Supplement Forms/Alternate Names
- B. bifidus
- L. acidophilus
- L. bulgaricus
- L. casei
- L. gasseri
- L. reuteri
- L. plantarum
- L. sakei
- Lactobacillus GG
- Lactobacillus LB
- S. salivarius
- S. thermophilus
- Saccharomyces boulardii
Principal Proposed Uses
Other Proposed Uses
- Allergic Rhinitis
- Behcet’s Syndrome
- Canker Sores
- Colds (Prevention)
- Colon Cancer (Prevention)
- Constipation (Chronic)
- Diverticular Disease
- High Cholesterol
- Immune Support
- Inflammatory Bowel Disease ( Ulcerative Colitis and Crohn’s Disease )
- Liver Disease
- Milk Allergies
- Rheumatoid Arthritis
- Vaginal Infection
- Ventilator-associated Pneumonia
- Yeast Hypersensitivity Syndrome
Lactobacillus acidophilus is a "friendly" strain of bacteria used to make yogurt and cheese. Although we are born without it, acidophilus soon establishes itself in our intestines and helps prevent intestinal infections. Acidophilus also flourishes in the vagina, where it protects women against yeast infections.
Acidophilus is one of several microbes known collectively as probiotics (literally, "pro life," indicating that they are bacteria and yeasts that help rather than harm). Others include the bacteria L. bulgaricus , L. reuteri , L. plantarum , L. casei , B. bifidus , S. salivarius , and S. thermophilus and the yeast Saccharomyces boulardii . Your digestive tract is like a rain forest ecosystem with billions of bacteria and yeasts rather than trees, frogs, and leopards. Some of these internal inhabitants are more helpful to your body than others. Acidophilus and related probiotics not only help the digestive tract function, they also reduce the presence of less healthful organisms by competing with them for the limited space available. For this reason, use of probiotics can help prevent infectious diarrhea.
Antibiotics can disturb the balance of your "inner rain forest" by killing friendly bacteria. When this happens, harmful bacteria and yeasts can move in and flourish. This can lead to vaginal yeast infections. Conversely, it appears that the regular use of probiotics can help prevent vaginal infections and generally improve the health of the gastrointestinal system. Whenever you take antibiotics, you should probably take probiotics as well and continue them for some time after you are done with the course of treatment.
Although we believe that they are helpful and perhaps even necessary for human health, we don't have a daily requirement for probiotic bacteria. They are living creatures, not chemicals, so they can sustain themselves in your body unless something comes along to damage them, such as antibiotics.
Cultured dairy products, such as yogurt and kefir, are good sources of acidophilus and other probiotic bacteria. Supplements are widely available in powder, liquid, capsule, or tablet form. Grocery stores and natural food stores both carry milk that contains live acidophilus. In addition to probiotics, related substances known as prebiotics may enhance the colonization of healthy bacteria in the intestinal tract. 140
Dosages of acidophilus are expressed not in grams or milligrams, but in billions of organisms. A typical daily dose should supply about 3 to 5 billion live organisms. Other probiotic bacteria are used similarly. The typical dose of S. boulardii yeast is 500 mg twice daily (standardized to provide 3 x 10 10 -colony-forming units per gram), to be taken while traveling or at the start of using antibiotics, and continued for a few days after antibiotics are stopped.
Because probiotics are not drugs, but rather living organisms that you are trying to transplant to your digestive tract, it is necessary to take the treatment regularly. Each time you do, you reinforce the beneficial bacterial colonies in your body, which may gradually push out harmful bacteria and yeasts growing there.
The downside of using a living organism is that probiotics may die on the shelf. In fact, a study reported in 1990 found that most acidophilus capsules on the market contained no living acidophilus. 1 The situation has improved in subsequent evaluations, but still some products are substandard. 99 The container label should guarantee living organisms at the time of purchase, not just at the time of manufacture. Another approach is to eat acidophilus-rich foods such as yogurt, in which the bacteria are most likely still alive.
To treat or prevent vaginal infections, mix 2 tablespoons of yogurt or the contents of a couple of capsules of acidophilus with warm water and use as a douche.
Finally, in addition to increasing your intake of probiotics, you can take fructo-oligosaccharides, supplements that can promote thriving colonies of helpful bacteria in the digestive tract. (Fructo-oligosaccharides are carbohydrates found in fruit. Fructo means "fruit," and an oligosaccharide is a type of carbohydrate.) Taking this supplement is like putting manure in a garden; it is thought to foster a healthy environment for the bacteria you want to have inside you. The typical daily dose of fructo-oligosaccharides is between 2 g and 8 g.
Evidence from many but not all double-blind, placebo-controlled trials suggests that probiotics may be helpful for many types of diarrhea , as well as for irritable bowel syndrome . 2 28,53-57,68,70,71,130,144,156,157,171,214,215,216,220,223
Probiotics may be helpful for controlling symptoms and maintaining remission in ulcerative colitis . 37-39,82,204,222 However, probiotics may be less useful for inducing remission; when probiotics were added to standard medications used for induction of remission, no additional benefits were seen in a study of people with mild-to-moderate ulcerative colitis. 155
Probiotics might help prevent colds , 43 possibly by improving immunity . 40-42,83,164 On a related note, one small, double-blind study found evidence that use of the probiotic bacteria Lactobacillus fermentum improved the effectiveness of the influenza vaccine. 135 (The probiotic supplement was taken in two doses. One was taken two weeks before the vaccine, and the other was taken two weeks after.)
Although probiotics are widely used to prevent or treat vaginal yeast infections ( Candida albicans ), evidence regarding potential benefit remains incomplete and inconsistent. 31-36,48,84-85 A small trial of 55 women with vulvovaginal candidiasis did demonstrate that daily Lactobacillus rhamnosus and L. reuteri supplementation for 4 weeks combined with single dose fluconazole (an anti-fungal medication) decreased symptoms compared to fluconazole alone. 202 Another large, well-designed trial, however, failed to find a Lactobacillus preparation helpful for preventing yeast infections caused by antibiotics. 86 One study did find that probiotics might reduce levels of Candida albicans in the mouth. 132
The bacteria Gardnerella vaginalis can cause a different type of vaginal infections ; as with vaginal yeast infections, probiotics have shown some promise for this condition, but evidence remains inconclusive. 145,158,175,190 A trial of 64 women taking a single dose of tinidazole for bacterial vaginosis suggests that women who also took daily probiotics capsules had better cure rates at 4 weeks. 195 A larger trial involving 120 women with a history of bacterial vagninosis found that taking one capsule daily of the probiotics Lactobacillus rhamnosus , acidophilus, and Streptococcus thermophilus reduced recurrence. 209
The bacteria Helicobacter pylori is the main cause of ulcers in the stomach and duodenum. Antibiotics can kill H. pylori , but more than one must be used at the same time, and, even then, the bacteria is not necessarily eradicated. Probiotics may be helpful. Evidence suggests that various probiotics can inhibit the growth of H. pylori . 65-67,87,169 While this effect does not appear to be strong enough for probiotic treatment to eradicate H. pylori on its own, preliminary evidence, including several small double-blind trials, suggest that various probiotics may help standard antibiotic therapy work better, reducing side effects and possibly increasing rate of eradication. 47,55,58,60,63,65,67,87,88, 97,98,131,148,149,162,185 For example, over a 2-week period, 82 adults with dyspepsia and H. pylori infection were randomized to receive lansoprazole (30 mg), amoxicillin (1,000 mg), clarithromycin (500 mg), plus kefir (a cultured dairy product rich in probiotics) or the medications plus placebo. Those in the kefir group experienced a better rate of H. pylori eradication and an improvement in their symptoms (eg, diarrhea, nausea, abdominal pain) compared to the placebo group. 217
Some, but not, all preliminary double-blind trials suggest that probiotics might improve cholesterol profile. 44-46,100-101,137 In addition, milk fermented by probiotics may slightly improve blood pressure levels. 104-106
Various probiotics might be helpful for allergic rhinitis (hay fever). 102-103,142 While there is some evidence that probiotics can help reduce symptoms of milk allergies, 49 one study found that adding probiotics to infant cow’s milk formula was not helpful. 176 One interesting study found that the use of probiotics during pregnancy and breastfeeding may decrease the likelihood that a highly allergic mother will pass her allergic tendencies to her breastfed infant. 180
One double-blind, placebo-controlled study of 70 people with chronic constipation found some evidence of benefit with Lactobacillus casei Shirota . 89 Another study found that Lactobacillus rhamnosus was helpful for chronic constipation in children. 141 A small trial also found benefits in children, this time with a mixture of bifidobacteria and lactobacilli . 151 In another study, a combination of B. lactis and B. longus showed promise for improving bowel regularity in nursing home residents. 146 Finally, in a 6-week double-blind, placebo-controlled trial of 274 people with constipation-predominant irritable bowel syndrome, use of a probiotic formula containing B. animalis significantly improved stool frequency. 144
A preliminary double-blind, placebo-controlled study found evidence that Lactobacillus GG might potentially be helpful for treating antibiotic-resistant bacteria. 138 This small study followed 23 people with severe kidney disease who tested positive for vancomycin-resistant bacteria in the stool. (Vancomycin is one of the main “last-ditch” antibiotics for treatment of resistant bacteria.) Use of a yogurt product containing L. rhamnosus appeared to be more effective at ridding the gastrointestinal tract of these bacteria than placebo. However, the study suffered from a number of flaws, especially its small size. Note also that participants in this study did not have active infection with antibiotic-resistant bacteria; they were carriers for it. Do not attempt to use probiotics as sole treatment for active infection with resistant bacteria.
On a related note, preventive use of probiotics does not appear to help prevent the development of resistant bacterial strains that may arise during antibiotic treatment. 96,111
One study found that giving probiotics to certain critically ill people could help prevent multiple organ failure. 133
One small, placebo-controlled study found that use of L. helveticus might improve sleep quality in seniors, for reasons that are not at all clear. 152
An open study found hints that probiotics might be helpful for mouth sores caused by Behcet’s syndrome. 147
As noted above, probiotics have shown some promise in the treatment of infections with the yeast Candida albicans . Probiotics are also proposed for the treatment of a theoretically related, but markedly controversial condition, known as yeast hypersensitivity syndrome (also known as chronic candidiasis, chronic candida, systemic candidiasis, or just candida ). As described by some alternative medicine practitioners, yeast hypersensitivity syndrome is a common problem that consists of a population explosion of the normally benign candida yeast that live in the vagina and elsewhere in the body, coupled with a type of allergic sensitivity to it. Probiotic supplements are widely recommended for this proposed condition because they establish large, healthy populations of friendly bacteria that compete with the candida that is trying to take up residence. However, there is no evidence that yeast hypersensitivity is a common problem, and virtually none that it exists at all.
