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Choosing an appropriate probiotic product for your patient: An evidence-based practical guide
Open accessAbstract
INTRODUCTION: Clinicians and patients face a daunting task when choosing the most appropriate probiotic for their specific needs. Available preparations encompass a diverse and continuously expanding product base, with most available products lacking evidence-based trials that support their use. Even when evidence exists, not all probiotic products are equally effective for all disease prevention or treatment indications. At this point in time, drug regulatory agencies offer limited assistance with regard to guidance and oversight in most countries, including the U.S. METHODS: We reviewed the current medical literature and sources on the internet to survey the types of available probiotic products and to determine which probiotics had evidence-based efficacy data. Standard medical databases from inception to June 2018 were searched and discussions with experts in the field were conducted. We graded the strength of the evidence for probiotics having multiple, randomized controlled trials and developed a guide for the practical selection of current probiotic products for specific uses. RESULTS: We found the efficacy of probiotic products is both strain-specific and disease-specific. Important factors involved in choosing the appropriate probiotic include matching the strain(s) with the targeted disease or condition, type of formulation, dose used and the source (manufacturing quality control and shelf-life). While we found many probiotic products lacked confirmatory trials, we found sufficient evidence for 22 different types of probiotics from 249 trials to be included. For example, several types of probiotics had strong evidence for the prevention of antibiotic-associated diarrhea [Saccharomyces boulardii I-745, a three-strain mixture (Lactobacillus acidophilus CL1285, L. casei Lbc80r, L. rhamnosus CLR2) and L. casei DN114001]. Strong evidence was also found for four types of probiotics for the prevention of a variety of other diseases/conditions (enteral-feed associated diarrhea, travellers' diarrhea, necrotizing enterocolits and side-effects associated with H. pylori treatments. The evidence was most robust for the treatment of pediatric acute diarrhea based on 59 trials (7 types of probiotics have strong efficacy), while an eight-strain multi-strain mixture showed strong efficacy for inflammatory bowel disease and two types of probiotics had strong efficacy for irritable bowel disease. Of the 22 types of probiotics reviewed, 15 (68%) had strong-moderate evidence for efficacy for at least one type of disease. CONCLUSION: The choice of an appropriate probiotic is multi-factored, based on the mode and type of disease indication and the specific efficacy of probiotic strain(s), as well as product quality and formulation. TRIAL REGISTRATION: This review was registered with PROSPERO: CRD42018103979.
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“Our findings do not support recommendations for the use of specific probiotics for acute infectious diarrhoea in children (Floch 2015; Guarino 2018; Sniffen 2018).”
From Probiotics for treating acute infectious diarrhoea (2020) · cites this paper as Sniffen 2018
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“Also, the most suitable single-strain or probiotic mixture can then be selected based on knowledge and the summary of clinical studies reported in the literature [182].”
From The Potential Impact of Probiotics on Human Health: An Update on Their Health-Promoting Properties (2024) · cites this paper as [182]
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“Data from the literature indicates that the first aspect is related to the mode of therapy, prevention, or treatment, because different probiotics may be more suitable for each objective [182].”
From The Potential Impact of Probiotics on Human Health: An Update on Their Health-Promoting Properties (2024) · cites this paper as [182]
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“The second aspect refers to the fact that certain probiotics are more suitable for the pediatric population compared with the adult population.”
From The Potential Impact of Probiotics on Human Health: An Update on Their Health-Promoting Properties (2024) · cites this paper as [182]
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Metadata
- Authors
- Sniffen, J. C., McFarland, L. V., Evans, C. T., & Goldstein, E. J. C.
- Affiliations
- AdventHealth (US)
- University of Washington (US)
- Northwestern University (US)
- University of California, Los Angeles (US)
- Corresponding author
- McFarland, Lynne V.
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-12-26
- Volume
- 13
- Issue
- 12
- Pages
- e0209205
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6306248
- OpenAlex
- W2905982611
- Cited by
- 265
- References
- 79
- Citations by year
- 2026: 18 · 2025: 35 · 2024: 39 · 2023: 36 · 2022: 44 · 2021: 40 · 2020: 35 · 2019: 16 · 2018: 1
- FWCI
- 2.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- public-domain
- creativecommons.org/publicdomain/zero/1.0/ (vor)
- Locations
- PLoS ONE (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Bio-K+ International
- Topics
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- probiotics, probiotic strain selection, antibiotic-associated diarrhea, Saccharomyces boulardii, Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus acidophilus, inflammatory bowel disease, irritable bowel disease, necrotizing enterocolitis, traveler's diarrhea, Helicobacter pylori treatment, probiotic regulation
- MeSH terms
- Humans, Randomized Controlled Trials as Topic, Evidence-Based Medicine, Probiotics
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