Probiotic use in clinical practice: what are the risks?
Open accessAbstract
Probiotics have been advocated for the prevention and treatment of a wide range of diseases, and there is strong evidence for their efficacy in some clinical scenarios. Probiotics are now widely used in many countries by consumers and in clinical practice. Given the increasingly widespread use of probiotics, a thorough understanding of their risks and benefits is imperative. In this article we review the safety of probiotics and discuss areas of uncertainty regarding their use. Although probiotics have an excellent overall safety record, they should be used with caution in certain patient groups-particularly neonates born prematurely or with immune deficiency. Because of the paucity of information regarding the mechanisms through which probiotics act, appropriate administrative regimens, and probiotic interactions, further investigation is needed in these areas. Finally, note that the properties of different probiotic species vary and can be strain-specific. Therefore, the effects of one probiotic strain should not be generalized to others without confirmation in separate studies. Careful consideration should be given to these issues before patients are advised to use probiotic supplements in clinical practice.
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Immune compromise (including a debilitated state or malignancy) has been identified as a risk factor for rare cases of bacteraemia or fungaemia in patients taking certain probiotics (most commonly Saccharomyces boulardii).
“Immune compromise (including a debilitated state or malignancy) has been identified as a risk factor for rare cases of bacteraemia or fungaemia in patients taking certain probiotics (most commonly Saccharomyces boulardii).74,75”
From Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice - an evidence-based international guide (2013) · cites this paper as [75]
The general consensus is that probiotic ingestion is safe, with large doses well tolerated and failing to exhibit any toxicity.
“The general consensus is that probiotic ingestion is safe [221, 222], with large doses well tolerated and failing to exhibit any toxicity [223].”
From International Society of Sports Nutrition Position Stand: Probiotics (2019) · cites this paper as [221]
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- Authors
- Boyle, R. J., Robins-Browne, R. M., & Tang, M. L.
- Affiliations
- Royal Children's Hospital (AU)
- Corresponding author
- Tang, Mimi LK
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2006-06
- Volume
- 83
- Issue
- 6
- Pages
- 1256-1264
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2170210827
- Cited by
- 776
- References
- 75
- Citations by year
- 2026: 21 · 2025: 38 · 2024: 37 · 2023: 46 · 2022: 32 · 2021: 48 · 2020: 39 · 2019: 36 · 2018: 32 · 2017: 45 · 2016: 40 · 2015: 37 · 2014: 50 · 2013: 45 · 2012: 52
- FWCI
- 4.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Health Sciences › Nursing › Nutrition and Dietetics › Infant Nutrition and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Keywords
- probiotics, probiotic safety, preterm infants, immunodeficiency, probiotic supplements
- MeSH terms
- Adult, Aged, Aged, 80 and over, Bifidobacterium, Child, Child, Preschool, Diarrhea, Female, Gastrointestinal Diseases, Humans, Infant, Infant, Newborn, Lactobacillus, Male, Middle Aged, Fungemia, Sepsis, Probiotics
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