Evidence for the effectiveness of probiotics in preventing urinary tract infections (UTI) has been mixed. A year-long open trial of 150 women, for example, failed to find Lactobacillus probiotics effective for preventing urinary tract infections as compared to cranberry juice or no treatment. 50 And a randomized trial involving 252 postmenopausal women found that Lactobacilli rhamnosus did not reduce the number of urinary tract infections compared to antibiotics. 226 Other studies, however, including a large (453-participant), 3-month, double-blind, placebo-controlled study of a special healthy E. coli probiotic, did find benefits. 107,175
A review of 9 randomized trials with 735 patients found that probiotics did not prevent recurrent UTIs in adults and children any better than no therapy, placebo, or other preventive methods.243
A substantial study failed to find a mixture of L. casei , L. bulgaricus , and S. thermophilus in yogurt and milk helpful for asthma in children. 142 But, another study found that the combination of a probiotic ( Bifidobacterium breve ) and a prebiotic (galacto/fructo-oligosaccharide) may help reduce wheezing in infants with eczema. 206
Probiotics have also been studied as possible treatment for liver disease . In one such study, 84 adults (aged 18-65) with liver disease ( cirrhosis or ) were randomized to receive yogurt (1 cup, 3 times daily) with or without the probiotics B. bifidus , L. acidophilus , L. bulgaricus , and S. thermophilus . 212 After 2 weeks, the people in the probiotics group experienced an improvement in their symptoms (eg, improved food intake and appetite). Chronic liver disease with cirrhosis can lead to a potentially life-threatening brain abnormality, called hepatic encephalopathy. A 2011 review of 7 randomized trials involving 550 people found inconclusive evidence to support the use of probiotics as a treatment for this condition. 218
What Is the Scientific Evidence for Acidophilus and Other Probiotics?
According to several studies, it appears that regular use of acidophilus and other probiotics can help prevent "traveler's diarrhea" (an illness caused by eating contaminated food, usually in developing countries). 4,12 One double-blind, placebo-controlled study followed 820 people traveling to southern Turkey, and found that use of Lactobacillus GG significantly protected against intestinal infection. 7
Other studies using S. boulardii have found similar benefits, 11,13,14 including a double-blind, placebo-controlled trial enrolling 3,000 Austrian travelers. 14 The greatest benefits were seen in travelers who visited North Africa and Turkey. The researchers noted that the benefit depended on consistent use of the product, and that a dosage of 1,000 mg daily was more effective than 250 mg daily.
Probiotics may also help prevent or treat acute infectious diarrhea in children and adults.
A 2001 review found 13 double-blind, placebo-controlled trials on the use of probiotics for acute infectious diarrhea in infants and children; 10 of these trials involved treatment and 3 involved prevention. 71 Overall, the evidence suggests that probiotics can significantly reduce the duration of diarrhea and perhaps help prevent it. The evidence is strongest for the probiotic Lactobacillus GG and for infection with a particular virus called rotavirus, which causes severe diarrhea in children.
Another more recent review of 63 trials involving over 8,000 people (mainly infants and children) found that probiotics reduced how long the episode of diarrhea lasted. 210 However, the authors concluded that more research needs to be done to determine which probiotics work best for infectious diarrhea.
And, in a subsequent smaller review focusing on persistent diarrhea (lasting for 2 weeks or longer), researchers concluded that probiotics are capable of reducing both the duration of the diarrhea episode as well as the stool frequency. 211 Another study that was part of this same review suggested that probiotics may help to reduce how long a child is hospitalized due to diarrhea.
One double-blind, placebo-controlled trial of 269 children (ages 1 month to 3 years) with acute diarrhea found that those treated with Lactobacillus GG recovered more quickly than those given placebo. 22 The best results were seen among children with rotavirus infection. Similar results with Lactobacillus GG were seen in a double-blind study of 71 children. 59 However, 224 young Chinese children with severe, acute diarrhea found no benefit from lactose-free formula supplemented with Bifidobacteria and S. thermophilus , suggesting that probiotics may not be as useful for cases of severe, dehydrating diarrhea. 170 Also, Lactobacillus rhamnosus GG is not always associated with improvement. When given for 10 days to 229 infants from rural India hospitalized with acute diarrhea it did not reduce the severity of the diarrhea during that time period. 198
In addition, a double-blind study evaluated the possible benefits of the probiotic L. reuteri in 66 children with rotavirus diarrhea. 5 The study found that treatment shortened the duration of symptoms, and the higher the dose, the better the effect. Similar benefits were seen in a placebo-controlled trial of 151 infants and children given the probiotic Escherichia coli Nissle 1917 (a safe strain of E. coli ) for 21 days for nonspecific (presumably viral) cases of mild to moderate diarrhea. 181 In another randomized trial of 74 children receiving oral rehydration solution for mild to moderate dehydration, L. reuteri reduced the frequency, duration, and relapse rate of acute diarrhea compared to placebo. 230
A double-blind, placebo-controlled study of 81 hospitalized children found that treatment with Lactobacillus GG reduced the risk of developing diarrhea, particularly rotavirus infection. 61 A double-blind, placebo-controlled study found that Lactobacillus GG helped prevent diarrhea in 204 undernourished children. 62
Other studies, though not entirely consistent, generally indicate that the probiotics B. bifidum , S. thermophilus, L. casei , Lactobacillus LB , and S. boulardii —both individually and combined with L. reuteri and L. rhamnosus —may also help prevent or treat diarrhea in infants and children. 8,9,11,15,23,26,56,57,92-93,108-109,150,183,220 One study found that bacteria in the B. bifidum family can kill numerous bacteria that cause diarrhea. 69
Researchers also studied whether adding Lactobacillus fermentum could have preventive benefits. 221 Two hundred and fifteen healthy infants were randomized to receive formula with prebiotics plus L. fermentum or the formula and prebiotics only. The infants in the L. fermentum group had fewer cases of gastrointestinal and upper respiratory infection.
Prophylactic use of probiotics was found to be effective at preventing C. difficile -induced diarrhea in a review of 20 randomized trials with 3,421 patients (including three trials with 605 children) when compared to placebo or no treatment. The most effective probiotics were S. boulardii and L. acidophilus combined with L. casei . 228
Keep in mind that diarrhea in young children can be serious. If it persists for more than a day, consult a physician.
A large (211-participant), double-blind, placebo-controlled study found that adults with diarrhea can benefit from probiotic treatment as well. 26 Another study found that regular use of probiotics could help prevent gastrointestinal infections in adults. 110
The results of many, but not all, double-blind and open trials suggest that probiotics, especially S. boulardii and Lactobacillus GG , may help prevent or treat antibiotic-related diarrhea. 10,11,16 18,25 28,75,76,94-95, 97-98,143,183,215 For example, one study evaluated 180 people, who received either placebo or 1,000 mg of saccharomyces daily along with their antibiotic treatment, and found that the treated group developed diarrhea significantly less often. 16 A similar study of 193 people also found benefit. 18 Three additional studies involving adults found that various species of Lactobacillus , taken either alone in combination, to be beneficial, 174,207 even in cases of Clostridium difficile , the most serious cause of antibiotic-induced diarrhea. 208
A review of 16 randomized trials further adds to this evidence. 219 This review included many different strains of probiotics (eg, Lactobacilli , Lactococcus , Bifidobacterium ), which were used alone or in combination. Bacteria that appeared to lack evidence of benefit included L. rhamnosus , L. sporogenes , B. lactis , and S. thermophilus . Like the earlier review, the pooled results of 34 randomized trials also found evidence to support the use of probiotics for the prevention of antibiotic-associated diarrhea in both children and adults. 225
On the other hand, a study of 302 people found no benefit with Lactobacillus GG . 25 And, a review of four probiotic studies found insufficient evidence for their effectiveness in the treatment of Clostridium difficile , the most serious cause of antibiotic-induced diarrhea. 159 Prophylactic use of Lactobacillus acidophilus LA-5 plus Bifidobacterium BB-12 (in combination with antibiotic treatment) was not associated with reduced incidence of diarrhea when compared to placebo. However, the probiotic reduced the duration time with diarrhea. 236
Although taking probiotic organisms in the proper concentration may be beneficial for antibiotic-induced diarrhea, at least one study found that consuming fresh yogurt during antibiotic treatments had no significant effect on the incidence of diarrhea. 160
Note: Diarrhea that occurs in the context of antibiotics may be dangerous; for this reason, physician consultation is essential.
Other Forms of Diarrhea
Two double-blind, placebo-controlled studies enrolling a total of almost 700 people undergoing radiation therapy for cancer found that use of probiotics significantly improved radiation-induced diarrhea. 79,136 Similar evidence supports the use of Lactobacillus rhamnosus , 153 as well as a special, nonpathogenic form of E. coli . 78 However, of 85 women receiving pelvic radiation for cervical or uterine cancer, those who consumed a liquid yogurt preparation enriched with Lactobacillus casei had no less diarrhea than those who took a placebo drink. 161
Small double-blind studies suggest S. boulardii might be helpful for treating chronic diarrhea in people with HIV, hospitalized patients being tube-fed, and people with Crohn's disease. 11,19 21
Premature infants weighing less than 2,500 grams (5.5 pounds) are at risk for a life-threatening intestinal condition called necrotizing enterocolitis (NEC). In a study that pooled the results of 9 randomized, placebo-controlled trials involving 1,425 infants, probiotic supplementation significantly reduced the occurrence of NEC and death associated with it. 177 A subsequent study found similar benefits in very low birth weight infants weighing less than 1,500 grams (3.3 pounds). 189 For one probiotic strain, L. reuteri , there may be other benefits, as well. In another study involving 249 premature infants, those treated with L. reuteri experienced fewer gastrointestinal symptoms, received fewer antibiotics, and were hospitalized less frequently than those treated with L. rhamnosus or no probiotic. 213
Benefits of probiotics for NEC was further supported in three reviews that evaluated 24 randomized trials involving infants at risk of developing NEC. Prophylactic enteral probiotic supplementation was compared to placebo or no treatment in infants who were preterm (less than 37 weeks gestation), had low birth weight (2,500 grams or 5.5 pounds), or both. Probiotics were associated with reduced incidence of severe NEC in 20 trials with 5,529 infants, fewer infant deaths for any cause in 17 trials with 5,112 infants, and fewer infant deaths related to NEC in 7 trials with 2,755 infants. 235
Inflammatory Bowel Disease (Ulcerative Colitis and Crohn’s Disease)
A double-blind trial of 116 people with ulcerative colitis compared probiotic treatment against a relatively low dose of the standard drug mesalazine. 37 The results suggest that probiotic treatment might be equally effective as low-dose mesalazine for controlling symptoms and maintaining remission. Evidence of benefit was seen in other trials, as well. 38,82,112 For example, a 2011 review of 4 randomized trials with a total of 587 patients seemed to support the use of probiotics to reduce the relapse rates in people with ulcerative colitis. 222 The authors, though, pointed out the need for better designed trials.
