The safety of probiotics

Division of Geographic Medicine and Infectious Diseases and Department of Medicine, Tufts-New England Medical Center, and Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Clinical Infectious Diseases (Impact Factor: 9.42). 03/2008; 46 Suppl 2(Suppl 2):S104-11; discussion S144-51. DOI: 10.1086/523331
Source: PubMed

ABSTRACT Probiotics are generally defined as microorganisms that, when consumed, generally confer a health benefit on humans. There is considerable interest in probiotics for a variety of medical conditions, and millions of people around the world consume probiotics daily for perceived health benefits. Lactobacilli, bifidobacteria, and lactococci have generally been regarded as safe. There are 3 theoretical concerns regarding the safety of probiotics: (1) the occurrence of disease, such as bacteremia or endocarditis; (2) toxic or metabolic effects on the gastrointestinal tract; and (3) the transfer of antibiotic resistance in the gastrointestinal flora. In this review, the evidence for safety of the use of or the study of probiotics is examined. Although there are rare cases of bacteremia or fungemia related to the use of probiotics, epidemiologic evidence suggests no population increase in risk on the basis of usage data. There have been many controlled clinical trials on the use of probiotics that demonstrate safe use. The use of probiotics in clinical trials should be accompanied by the use of a data-safety monitoring board and by knowledge of the antimicrobial susceptibilities of the organism used.

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    ABSTRACT: Aims of methods. Effects of intervention with Lactobacillus casei Shirota (LcS) on the incidence of antibiotic-associated diarrhoea (AAD), Clostridium difficile infection (CDI) and changes in faecal microbiota were analysed using C. difficile ELISA (678 patients), qPCR using 16S rRNA group-specific primers, C. difficile-toxin kit and polymerase chain reaction/denaturing gradient gel electrophoresis (56 patients).ResultsResults. As much as 18.5% of antibiotic treated group developed AAD, but only 5% of patients treated with antibiotics and LcS. Following antibiotic therapy, a decrease in the abundance of total Bacteria, Clostridium cluster IV and XI, Bifidobacterium spp. and butyryl-CoA CoA transferase genes was observed, whereas Enterobacteriaceae increased. LcS intervention reduced the antibiotic-associated decrease in the diversity of microbiota, increased the abundance of Lactobacillus spp. and reduced the antibiotic-induced decrease of Bifidobacterium spp.Conclusions Conclusions. Antibiotic treatment affects the diversity and the composition of the microbiota impairing butyrate production. Intervention with certain Lactobacillus strains may antagonise some of these changes, and more potent short-chain fatty acid-stimulating probiotics are desirable for intervention in AAD.
    Food and Agricultural Immunology 01/2012; DOI:10.1080/09540105.2012.689816 · 0.98 Impact Factor
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    Type 1 Diabetes - Complications, Pathogenesis, and Alternative Treatments, 11/2011; , ISBN: 978-953-307-756-7
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    ABSTRACT: Strains of the genus Bifidobacterium are frequently used as probiotics, for which the absence of acquired antimicrobial resistance has become an important safety criterion. This clarifies the need for antibiotic susceptibility data for bifidobacteria. Based on a recently published standard for antimicrobial susceptibility testing of bifidobacteria with broth microdilution method, the range of susceptibility to selected antibiotics in 117 animal bifidobacterial strains was examined. Narrow unimodal MIC distributions either situated at the low-end (chloramphenicol, linezolid, and quinupristin/dalfopristin) or high-end (kanamycin, neomycin) concentration range could be detected. In contrast, the MIC distribution of trimethoprim was multimodal. Data derived from this study can be used as a basis for reviewing or verifying present microbiological breakpoints suggested by regulatory agencies to assess the safety of these micro-organisms intended for the use in probiotics.
    04/2011; 2011:989520. DOI:10.1155/2011/989520