adverse effects of probiotics are systemic infections, gastrointestinal side effects, skin complications, inflammation of endocardium, gene transfer from probiotics to the normal microbial flora, metabolic harmful impacts of probiotics, and immune system stimulation. The most at-risk groups consist of infants, elderly people, patients in hospitalized condition, and those with immunodeficiency due to a genetic or acquired disease. The existing evidence suggests careful evaluation of the risk-benefit ratio of probiotics prior to prescription or recommendation to use.
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Lactobacillus strains have been found to carry resistance genes to erythromycin, tetracycline, streptomycin, chloramphenicol, lincosamide, macrolides, and streptogramins.
“Additionally, Lactobacillus strains have been found to carry resistance genes to antibiotics such as erythromycin, tetracycline, streptomycin, chloramphenicol, lincosamide, macrolides, and streptogramins [28].”
From Current Concepts in Probiotic Safety and Efficacy (2026) · cites this paper as [28]
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Gut microbiota and dysbiosis in Alzheimer's disease: Implications for pathogenesis and treatment
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Antibiotic resistance propagation through probiotics
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Probiotics as modulators of gut-brain axis for cognitive development
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Potential Role of Natural Antioxidant Products in Oncological Diseases
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Gut microbiota: a new avenue to reveal pathological mechanisms of constipation
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Functional meat products: Trends in pro-, pre-, syn-, para- and post-biotic use
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Bioactive peptides produced by engineered probiotics and other food-grade bacteria: A review
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Invasive Infections Associated with the Use of Probiotics in Children: A Systematic Review
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Postbiotics versus probiotics: Possible new allies for human health
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Biodetoxification and Protective Properties of Probiotics
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A Narrative Review of Psychobiotics: Probiotics That Influence the Gut–Brain Axis
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Gut Microbiota: An Important Participant in Childhood Obesity
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A brief overview on the use of probiotics to treat overweight and obese patients
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Self-citationMicrobial Variability of Commercial Equine Probiotics
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Accounting for the health risk of probiotics
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Overview of Dairy-based Products with Probiotics: Fermented or Non-fermented Milk Drink
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Gut-brain axis and Alzheimer's disease: Therapeutic interventions and strategies
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Probiotics as a Complementary Therapy for Management of Obesity: A Systematic Review
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A Narrative Review on the Advance of Probiotics to Metabiotics
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An overview of interventions for constipation in adults
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2025 Seoul Consensus on Clinical Practice Guidelines for Irritable Bowel Syndrome
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Perspectives on Probiotics and Bronchopulmonary Dysplasia
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A review of the auditory-gut-brain axis
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Drug discovery strategies for modulating oxidative stress in gastrointestinal disorders
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Self-citationGut Microbiota: A Potential Target for Cancer Interventions
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Current Concepts in Probiotic Safety and Efficacy
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“Probiotics are considered safe due to their composition and may also be suitable for most vulnerable populations, such as infants, the elderly, and those with weakened immune systems [28].”
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Psychobiotics as a novel strategy for alleviating anxiety and depression
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Recommendations for nutritional supplements for dry eye disease: current advances
Cong, Y., Zhang, Y., Han, Y., Wu, Y., Wang, D., & Zhang, B. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1388787 · Cited by 22 · see citing works
Probiotics in the Management of Mental and Gastrointestinal Post-COVID Symptomes
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Gut microbiota alteration - Cancer relationships and synbiotic roles in cancer therapies
Rowaiye, A. B., Ibeanu, G. C., Bur, D., Nnadi, S., Mgbeke, O. E., & Morikwe, U. C. (2024) · The Microbe · doi:10.1016/j.microb.2024.100096 · Cited by 20 · see citing works
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Postbiotics as Potential Detoxification Tools for Mitigation of Pesticides
Khani, N., Noorkhajavi, G., Raziabad, R. H., Rad, A. H., & Ziavand, M. (2023) · Probiotics and Antimicrobial Proteins · doi:10.1007/s12602-023-10184-1 · Cited by 19 · see citing works
An insight into the health beneficial of probiotics dairy products: a critical review
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Postbiotic Bioactive Packaging Systems: A Review
Soleimani, R. A., Shokouhian, S. M. J., Houshyar, J., Khani, N., Abachi, S., Milani, P. G., Panahi, E., & Rad, A. H. (2023) · Current Nutrition & Food Science · doi:10.2174/1573401319666230309122819 · Cited by 17 · see citing works
Safety of probiotics in humans: A dark side revealed?
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Antioxidant and Anti-Inflammatory Activities of Probiotic Strains
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Host Microbiomes in Tumor Precision Medicine: How far are we?
D’Amico, F., Barone, M., Tavella, T., Rampelli, S., Brigidi, P., & Turroni, S. (2022) · Current Medicinal Chemistry · doi:10.2174/0929867329666220105121754 · Cited by 15 · see citing works
Current research status and trends in the bioactivity of postbiotics
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Is there a role for microbiome-based approach in common variable immunodeficiency?
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Engineered microorganisms: A new direction in kidney stone prevention and treatment
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Modulating the Gut Microbiome in Type 2 Diabetes: Nutritional and Therapeutic Strategies
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Fruit Juices as Alternative to Dairy Products for Probiotics’ Intake
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Probiotics in fermented products and supplements
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- Authors
- Sotoudegan, F., Daniali, M., Hassani, S., Nikfar, S., & Abdollahi, M.
- Affiliations
- Pharmaceutical Quality Assurance Research Center (IR)
- Tehran University of Medical Sciences (IR)
- Pharmaceutical Management and Economics Research Center (IR)
- Corresponding author
- Nikfar, Shekoufeh
- Abdollahi, Mohammad
- Venue
- Food and Chemical Toxicology
- Publisher
- Elsevier BV
- Published
- 2019-07
- Volume
- 129
- Pages
- 22-29
- ISSN
- 0278-6915 (ISSN-L)
- OpenAlex
- W2936535283
- Semantic Scholar
- eb40ff5c62f7d06b2ae4bbb7558b0b98a5d5b527
- Cited by
- 154
- References
- 102
- Citations by year
- 2026: 22 · 2025: 15 · 2024: 23 · 2023: 28 · 2022: 21 · 2021: 23 · 2020: 18 · 2019: 3 · 2017: 1
- FWCI
- 1.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Food and Chemical Toxicology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- probiotics, probiotic safety, adverse effects, systemic infection, gastrointestinal adverse effects, skin complications, endocarditis, metabolic effects, immunostimulation, immunodeficiency, infants, older adults, hospitalized patients, risk-benefit assessment
- MeSH terms
- Humans, Probiotics, Patient Safety, Drug-Related Side Effects and Adverse Reactions
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