One preliminary study found S. boulardii helpful for mild diarrhea in stable Crohn’s disease. 20 However, two studies failed to find benefit with Lactobacillus probiotics, 113-114 and in an analysis of 8 randomized, placebo-controlled studies, probiotics were ineffective at maintaining remission in Crohn’s disease patients. 165
Probiotics might be useful for people with ulcerative colitis who have had part or all of the colon removed. Such people frequently develop a complication called pouchitis, inflammation of part of the remaining intestine. A 9-month, double-blind trial of 40 people found that a combination of three probiotic bacteria could significantly reduce the risk of a pouchitis flare-up in people with chronic pouchitis. 39 Participants were given either placebo or a mixture of various probiotics, including four strains of Lactobacilli , three strains of Bifidobacteria , and one strain of Streptococcus salivarius . The results showed that treated people were far less likely to have relapses of pouchitis. Another study found that probiotics used right after surgery can help prevent pouchitis from developing at all. 80 One study, however, failed to find benefit with Lactobacillus johnsonii in people with Crohn’s disease who have undergone a similar operation. 129
Finally, some evidence hints that probiotics might reduce the joint pain that commonly occurs in people with either kind of inflammatory bowel disease. 115
Irritable Bowel Syndrome
People with irritable bowel syndrome (IBS) experience crampy digestive pain as well as alternating diarrhea and constipation and other symptoms. Although the cause of irritable bowel syndrome is not known, one possibility is a disturbance in healthy intestinal bacteria. Based on this theory, probiotics have been tried as a treatment for IBS, with some success.
For example, in a 6-week double-blind, placebo-controlled trial of 274 people with constipation-predominant irritable bowel syndrome, use of a probiotic formula containing Bifidobacterium animalis significantly reduced discomfort and increased stool frequency. 144 In another trial of 298 IBS patients, 8 weeks of treatment with beneficial Escherichia coli reduced typical symptoms compared to placebo. 200 In a review of 3 randomized trials, Lactobacillus rhamnosus GG was associated with improvement in symptom, especially a reduction in abdominal pain, among 393 children with IBS. 223 And finally, a 4-week randomized trial involving 122 people with IBS found evidence that B. bifidum improved symptoms and quality of life compared to placebo. 224
Benefits have also been seen in small, double-blind trials using L. plantarum , 2,53,70L. acidophilus , 3,163L. rhamnosus , 130L. salivarus and Bifidobacterium , 116,188 in addition to proprietary probiotic combinations including various strains. 54,117,156,187 One such combination, called VSL#3, contains B. longum , B. infantis , L. acidophilus , L. plantarum , L. casei , L. bulgaricus , and Streptococcus thermophilus . In a double-blind, crossover trial , 59 children aged 5-18 years old were randomized to receive VSL#3 or placebo for 6 weeks. 214 After a 2-week "wash-out" period, the children were switched to the other treatment. VSL#3 was associated with a reduction in symptoms, including abdominal pain, bloating, and gas. Benefits have also been seen with combination prebiotic /probiotic formulas 118, 182, 199 and prebiotics alone. 197
Of course, other studies have failed to find probiotics more effective than placebo. 68,119,172 One randomized trial involving 90 people with diarrhea-predominant IBS found Saccharomyces boulardii to be more effective than placebo at improving quality of life. 216 But, the probiotic did not seem to improve the actual symptoms of IBS. Two studies that pooled previous randomized trials on the use of probiotics for IBS came to similar conclusions: probiotics appear to offer some benefit, most notably for global symptoms and abdominal discomfort. However, these two studies were unable to determine which probiotic species were most effective. 178,179
Lactobacillus plantarum 299v failed to provide significant improvements in abdominal pain, bloating, or quality of life when compared to placebo in a randomized trial with 81 adults over an 8 week period. 239
Probiotics Lactobacillus, Bifidobacterium, Escherichia , and Streptococcus (alone or in combination) were evaluated in a review of 37 randomized trials. Priobiotics were associated with fewer global symptoms, abdominal pain, bloating, and flatulence when compared to placebo. There were no differences found in urgency-related symptoms. Although probiotic therapy appears effective, the right combination of strains remains unknown. 238
Use of probiotics during pregnancy and after childbirth may reduce risk of childhood eczema . In a very large, long-term, double-blind study, 1,223 pregnant women were given either placebo or a probiotic mixture (containing Lactobacilli and Bifidobacteria ) beginning 2-4 weeks before delivery. 125 Their newborn children then received either probiotics or placebo for six months. The results showed that the probiotics mixture markedly reduced the incidence of eczema (though not of other allergic diseases). However, in a follow-up to this study, researchers found that the probiotic supplementation was not associated with reduced eczema in children followed through age 5. The probiotics also had no effect on allergic rhinitis or asthma. 193
Another study also yielded marginal results, 139 and a third study involving only lactobacillus found no benefit at all for the prevention of eczema. This latter study actually demonstrated a modestly increased the risk of wheezing bronchitis in infants who took the probiotic. 168 But, some probiotics combined with prebiotics may help to reduce wheezing in infants with eczema. For example, Bifidobacterium breve and a galacto-/fructo-oligosaccharide mixture (Immunofortis) showed benefit in one randomized study involving 90 infants. 206
Bifidobacterium longum and Lactobacillus rhamnosus supplementation did not reduce incidence of eczema atopic dermatitis or allergic sensitization at 12 months among Asian infants at risk of allergic diseases. 196
Researchers in another study concluded that not all probiotics are created equal. In this placebo-controlled study involving pregnant women and their infants, Lactobacillus rhamnosus reduced the incidence of eczema in the children, but a strain of Bifidobacterium animalis did not. 186
Lactobacillus plantarum was effective in reducing the severity of eczema symptoms. The randomized trial included 118 children aged 1-13 years with eczema comparing L. plantarum to placebo for 12 weeks. 227
According to some but not all studies, infants who already have eczema may benefit from probiotics. 30,51,52,77,120-121,128,154,166 However, a careful review of 12 studies involving a total of 781 children found no convincing evidence that probiotics can effectively treat eczema in this age group. 191
If probiotics are beneficial for childhood eczema, they are probably more effective at preventing the condition rather than treating it. A carefully conducted review of numerous studies cautiously concluded that probiotics may help reduce the risk of eczema in infants and children, particularly those at high risk. 154 And two subsequent reviews found that probiotics were more effective at preventing childhood eczema, particularly when given both to mother (before birth) and infant. 166,173
A number of studies suggest that various probiotics can enhance immune function . One 12-week, double-blind, placebo-controlled trial evaluated 25 healthy elderly people, half of whom were given milk containing a particular strain of Bifidobacterium lactis , the others milk alone. 42 The results showed various changes in immune parameters which the researchers took as possibly indicating improved immune function. Another double-blind, placebo-controlled study of 50 people using B. lactis had similar results. 41
A 7-month, double-blind, placebo-controlled study of 571 children in daycare centers in Finland found that use of milk fortified with Lactobacillus GG reduced the number and severity of respiratory infections. 43 In another controlled trial, probiotics ( Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb-12) given daily to infants in their formula significantly reduced the risk of acute otitis media and recurrent respiratory infections during the first year of life compared to placebo. 192
Benefits were seen in three other large studies, in which probiotics combined with multivitamins and minerals helped prevent colds (or reduce their duration and severity) in adults. 122-124 However, a smaller and shorter study failed to find any effect on respiratory infections. 81 Similarly, Lactobacillus fermentum given to 20 healthy elite distance runners over a 4-month period during winter training was significantly more effective at reducing the number and severity of respiratory symptoms compared with a placebo. 164
One study found that Lactobacillus GG or L. acidophilus may improve the immune response to vaccinations. 83
A review of 13 randomized trials with 3,780 children, adults, and older adults compared different probiotics to either placebo or no treatment for prevention of colds. Probiotic use was associated with lower risk of number of colds and shorter duration of cold. Several types of probiotics were used in the trials, including: 240
- Actimel with L. paracasei (L. casei) , Streptococcus thermophilus , and Lactobacillus bulgaricus
- L. plantarum HEAL 9 plus L. paracasei 8700:2
- Lactobacillus rhamnosus strain GG
- L. rhamnosus plus Bifidobacterium lactis Bb-12
- Lactobacillus acidophilus plus Bifidobacterium bifidum
- L. acidophilus plus L. casei
An 8-week, double-blind, placebo-controlled trial of 70 overweight people found that a probiotic treatment containing S. thermophilus and Enterococcus faecium could reduce LDL ("bad") cholesterol by about 8%. 45 Similarly positive results were seen in other short-term trials of various probiotics. 44,46,73,74,100-101 However, a 6-month, double-blind, placebo-controlled trial found no long-term benefit. 72 Researchers speculate that participants stopped using the product regularly toward the later parts of the study.
The addition of the probiotic Lactobacillus rhamnosus to regular was no better than than placebo in 77 patients with chronic rhinosinusitis. 201
Critical illnesses can result in changes to gut bacteria, leading to a loss of healthy bacteria and overgrowth of harmful bacteria. This change in bacteria may affect the immune system, affecting overall health. Certain strains of probiotics may restore balance to the to the intestinal tract, which can help with overall immunity. Probiotics were analyzed in 2 reviews of 31 randomized trial with 3,236 critically ill patients. When compared to placebo or no treatment, probiotics were associated with fewer cases of ventilator-associated pneumonia (VAP), less risk of VAP, and other serious complications resulting from infection. Some data suggested probiotics may also be connected to fewer intensive care deaths. Although the results of these reviews are promising, more research needs to be done to make firm conclusions. 237
Supplementation for Infant Growth and Development
A review of 25 randomized trials with 2,971 infants did not find sufficient evidence to support supplementation of infant formula with synbiotics, probiotics, or prebiotics. There were no significant effects on growth, crying, colic, regurgitation, or restlessness compared to conventional infant formula. Synbiotics and prebiotics were associated with increased stool frequency.
Probiotics may play a role in balancing bacteria in the gut, but not all probiotics may be helpful.
A randomized trial of 82 breastfed infants with colic compared supplementation with oral Lactobacillus reuteri (L. reuteri) to placebo for 21 days. A reduction in more that 50% in mean crying time was seen in all infants who received L. reuteri compared to 63% of infants in placebo group. L. reuteri supplement and was also associated with a larger decrease in the amount of daily crying and better family quality of life scores. 231
In another randomized trial of 50 exclusively breastfed infants with colic, supplementation with L. reuteri for 21 days was associated with a 50% reduction in daily crying time when compared with placebo. 234
A second randomized trial with 90 infants found a similar decrease in crying time with L. reuteri , but there were no significant differences in crying time found in a small trial of 18 infants when Lactobacillus rhamnosus and Propionibacterium freudenreichii were compared to placebo. 232
L. reuteri was also found to have significantly better reduction in crying time compared to simethicone in randomized trial of 82 infants with colic. After 28 days, median crying time was reduced from 197 minutes a day to 51 minutes a day with L. reuteri supplemention compared to 145 minutes a day with simethicone. Crying time decreased by 50% or more in 95% of infants taking L. reuteri compared to 7% of infants taking simethicone. 233
However, L. reuteri in formula-fed infants 6 weeks old or less had the opposite effect. The probiotic was associated with an increase in fussing time (not crying, but awake and not content) compared to placebo. Probiotics were used for one month and the infants were followed for six months. L. reuteri showed no benefit for infants that were exclusively breastfed. 241
Probiotics may occasionally cause a temporary increase in digestive gas. But, beyond that, they do not present any known risks for most people. In one trial of 140 healthy infants, formula supplemented with long-chain polyunsaturated fatty acids and probiotics appeared as safe as standard formula, and did not have any effect on infant growth by the end of the 7-month trial. 194
However, individuals who are immunosuppressed could conceivably be at risk for developing a dangerous infection with the probiotic organism itself; at least one person taking immunosuppressive medications has died in this manner. 31
In a detailed review of four studies, researchers concluded that the use probiotics did not benefit patients with severe acute pancreatitis. 184 Furthermore, according to one study, the use of probiotics led to an increased risk of mortality in patients with severe acute pancreatitis, and should, therefore, be avoided under these circumstances. 167
Interactions You Should Know About
- If you are taking antibiotics : It may be beneficial to take probiotic supplements at the same time, and to continue them for a couple of weeks after you have finished the course of drug treatment. This will help restore the balance of natural bacteria in your digestive tract.
REF1 Hughes VL. Microbiologic characteristics of Lactobacillus products used for colonization of the vagina. Obstet Gynecol. 1990;75:244-248.
REF2 Nobaek S, Johansson M-L, Molin G, et al. Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol. 2000;95:1231-1238.
REF3 Halpern GM, Prindiville T, Blankenberg M, et al. Treatment of irritable bowel syndrome with Lacteol Fort: a randomized, double-blind, cross-over trial. Am J Gastroenterol. 1996;91:1579-1585.
REF4 Scarpignato C, Rampal P. Prevention and treatment of traveler's diarrhea: a clinical pharmacological approach. Chemotherapy. 1995;41(suppl 1):48-81.
REF5 Shornikova AV, Casas IA, Mykkanen H, et al. Bacteriotherapy with Lactobacillus reuteri in rotavirus gastroenteritis. Pediatr Infect Dis J. 1997;16:1103-1107.
REF6 Shornikova AV, Casas IA, Isolauri E, et al. Lactobacillus reuteri as a therapeutic agent in acute diarrhea in young children. J Pediatr Gastroenterol Nutr. 1997;24:399-404.
REF7 Oksanen PJ, Salminen S, Saxelin M, et al. Prevention of traveller's diarrhoea by Lactobacillus GG.Ann Med. 1990;22:53-56.
REF8 Saavedra JM, Bauman NA, Oung I, et al. Feeding of Bifidobacterium bifidum and Streptococcus thermophilus to infants in hospital for prevention of diarrhoea and shedding of rotavirus. Lancet. 1994;344:1046-1049.
REF9 Pedone CA, Bernabeu AO, Postaire ER, et al. The effect of supplementation with milk fermented by Lactobacillus casei (strain DN-114 001) on acute diarrhoea in children attending day care centres. Int J Clin Pract. 1999;53:179-184.
REF10 Colombel JF, Cortot A, Neut C, et al. Yoghurt with Bifidobacterium longum reduces erythromycin-induced gastrointestinal effects. Lancet. 1987;2:43.
REF11 Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA. 1996;275:870-876.
REF12 Hilton E, Kolakowski P, Singer C, et al. Efficacy of Lactobacillus GG as a diarrheal preventive in travelers. J Travel Med. 1997;4:41-43.
REF13 Kirchhelle VA, Fruhwein N, Toburen D. Treatment of persistent diarrhea with Saccharomyces boulardii. Results of a prospective study [in German; English abstract]. Fortschr Med. 1996;114:136-140.
REF14 Kollaritsch VH, Holst H, Grobara P, et al. Prevention of traveler's diarrhea with Saccharomyces boulardii. Results of a placebo-controlled double-blind study [translated from German]. Fortschr Med. 1993;111:152-156.
REF15 Chapoy P. Treatment of acute infantile diarrhea: controlled trial of Saccharomyces boulardii [in French; English abstract]. Ann Pediatr (Paris). 1985;32:561-563.
REF16 Surawicz CM, Elmer GW, Speelman P, et al. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: a prospective study. Gastroenterology. 1989;96:981-988.
REF17 Surawicz CM, McFarland LV, Elmer G, et al. Treatment of recurrent Clostridium difficile colitis with vancomycin and Saccharomyces boulardii.Am J Gastroenterol. 1989;84:1285-1287.
REF18 McFarland LV, Surawicz CM, Greenberg RN, et al. Prevention of Beta-lactam-associated diarrhea by Saccharomyces boulardii compared with placebo. Am J Gastroenterol. 1995;90:439-448.
REF19 Bleichner G, Blehaut H, Mentec H, et al. Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients. A multicenter, randomized, double-blind placebo-controlled trial. Intensive Care Med. 1997;23:517-523.
REF20 Plein K, Hotz J. Therapeutic effects of Saccharomyces boulardii on mild residual symptoms in a stable phase of Crohn's disease with special respect to chronic diarrhea—a pilot study. Z Gastroenterol. 1993;31:129-134.
REF21 Elmer GW, Moyer KA, Vega R, et al. Evaluation of Saccharomyces boulardii for patients with HIV-related diarrhoea and in healthy volunteers receiving antifungals. Microecol Ther. 1995;25:23-31.
REF22 Guandalini S, Pensabene L, Zikri MA, et al. Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. J Pediatr Gastroenterol Nutr. 2000;30:54-60.
REF23 Simakachorn N, Pichaipat V, Rithipornpaisarn P, et al. Clinical evaluation of the addition of lyophilized, heat-killed Lactobacillus acidophilus LB to oral rehydration therapy in the treatment of acute diarrhea in children. J Pediatr Gastroenterol Nutr. 2000;30:68-72.
REF24 Armuzzi A, Cremonini F, Ojetti V, et al. Effect of Lactobacillus GG supplementation on antibiotic-associated gastrointestinal side effects during Helicobacter pylori eradication therapy: a pilot study. Digestion. 2001;63:1-7.
REF25 Thomas MR, Litin SC, Osmon DR, et al. Lack of effect of Lactobacillus GG on antibiotic-associated diarrhea: a randomized, placebo-controlled trial. Mayo Clin Proc. 2001;76:883-889.
REF26 Buydens P, Debeuckelaere S. Efficacy of SF 68 in the treatment of acute diarrhea. A placebo-controlled trial. Scand J Gastroenterol. 1996;31:887-891.
REF27 Vanderhoof JA, Whitney DB, Antonson DL, et al. Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children. J Pediatr. 1999;135:564-568.
REF28 Tankanow RM, Ross MB, Ertel IJ, et al. A double-blind, placebo-controlled study of the efficacy of Lactinex in the prophylaxis of amoxicillin-induced diarrhea. DICP. 1990;24:382-384.
REF29 Kalliomaki M, Salminen S, Arvilommi H, et al. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 2001;357:1076-1079.
REF30 Isolauri E, Arvola T, Sutas Y, et al. Probiotics in the management of atopic eczema. Clin Exp Allergy. 2000;30:1604-1610.
REF31 MacGregor G, Smith AJ, Thakker B, et al. Yoghurt biotherapy: contraindicated in immunosuppressed patients? Postgrad Med J. 2002;78:366-367.
REF32 Reid G, Bruce AW, McGroarty JA, et al. Is there a role for Lactobacilli in prevention of urogenital and intestinal infections? Clin Microbiol Rev. 1990;3:335-344.
REF33 McGroarty JA. Probiotic use of lactobacilli in the human female urogenital tract. FEMS Immunol Med Microbiol. 1993;6:251-264.
REF34 Hilton E, Isenberg HD, Alperstein P, et al. Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med. 1992;116:353-357.
REF35 Friedlander A, Druker MM, Schachter A. Lactobacillus acidophillus and vitamin B complex in the treatment of vaginal infection. Panminerva Med. 1986;28:51-53.
REF36 Hilton E, Rindos P, Isenberg HD. Lactobacillus GG vaginal supositories and vaginitis. J Clin Microbiol. 1995;33:1433.
REF37 Rembacken BJ, Snelling AM, Hawkey PM, et al. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomised trial. Lancet. 1999;354:635-639.
REF38 Faubion WA, Sandborn WJ. Probiotic therapy with E. coli for ulcerative colitis: take the good with the bad. Gastroenterology. 2000;118:630-631.
REF39 Gionchetti P, Rizzello F, Venturi A, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology. 2000;119:305-309.
REF40 Meydani SN, Ha WK. Immunological effects of yogurt. Am J Clin Nutr. 2000;71:861-872.
REF41 Arunachalam K, Gill HS, Chandra RK. Enhancement of natural immune function by dietary consumption of Bifidobacterium lactis . Eur J Clin Nutr. 2000;54:263-267.
REF42 Chiang BL, Sheih YH, Wang LH, et al. Enhancing immunity by dietary consumption of a probiotic lactic acid bacterium ( Bifidobacterium lactis HN019): optimization and definition of cellular immune responses. Eur J Clin Nutr. 2000;54:849-855.
REF43 Hatakka K, Savilahti E, Ponka A, et al. Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial. BMJ. 2001;322:1-5.
REF44 Anderson JW, Gilliland SE. Effect of fermented milk (yogurt) containing Lactobacillus acidophilus L1 on serum cholesterol in hypercholesterolemic humans. J Am Coll Nutr. 1999;18:43-50.
REF45 Agerholm-Larsen L, Raben A, Haulrik N, et al. Effect of 8 week intake of probiotic milk products on risk factors for cardiovascular diseases. Eur J Clin Nutr. 2000;54:288-297.
REF46 Agerholm-Larsen L, Bell ML, Grunwald GK, et al. The effect of a probiotic milk product on plasma cholesterol: a meta-analysis of short-term intervention studies. Eur J Clin Nutr. 2000;54:856-860.
REF47 Sakamoto I, Igarashi M, Kimura K, et al. Suppressive effect of Lactobacillus gasseri OLL 2716 (LG21) on Helicobacter pylori infection in humans. J Antimicrob Chemother. 2001;47:709-710.
REF48 Reid G, Charbonneau D, Erb J, et al. Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. FEMS Immunol Med Microbiol. 2003;35:131-134.
REF49 Pelto L, Isolauri E, Lilius EM, et al. Probiotic bacteria down-regulate the milk-induced inflammatory response in milk-hypersensitive subjects but have an immunostimulatory effect in healthy subjects. Clin Exp Allergy. 1998;28:1474-1479.
REF50 Kontiokari T, Sundqvist K, Nuutinen M, et al. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ. 2001;322:1-5.
REF51 Rosenfeldt V, Benfeldt E, Nielsen SD, et al. Effect of probiotic Lactobacillus strains in children with atopic dermatitis. J Allergy Clin Immunol. 2003;111:389-395.
REF52 Kirjavainen PV, Salminen SJ, Isolauri E. Probiotic bacteria in the management of atopic disease: underscoring the importance of viability. J Pediatr Gastroenterol Nutr. 2003;36:223-227.
REF53 Sen S, Mullan MM, Parker TJ, et al. Effect of Lactobacillus plantarum 299v on colonic fermentation and symptoms of irritable bowel syndrome. Dig Dis Sci. 2002;47:2615-2620.
REF54 Kim HJ, Camilleri M, McKinzie S, et al. A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2003;17:895-904.
REF55 Cremonini F, Di Caro S, Covino M, et al. Effect of different probiotic preparations on anti- Helicobacter pylori therapy-related side effects: a parallel group, triple blind, placebo-controlled study. Am J Gastroenterol. 2002;97:2744-2749.
REF56 Rosenfeldt V, Michaelsen KF, Jakobsen M, et al. Effect of probiotic Lactobacillus strains in young children hospitalized with acute diarrhea. Pediatr Infect Dis J. 2002;21:411-416.
REF57 Van Niel CW, Feudtner C, Garrison MM, et al. Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics. 2002;109:678-684.
REF58 Wendakoon CN, Thomson AB, Ozimek L. Lack of therapeutic effect of a specially designed yogurt for the eradication of Helicobacter pylori infection. Digestion. 2002;65:16-20.
REF59 Isolauri E, Juntunen M, Rautanen T, et al. A human Lactobacillus strain ( Lactobacillus casei sp strain GG) promotes recovery from acute diarrhea in children. Pediatrics. 1991;88:90-97.
REF60 De Francesco V, Stoppino V, Sgarro C, et al. Lactobacillus acidophilus administration added to omeprazole/amoxycillin-based double therapy in Helicobacter pylori eradication. Dig Liver Dis. 2000;32:746-747.
REF61 Szajewska H, Kotowska M, Mrukowicz JZ, et al. Efficacy of Lactobacillus GG in prevention of nosocomial diarrhea in infants. J Pediatr. 2001;138:361-365.
REF62 Oberhelman RA, Gilman RH, Sheen P, et al. A placebo-controlled trial of Lactobacillus GG to prevent diarrhea in undernourished Peruvian children. J Pediatr. 1999;134:15-20.
REF63 Canducci F, Armuzzi A, Cremonini F, et al. A lyophilized and inactivated culture of Lactobacillus acidophilus increases Helicobacter pylori eradication rates. Aliment Pharmacol Ther. 2000;14:1625-1629.
REF64 Armuzzi A, Cremonini F, Bartolozzi F, et al. The effect of oral administration of Lactobacillus GG on antibiotic-associated gastrointestinal side-effects during Helicobacter pylori eradication therapy. Aliment Pharmacol Ther. 2001;15:163-169.
REF65 Michetti P, Dorta G, Wiesel PH, et al. Effect of whey-based culture supernatant of Lactobacillus acidophilus ( johnsonii ) La1 on Helicobacter pylori infection in humans Digestion. 1999;60:203-209.
REF66 Felley CP, Corthesy-Theulaz I, Rivero JL, et al. Favourable effect of an acidified milk (LC-1) on Helicobacterpylori gastritis in man. Eur J Gastroenterol Hepatol. 2001;13:25-29.
REF67 Aiba Y, Suzuki N, Kabir AM, et al. Lactic acid-mediated suppression of Helicobacter pylori by the oral administration of Lactobacillus salivarius as a probiotic in a gnotobiotic murine model. Am J Gastroenterol. 1998;93:2097-2101.
REF68 O’Sullivan MA, et al. Bacterial supplementaion in the irritable bowel syndrome. A randomized double-blind placebo-controlled crossover study. Digest Liver Dis. 2000;32:294-301.
REF69 Lievin V, Peiffer I, Hudault S, et al. Bifidobacterium strains from resident infant human gastrointestinal microflora exert antimicrobial activity. Gut. 2000;47:646-652.
REF70 Niedzielin K, Kordecki H, Birkenfeld B. A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2001;13:1143-1147.
REF71 Szajewska H, Mrukowicz JZ. Probiotics in the treatment and prevention of acute infectious diarrhea in infants and children: a systematic review of published randomized, double-blind, placebo-controlled trials. J Pediatr Gastroenterol Nutr. 2001;33(suppl 4):S17-S25.
REF72 Richelsen B, Kristensen K, Pedersen SB. Long-term (6 months) effect of a new fermented milk product on the level of plasma lipoproteins—a placebo-controlled and double blind study. Eur J Clin Nutr. 1996;50:811-815.
REF73 Bertolami MC, Faludi AA, Batlouni M. Evaluation of the effects of a new fermented milk product (Gaio) on primary hypercholesterolemia. Eur J Clin Nutr. 1999;53:97-101.
REF74 Agerbaek M, Gerdes LU, Richelsen B. Hypocholesterolaemic effect of a new fermented milk product in healthy middle-aged men. Eur J Clin Nutr. 1995;49:346-352.
REF75 Arvola T, Laiho K, Torkkeli S, et al. Prophylactic Lactobacillus GG reduces antibiotic-associated diarrhea in children with respiratory infections: a randomized study. Pediatrics. 1999;104:e64.
REF76 Siitonen S, Vapaatalo H, Salminen S, et al. Effect of Lactobacillus GG yoghurt in prevention of antibiotic associated diarrhoea. Ann Med. 1990;22:57-59.
REF77 Majamaa H, Isolauri E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol. 1997;99:179-185.
REF78 Unger C, Haring B, Kruse A, et al. Double-blind randomised placebo-controlled phase III study of an E. coli extract plus 5-fluorouracil versus 5-fluorouracil in patients with advanced colorectal cancer. Arzneimittelforschung. 2001;51:332-338.
REF79 Urbancsek H, Kazar T, Mezes I, et al. Results of a double-blind, randomized study to evaluate the efficacy and safety of Antibiophilus in patients with radiation-induced diarrhoea. Eur J Gastroenterol Hepatol. 2001;13:391-396.
REF80 Gionchetti P, Rizzello F, Helwig U, et al. Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial. Gastroenterology. 2003;124:1202-1209.
REF81 Weizman Z, Asli G, Alsheikh A, et al. Effect of a probiotic infant formula on infections in child care centers: comparison of two probiotic agents. Pediatrics. 2005;115:5-9.
REF82 Kato K, Mizuno S, Umesaki Y, et al. Randomized placebo-controlled trial assessing the effect of bifidobacteria-fermented milk on active ulcerative colitis. Aliment Pharmacol Ther. 2004;20:1133-1141.
REF83 de Vrese M, Rautenberg P, Laue C, et al. Probiotic bacteria stimulate virus-specific neutralizing antibodies following a booster polio vaccination. Eur J Nutr. 2004 Dec 1. [Epub ahead of print]
REF84 Jeavons HS. Prevention and treatment of vulvovaginal candidiasis using exogenous Lactobacillus.J Obstet Gynecol Neonatal Nurs. 2003;32:287-296.
REF85 Pirotta M, Gunn J, Chondros P, et al. Effect of Lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial. BMJ. 2004;329:548.
REF86 Pirotta M, Gunn J, Chondros P, et al. Effect of Lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial. BMJ. 2004;329:548.
REF87 Pantoflickova D, Corthesy-Theulaz I, Dorta G, et al. Favourable effect of regular intake of fermented milk containing Lactobacillus johnsonii on Helicobacter pylori associated gastritis. Aliment Pharmacol Ther. 2003;18:805-814.
REF88 Hamilton-Miller JM. The role of probiotics in the treatment and prevention of Helicobacter pylori infection. Int J Antimicrob Agents. 2003;22:360-366.
REF89 Koebnick C, Wagner I, Leitzmann P, et al. Probiotic beverage containing Lactobacillus casei Shirota improves gastrointestinal symptoms in patients with chronic constipation. Can J Gastroenterol. 2003;17:655-659.
REF90 Nikawa H, Makihira S, Fukushima H, et al. Lactobacillus reuteri in bovine milk fermented decreases the oral carriage of mutans streptococci. Int J Food Microbiol. 2004;95:219-223.
REF91 Hatakka K, Martio J, Korpela M, et al. Effects of probiotic therapy on the activity and activation of mild rheumatoid arthritis—a pilot study. Scand J Rheumatol. 2003;32:211-215.
REF92 Thibault H, Aubert-Jacquin C, Goulet O. Effects of long-term consumption of a fermented infant formula (with Bifidobacterium breve c50 and Streptococcus thermophilus on acute diarrhea in healthy infants. J Pediatr Gastroenterol Nutr. 2004;39:147-152.
REF93 Salazar-Lindo E, Miranda-Langschwager P, Campos-Sanchez M, et al. Lactobacillus casei strain GG in the treatment of infants with acute watery diarrhea: a randomized, double-blind, placebo controlled clinical trial. BMC Pediatr. 2004 Sep 2. [Epub ahead of print]
REF94 Wullt M, Hagslatt ML, Odenholt I. Lactobacillus plantarum 299v for the treatment of recurrent Clostridium difficile -associated diarrhoea: a double-blind, placebo-controlled trial. Scand J Infect Dis. 2003;35:365-367.
REF95 Beniwal RS, Arena VC, Thomas L, et al. A randomized trial of yogurt for prevention of antibiotic-associated diarrhea. Dig Dis Sci. 2003;48:2077-2082.
REF96 Sullivan A, Johansson A, Svenungsson B, et al. Effect of Lactobacillus F19 on the emergence of antibiotic-resistant microorganisms in the intestinal microflora. J Antimicrob Chemother. 2004 Aug 25. [Epub ahead of print]
REF97 Myllyluoma E, Veijola L, Ahlroos T, et al. Probiotic supplementation improves tolerance to Helicobacter pylori eradication therapy - a placebo-controlled, double-blind randomized pilot study. Aliment Pharmacol Ther. 2005;21:1263-1272.
REF98 Duman DG, Bor S, Ozutemiz O, et al. Efficacy and safety of Saccharomyces boulardii in prevention of antibiotic-associated diarrhoea due to Helicobacterpylori eradication. Eur J Gastroenterol Hepatol. 2005;17:1357-1361.
REF99 Product review: probiotic supplements and foods (including lactobacillus acidophilus and bifidobacterium ). ConsumerLab website. Available at: http://www.consumerlab.com/results/probiotics.asp . Accessed May 26, 2006.
REF100 Lewis SJ, Burmeister S. A double-blind placebo-controlled study of the effects of Lactobacillus acidophilus on plasma lipids. Eur J Clin Nutr. 2005 Apr 20. [Epub ahead of print]
REF101 Hlivak P, Odraska J, Ferencik M, et al. One-year application of probiotic strain Enterococcus faecium M-74 decreases serum cholesterol levels. Bratisl Lek Listy. 2005;106:67-72.
REF102 Ishida Y, Nakamura F, Kanzato H, et al. Clinical Effects of Lactobacillus acidophilus Strain L-92 on Perennial Allergic Rhinitis: A Double-Blind, Placebo-Controlled Study. J Dairy Sci. 2005;88:527-533.
REF103 Ishida Y, Nakamura F, Kanzato H, et al. Effect of milk fermented with lactobacillus acidophilus strain L-92 on symptoms of Japanese cedar pollen allergy: a randomized placebo-controlled trial. Biosci Biotechnol Biochem. 2005;69:1652-1660.
REF104 Jauhiainen T, Vapaatalo H, Poussa T, et al. Lactobacillus helveticus fermented milk lowers blood pressure in hypertensive subjects in 24-h ambulatory blood pressure measurement. Am J Hypertens. 2005;18:1600-1605.
REF105 Seppo L, Jauhiainen T, Poussa T, et al. A fermented milk high in bioactive peptides has a blood pressure-lowering effect in hypertensive subjects. Am J Clin Nutr. 2003;77:326-330.
REF106 Inoue K, Shirai T, Ochiai H, et al. Blood-pressure-lowering effect of a novel fermented milk containing gamma-aminobutyric acid (GABA) in mild hypertensives. Eur J Clin Nutr. 2003;57:490-495.
REF107 Bauer HW, Alloussi S, Egger G, et al. A long-term, multicenter, double-blind study of an escherichia coli extract (OM-89) in female patients with recurrent urinary tract infections. Eur Urol. 2005;47:542-548.
REF108 Kurugol Z, Koturoglu G. Effects of saccharomyces boulardii in children with acute diarrhea. Acta Paediatr. 2005;94:44-47.
REF109 Kotowska M, Albrecht P, Szajewska H, et al. Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea in children: a randomized double-blind placebo-controlled trial. Aliment Pharmacol Ther. 2005;21:583-590.
REF110 Tubelius P, Stan V, Zachrisson A, et al. Increasing work-place healthiness with the probiotic Lactobacillus reuteri: A randomised, double-blind placebo-controlled study. Environ Health. 2005 Nov 7. [Epub ahead of print]
REF111 Plummer SF, Garaiova I, Sarvotham T, et al. Effects of probiotics on the composition of the intestinal microbiota following antibiotic therapy. Int J Antimicrob Agents. 2005 Jun 17. [Epub ahead of print]
REF112 Furrie E, Macfarlane S, Kennedy A, et al. Synbiotic therapy (Bifidobacterium longum/Synergy 1) initiates resolution of inflammation in patients with active ulcerative colitis: a randomised controlled pilot trial. Gut. 2005;54:242-249
REF113 Bousvaros A, Guandalini S, Baldassano RN, et al. A randomized, double-blind trial of Lactobacillus GG versus placebo in sddition to standard maintenance therapy for children with Crohn's disease. Inflamm Bowel Dis. 2005;11:833-839.
REF114 Marteau P, Lemann M, Seksik P, et al. Ineffectiveness of Lactobacillus johnsonii LA1 for prophylaxis of postoperative recurrence in Crohn's disease: a randomised, double-blind, placebo-controlled GETAID trial. Gut. 2005 Dec 23. [Epub ahead of print]
REF115 Karimi O, Pena AS, van Bodegraven AA, et al. Probiotics (VSL#3) in arthralgia in patients with ulcerative colitis and Crohn's disease: A pilot study. Drugs Today. (Barc). 2005;41:453-459.
REF116 O¹Mahony L, J, Kelly P, et al. Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology. 2005;128:541-550.
REF117 Kim HJ, Vazquez Roque MI, Camilleri M, et al. A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil. 2005;17:687-696.
REF118 Bittner AC, Croffut RM, Stranahan MC, et al. Prescript-Assist probiotic-prebiotic treatment for irritable bowel syndrome: a methodologically oriented, 2-week, randomized, placebo-controlled, double-blind clinical study. Clin Ther. 2005;27:755-761.
REF119 Niv E, Naftali T, Hallak R, et al. The efficacy of Lactobacillus reuteri ATCC 55730 in the treatment of patients with irritable bowel syndrome-a double blind, placebo-controlled, randomized study. Clin Nutr. 2005 Jul 26. [Epub ahead of print].
REF120 Weston S, Halbert AR, Richmond P, et al. Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child. 2005 Apr 29. [Epub ahead of print].
REF121 Viljanen M, Savilahti E, Haahtela T, et al. Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants: a double-blind placebo-controlled trial. Allergy. 2005;60:494-500.
REF122 Tubelius P, Stan V, Zachrisson A, et al. Increasing work-place healthiness with the probiotic Lactobacillus reuteri: A randomised, double-blind placebo-controlled study. Environ Health. 2005 Nov 7. [Epub ahead of print]
REF123 de Vrese M, Winkler P, Rautenberg P, et al. Effect of Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, B. bifidum MF 20/5 on common cold episodes: A double blind, randomized, controlled trial. Clin Nutr. 2005;24:481-491.
REF124 Winkler P, de Vrese M, Laue C, et al. Effect of a dietary supplement containing probiotic bacteria plus vitamins and minerals on common cold infections and cellular immune parameters. Int J Clin Pharmacol Ther. 2005;43:318-26.
REF125 Kukkonen K, Savilahti E, Haahtela T, et al. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: A randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol. 2006 Oct 27. [Epub ahead of print]
REF126 Folster-Holst R, Muller F, Schnopp N, et al. Prospective, randomized controlled trial on Lactobacillus rhamnosus in infants with moderate to severe atopic dermatitis. Br J Dermatol. 2006;155:1256-1261.
REF127 Tamura M, Shikina T, Morihana T, et al. Effects of probiotics on allergic rhinitis induced by Japanese cedar pollen: randomized, double-blind, placebo-controlled clinical trial. Int Arch Allergy Immunol. 2006 Dec 29. [Epub ahead of print]
REF128 Taylor AL, Dunstan JA, Prescott SL. Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: a randomized controlled trial. J Allergy Clin Immunol. 2007;119:184-191.
REF129 Van Gossum A, Dewit O, Louis E, et al. Multicenter randomized-controlled clinical trial of probiotics ( Lactobacillus johnsonii , LA1) on early endoscopic recurrence of Crohn's disease after ileo-caecal resection. Inflamm Bowel Dis. 2006 Dec 19. [Epub ahead of print]
REF130 Gawronska A, Dziechciarz P, Horvath A, et al. A randomized double-blind placebo-controlled trial of Lactobacillus GG for abdominal pain disorders in children. Aliment Pharmacol Ther. 2007;25:177-84.
REF131 Tong JL, Ran ZH, Shen J, et al. Meta-analysis: the effect of supplementation with probiotics on eradication rates and adverse events during Helicobacter pylori eradication therapy. Aliment Pharmacol Ther. 2007;25:155-168.
REF132 Hatakka K, Ahola AJ, Yli-Knuuttila H, et al. Probiotics reduce the prevalence of oral Candida in the elderly--a randomized controlled trial. J Dent Res. 2007;86:125-130.
REF133 Alberda C, Gramlich L, Meddings J, et al. Effects of probiotic therapy in critically ill patients: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr. 2007;85:816-823.
REF134 Hatakka K, Blomgren K, Pohjavuori S, et al. Treatment of acute otitis media with probiotics in otitis-prone children: a double-blind, placebo-controlled randomised study. Clin Nutr. 2007 Mar 10. [Epub ahead of print]
REF135 Olivares M, Diaz-Ropero MP, Sierra S, et al. Oral intake of Lactobacillus fermentum CECT5716 enhances the effects of influenza vaccination. Nutrition. 2007;23:254-260.
REF136 Delia P, Sansotta G, Donato V, et al. Use of probiotics for prevention of radiation-induced diarrhea. World J Gastroenterol. 2007;13:912-915.
REF137 Greany KA, Bonorden MJ, Hamilton-Reeves JM, et al. Probiotic capsules do not lower plasma lipids in young women and men. Eur J Clin Nutr. 2007 Mar 14. [Epub ahead of print]
REF138 Manley KJ, Fraenkel MB, Mayall BC, et al. Probiotic treatment of vancomycin-resistant enterococci: a randomised controlled trial. Med J Aust. 2007;186:454-457.
REF139 Abrahamsson TR, Jakobsson T, Bottcher MF, et al. Probiotics in prevention of IgE-associated eczema: a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol. 2007;119:1174-1180.
REF140 Bouhnik Y, Raskine L, Champion K, et al. Prolonged administration of low-dose inulin stimulates the growth of bifidobacteria in humans. Nutr Res. 2007;27:187-193.
REF141 Bu LN, Chang MH, Ni YH, et al. Lactobacillus casei rhamnosus Lcr35 in children with chronic constipation. Pediatr Int. 2007;49:485-90.
REF142 Giovannini M, Agostoni C, Riva E, et al. A randomized prospective double blind controlled trial on effects of long-term consumption of fermented milk containing Lactobacillus casei in pre-school children with allergic asthma and/or rhinitis. Pediatr Res. 2007 Jun 25. [Epub ahead of print]
REF143 Hickson M, D'Souza AL, Muthu N, et al. Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial. BMJ. 2007 Jun 29. [Epub ahead of print]
REF144 Guyonnet D, Chassany O, Ducrotte P, et al. Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial. Aliment Pharmacol Ther. 2007;26:475-486.
REF145 Falagas ME, Betsi GI, Athanasiou S. Probiotics for the treatment of women with bacterial vaginosis . Clin Microbiol Infect. 2007;13:657-664.
REF146 Pitkala KH, Strandberg TE, Finne Soveri UH, et al. Fermented cereal with specific bifidobacteria normalizes bowel movements in elderly nursing home residents. A randomized, controlled trial. J Nutr Health Aging. 2007;11:305-311.
REF147 Tasli L, Mat C, De Simone C, et al. Lactobacilli lozenges in the management of oral ulcers of Behcet's syndrome. Clin Exp Rheumatol. 2006;24:S083-S086.
REF148 Cindoruk M, Erkan G, Karakan T, et al. Efficacy and safety of saccharomyces boulardii in the 14-day triple anti-helicobacter pylori therapy: A prospective randomized placebo-controlled double-blind study. Helicobacter. 2007;12:309-136.
REF149 Imase K, Tanaka A, Tokunaga K, et al. Lactobacillus reuteri tablets suppress Helicobacter pylori infection—a double-blind randomised placebo-controlled cross-over clinical study. Kansenshogaku Zasshi. 2007;81:387-393.
REF150 Canani RB, Cirillo P, Terrin G, et al. Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations. BMJ. 2007 Aug 9. [Epub ahead of print]
REF151 Bekkali N, Bongers ME, Van den Berg MM, et al. The role of a probiotics mixture in the treatment of childhood constipation: a pilot study. Nutr J. 2007 Aug 4. [Epub ahead of print]
REF152 Yamamura S, Morishima H, Kumano-Go T, et al. The effect of Lactobacillus helveticus fermented milk on sleep and health perception in elderly subjects. Eur J Clin Nutr. 2007 Sep 12. [Epub ahead of print]
REF153 Osterlund P, Ruotsalainen T, Korpela R, et al. Lactobacillus supplementation for diarrhea related to chemotherapy of colorectal cancer: a randomised study. Br J Cancer. 2007 Sep 25. [Epub ahead of print]
REF154 Osborn D, Sinn J. Probiotics in infants for prevention of allergic disease and food hypersensitivity. Cochrane Database Syst Rev. 2007;4:CD006475.
REF155 Mallon P, McKay D, Kirk S, et al. Probiotics for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2007 Oct 17;CD005573.
REF156 Kajander K, Myllyluoma E, Rajilic-Stojanovic M, et al. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of IBS and stabilises intestinal microbiota. Aliment Pharmacol Ther. 2007 Oct 6. [Epub ahead of print]
REF157 Beausoleil M, Fortier N, Guenette S, et al. Effect of a fermented milk combining lactobacillus acidophilus Cl1285 and lactobacillus casei in the prevention of antibiotic-associated diarrhea: A randomized, double-blind, placebo-controlled trial. Can J Gastroenterol. 2007;21:732-736.
REF158 Larsson PG, Stray-Pedersen B, Ryttig KR, et al. Human lactobacilli as supplementation of clindamycin to patients with bacterial vaginosis reduce the recurrence rate; a 6-month, double-blind, randomized, placebo-controlled study. BMC Womens Health. 2008 Jan 15.
REF159 Pillai A, et al. Probiotics for treatment of Clostridium difficile-associated colitis in adults. Cochrane Database Syst Rev. 2008;CD004611.
REF160 Conway S, Hart A, Clark A, et al. Does eating yogurt prevent antibiotic-associated diarrhoea? A placebo-controlled randomised controlled trial in general practice. Br J Gen Pract. 2007;57:953-959.
REF161 Giralt J, Regadera JP, Verges R, et al. Effects of Probiotic Lactobacillus casei DN-114 001 in prevention of radiation-induced diarrhea: results from multicenter, randomized, placebo-controlled nutritional trial. Int J Radiat Oncol Biol Phys. 2008 Feb 1.
REF162 Park SK, Park DI, Choi JS, et al. The effect of probiotics on Helicobacter pylori eradication. Hepatogastroenterology. 2007;54:2032-2036.
REF163 Sinn DH, Song JH, Kim HJ, et al. Therapeutic effect of Lactobacillus acidophilus -SDC 2012, 2013 in patients with irritable bowel syndrome. Dig Dis Sci. 2008 Feb 15.
REF164 Cox AJ, Pyne DB, Saunders PU, et al. Oral administration of the probiotic Lactobacillus fermentum VRI-003 and mucosal immunity in endurance athletes. Br J Sports Med. 2008 Feb 13.
REF165 Rahimi R, Nikfar S, Rahimi F, et al. A meta-analysis on the efficacy of probiotics for maintenance of remission and prevention of clinical and endoscopic relapse in Crohn's disease. Dig Dis Sci. 2008 Feb 14.
REF166 Betsi GI, Papadavid E, Falagas ME. Probiotics for the treatment or prevention of atopic dermatitis: a review of the evidence from randomized controlled trials. Am J Clin Dermatol. 2008;9:93-103.
REF167 Besselink MG, van Santvoort HC, Buskens E, et al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet. 2008 Feb 13.
REF168 Kopp MV, Hennemuth I, Heinzmann A, et al. Randomized, double-blind, placebo-controlled trial of probiotics for primary prevention: no clinical effects of lactobacillus GG supplementation. Pediatrics. 2008 Mar 10.
REF169 Gotteland M, Andrews M, Toledo M, et al. Modulation of Helicobacter pylori colonization with cranberry juice and Lactobacillus johnsonii La1 in children. Nutrition. 2008 Mar 14.
REF170 Mao M, Yu T, Xiong Y, et al. Effect of a lactose-free milk formula supplemented with bifidobacteria and streptococci on the recovery from acute diarrhoea. Asia Pac J Clin Nutr. 2008;17:30-34.
REF171 Wilhelm SM, Brubaker CM, Varcak EA, et al. Effectiveness of probiotics in the treatment of irritable bowel syndrome. Pharmacotherapy. 2008;28:496-505.
REF172 Drouault-Holowacz S, Bieuvelet S, Burckel A, et al. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol. 2008;32:147-52.
REF173 Lee J, Seto D, Bielory L. Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis. J Allergy Clin Immunol. 2008;121:116-121.e11.
REF174 Ruszczynski M, Radzikowski A, Szajewska H. Clinical trial: effectiveness of Lactobacillus rhamnosus (strains E/N, Oxy, and Pen) in the prevention of antibiotic-associated diarrhea in children. Aliment Pharmacol Ther. 2008 Apr 13.
REF175 Barrons R, Tassone D. Use of Lactobacillus probiotics for bacterial genitourinary infections in women: A review. Clin Ther. 2008;30:453-468.
REF176 Hol J, van Leer EH, Elink Schuurman BE, et al. The acquisition of tolerance toward cow's milk through probiotic supplementation: A randomized controlled trial. J Allergy Clin Immunol. 2008 Apr 22.
REF177 Alfaleh K, Bassler D. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database of Systematic Reviews. 2008;(1):CD005496.
REF178 Nikfar S, Rahimi R, Rahimi F, et al. Efficacy of probiotics in irritable bowel syndrome: a meta-analysis of randomized, controlled trials. Dis Colon Rectum. 2008 May 9.
REF179 McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol. 2008;14:2650-2661.
REF180 Huurre A, Laitinen K, Rautava S, et al. Impact of maternal atopy and probiotic supplementation during pregnancy on infant sensitization: a double-blind placebo-controlled study. Clin Exp Allergy. 2008 May 7.
REF181 Henker J, Laass MW, Blokhin BM, et al. Placebo versus probiotic Escherichia coli Nissle 1917 for treating diarrhea of greater than 4 days duration in infants and toddlers. Pediatr Infect Dis J. 2008 May 8.
REF182 De Paula JA, Carmuega E, Weill R. Effect of the ingestion of a symbiotic yogurt on the bowel habits of women with functional constipation. Acta Gastroenterol Latinoam. 2008;38:16-25.
REF183 Guandalini S. Probiotics for children with diarrhea: an update. J Clin Gastroenterol. 2008 May 23.
REF184 Sun S, Yang K, He X, et al. Probiotics in patients with severe acute pancreatitis: a meta-analysis. Langenbecks Arch Surg. 2009 Jan;394:171-7..
REF185 Kim MN, Kim N, Lee SH, et al. The effects of probiotics on PPI-triple therapy for Helicobacter pylori eradication. Helicobacter. 2008;13:261-268.
REF186 Wickens K, Black PN, Stanley TV, et al. A differential effect of 2 probiotics in the prevention of eczema and atopy: A double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol. 2008 Aug 31.
REF187 Williams E, Stimpson J, Wang D, et al. Clinical trial: a multistrain probiotic preparation significantly reduces symptoms of irritable bowel syndrome in a double-blind placebo-controlled study. Aliment Pharmacol Ther. 2008 Sep 10.
REF188 Agrawal A, Houghton LA, Morris J, et al. Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173-010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation. Aliment Pharmacol Ther. 2008 Sep 17.
REF189 Lin HC, Hsu CH, Chen HL, et al. Oral probiotics prevent necrotizing enterocolitis in very low birth weight preterm infants: a multicenter, randomized, controlled trial. Pediatrics. 2008;122:693-700.
REF190 Petricevic L, Witt A. The role of Lactobacillus casei rhamnosus Lcr35 in restoring the normal vaginal flora after antibiotic treatment of bacterial vaginosis. BJOG. 2008;115:1369-1374.
REF191 Boyle RJ, Bath-Hextall FJ, Leonardi-Bee J, Murrell DF, Tang ML. Probiotics for treating eczema. Cochrane Database Syst Rev. 2008;CD006135.
REF192 Rautava S, Salminen S, Isolauri E. Specific probiotics in reducing the risk of acute infections in infancy - a randomised, double-blind, placebo-controlled study. Br J Nutr. 2009;101:1722-6.
REF193 Kuitunen M, Kukkonen K, Juntunen-Backman K, et al. Probiotics prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort. J Allergy Clin Immunol. 2009;123:335-341.
REF194 Gibson RA, Barclay D, Marshall H, Moulin J, Maire JC, Makrides M. Safety of supplementing infant formula with long-chain polyunsaturated fatty acids and Bifidobacterium lactis in term infants: a randomised controlled trial. Br J Nutr . 2009; 101:1706-13.
REF195 Martinez RC, Franceschini SA, Patta MC, et al. Improved cure of bacterial vaginosis with single dose of tinidazole (2 g), Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14: a randomized, double-blind, placebo-controlled trial. Can J Microbiol. 2009; 55:133-8.
REF196 Soh SE, Aw M, Gerez I, et al. Probiotic supplementation in the first 6 months of life in at risk Asian infants—effects on eczema and atopic sensitization at the age of 1 year. Clin Exp Allergy. 2009;39:571-8.
REF197 Silk DB, Davis A, Vulevic J, Tzortzis G, Gibson GR. Clinical trial: the effects of a trans-galactooligosaccharide prebiotic on faecal microbiota and symptoms in irritable bowel syndrome. Aliment Pharmacol Ther. 2009;29:508-18.
REF198 Misra S, Sabui TK, Pal NK. A randomized controlled trial to evaluate the efficacy of lactobacillus GG in infantile diarrhea. J Pediatr. 2009;155:129-32.
REF199 Underwood MA, Salzman NH, Bennett SH, et al. A randomized placebo-controlled comparison of 2 prebiotic/probiotic combinations in preterm infants: impact on weight gain, intestinal microbiota, and fecal short-chain fatty acids. J Pediatr Gastroenterol Nutr. 2009;48:216-25.
REF200 Enck P, Zimmermann K, Menke G, Klosterhalfen S. Randomized controlled treatment trial of irritable bowel syndrome with a probiotic E.-coli preparation (DSM17252) compared to placebo. Z Gastroenterol. 2009;47:209-14.
REF201 Mukerji SS, Pynnonen MA, Kim HM, Singer A, Tabor M, Terrell JE. Probiotics as adjunctive treatment for chronic rhinosinusitis: a randomized controlled trial. Otolaryngol Head Neck Surg. 2009;140:202-8.
REF202 Martinez RC, Franceschini SA, Patta MC, et al. Improved treatment of vulvovaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. Lett Appl Microbiol. 2009;48:269-74.
REF203 Woo SI, Kim JY, Lee YJ, et al. Effect of Lactobacillus sakei supplementation in children with atopic eczema-dermatitis syndrome. Ann Allergy Asthma Immunol. 2010 Apr;104(4):343.
REF204 Do VT, Baird BG, Kockler DR. Probiotics for maintaining remission of ulcerative colitis in adults. Ann Pharmacother. 2010 Mar;44(3):565.
REF205 Kim JY, Kwon JH, Ahn SH, et al. Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: a double-blind, randomized, placebo-controlled trial. Pediatr Allergy Immunol. 2010 Mar;21(2 Pt 2):e386.
REF206 van der Aa LB, van Aalderen WM, Heymans HS, et al. Synbiotics prevent asthma-like symptoms in infants with atopic dermatitis. Allergy. 2010 Jun 17.
REF207 Hickson M, D'Souza AL, Muthu N, Rogers TR, Want S, Rajkumar C, Bulpitt CJ. Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial. BMJ. 2007;335(7610):80.
REF208 Gao XW, Mubasher M, Fang CY, Reifer C, Miller LE. Dose-response efficacy of a proprietary probiotic formula of Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R for antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea prophylaxis in adult patients. Am J Gastroenterol. 2010;105(7):1636-1641.
REF209 Ya W, Reifer C, Miller LE. Efficacy of vaginal probiotic capsules for recurrent bacterial vaginosis: a double-blind, randomized, placebo-controlled study. Am J Obstet Gynecol. 2010;203(2):120.e1-6.
REF210 Allen S, Martinez E, Gregorio G, Dans L. Probiotics for treating acute infectious diarrhea. Cochrane Database Syst Rev. 2010;(12):CD003048.
REF211 Aponte G, Mancilla C, Pariasca N, Galarza R. Probiotics for treating persistent diarrhoea in children. Cochrane Database Syst Rev. 2010;(11):CD007401.
REF212 Liu JE, Zhang Y, Zhang J, Dong PL, Chen M, Duan ZP. Probiotic yogurt effects on intestinal flora of patients with chronic liver disease. Nurs Res. 2010;59(6):426-432.
REF213 Romeo MG, Romeo DM, Trovato L, Oliveri S, Palermo F, Cota F, Betta P. Role of probiotics in the prevention of the enteric colonization by Candida in preterm newborns: incidence of late-onset sepsis and neurological outcome. J Perinatol. 2011;31(1):63-69.
REF214 Guandalini S, Magazzù G, Chiaro A, et al. VSL#3 improves symptoms in children with irritable bowel syndrome: a multicenter, randomized, placebo-controlled, double-blind, crossover study. J Pediatr Gastroenterol Nutr. 2010;51(1):24-30.
REF215 Cimperman L, Bayless G, Best K, et al. A randomized, double-blind, placebo-controlled pilot study of Lactobacillus reuteri ATCC 55730 for the prevention of antibiotic-associated diarrhea in hospitalized adults. J Clin Gastroenterol . 2011 May 5.
REF216 Choi CH, Jo SY, Park HJ, Chang SK, Byeon JS, Myung SJ. A randomized, double-blind, placebo-controlled multicenter trial of saccharomyces boulardii in irritable bowel syndrome: effect on quality of life. J Clin Gastroenterol. 2011;45(8):679-683.
REF217 Bekar O, Yilmaz Y, Gulten M. Kefir improves the efficacy and tolerability of triple therapy in eradicating Helicobacter pylori. J Med Food. 2011;14(4):344-347.
REF218 McGee RG, Bakens A, Wiley K, Riordan SM, Webster AC. Probiotics for patients with hepatic encephalopathy. Cochrane Database Syst Rev. 2011 Nov 9;11:CD008716.
REF219 Johnston BC, Goldenberg JZ, Vandvik PO, Sun X, Guyatt GH. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev. 2011;11:CD004827.
REF220 Corrêa NB, Penna FJ, Lima FM, Nicoli JR, Filho LA. Treatment of acute diarrhea with Saccharomyces boulardii in infants. J Pediatr Gastroenterol Nutr. 2011;53(5):497-501.
REF221 Maldonado J, Cañabate F, Sempere L, et al. Human milk probiotic Lactobacillus fermentum CECT5716 reduces the incidence of gastrointestinal and upper respiratory tract infections in infants. J Pediatr Gastroenterol Nutr. 2012;54(1):55-61.
REF222 Naidoo K, Gordon M, Fagbemi AO, Thomas AG, Akobeng AK. Probiotics for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2011;12:CD007443.
REF223 Horvath A, Dziechciarz P, Szajewska H. Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood. Aliment Pharmacol Ther. 2011;33(12):1302-1310.
REF224 Guglielmetti S, Mora D, Gschwender M, Popp K. Randomised clinical trial: Bifidobacterium bifidum MIMBb75 significantly alleviates irritable bowel syndrome and improves quality of life--a double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2011;33(10):1123-1132.
REF225 Videlock EJ, Cremonini F. Meta-analysis: probiotics in antibiotic-associated diarrhoea. Aliment Pharmacol Ther. 2012;35(12):1355-1369.
REF226 Beerepoot MA, Ter Riet G, Nys S, et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med. 2012;172(9):704-712.
REF227 Han Y, Kim B, Ban J, et al. A randomized trial of Lactobacillus plantarum CJLP133 for the treatment of atopic dermatitis. Pediatr Allergy Immunol . 2012;23(7):667-673.
REF228 Johnston BC, Ma SS, Goldenberg JZ. Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta-analysis. Ann Intern Med. 2012;157(12):878-888.
REF229 Mugambi MN, Musekiwa A, Lombard M. Synbiotics, probiotics or prebiotics in infant formula for full term infants: a systematic review. Nutr J . 2012;11:81.
REF230 Francavilla R, Lionetti E, et al. Randomised clinical trial: Lactobacillus reuteri DSM 17938 vs. placebo in children with acute diarrhoea--a double-blind study. Aliment Pharmacol Therap . 2012;36(4):363-369.
REF231 Szajewska H, Gyrczuk E, et al. Lactobacillus reuteri DSM 17938 for the management of infantile colic in breastfed infants: a randomized, double-blind, placebo-controlled trial. J Pediatr. 2013;162(2):257-262.
REF232 Perry R, Hunt K, et al. Nutritional supplements and other complementary medicines for infantile colic: a systematic review. Pediatrics. 2011;127(4):720-733.
REF233 Savino R, Pelle E, et al. Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study. Pediatrics. 2007;119(1):124-130.
REF234 Savino F, Cordisco L, et al. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics. 2010;126(3):e526-e533.
REF235 AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in premature infants. Cochrane Database Syst Rev. 2014 Apr:CD005496.
REF236 Chatterjee S, Kar P, et al. Randomised placebo-controlled double blind multicentric trial on efficacy and safety of Lactobacillus acidophilus LA-5 and Bifidobacterium BB-12 for prevention of antibiotic-associated diarrhoea. J Assoc Physicians India. 2013;61(10):708-712.
REF237 Petrof EO, Dhaliwal R, et al. Probiotics in the critically ill: a systematic review of the randomized trial evidence. Crit Care Med. 2012;40(12):3290-3302.
REF238 Ford AC, Quigley EM, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: Systematic review and meta-analysis. Am J Gastroenterol. 2014;109(10):1547-1561.
REF239 Stevenson C, Blaauw R, et al. Randomized clinical trial: Effect of Lactobacillus plantarum 299v on symptoms of irritable bowel syndrome. Nutrition. 2014;30(10):1151-1157.
REF240 Hao Q, Dong BR, et al. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev. 2015;2:CD006895.
REF241 Sung V, Hiscock H, et al. Treating infant colic with the probiotic Lactobacillus reuteri : Double blind, placebo controlled randomised trial. BMJ. 2014;348:g2107.
REF242 Cuello-Garcia., Brozek JL, Fiocchi A, et al. Probiotics for the prevention of allergy: a systematic review and meta-analysis of randomized controlled trials. J Allergy Clin Immunol. 2015;136(4):952-961.
REF243 Schwenger EM, Tejani AM, Loewen PS. Probiotics for preventing urinary tract infections in adults and children. Cochrane Database Syst Rev. 2015;(12):CD008772.