Probiotics

Aka: Probiotics

1. Definition
   1. Microorganisms taken as dietary supplements to help improve intestinal microbial balance
2. Indications
   1. Prevention of antibiotic-associated Diarrhea
   2. Infectious Diarrhea
   3. Irritable Bowel Syndrome
   4. Atopic Dermatitis in Infants
3. Contraindications
   1. Severe immunompromised state
   2. Short-Gut Syndrome (relative contraindication)
4. Dosing
   1. Children: 5-10 Billion Colony Forming Units per day
   2. Adults: 10-20 Billion Colony Forming Units per day
5. Components (most brands contain a mixture of multiple probiotic strains)
   1. Lactobacillus acidophilus
   2. Lactobacillus rhamnosus
   3. Lactobacillus bulgaricus
   4. Bifidobacterium bifidum
   5. Bifidobacterium longum
6. Adverse Effects
   1. Flatulence
   2. Abdominal discomfort
7. Drug Interactions
   1. None
8. Efficacy
   1. Antibiotic Associated Diarrhea significantly reduced if Probiotics started in first 3 days of antibiotics
      1. Sazawal (2006) Lancet Infect Dis 6(6): 374-82
      2. McFarland (2006) Am J Gastroenterol 101(4): 812-22
   2. Acute Infectious Diarrhea reduced duration with Probiotics
      1. Canani (2007) BMJ 335(7615):340
   3. Irritable Bowel Syndrome with reduced symptoms in women on Probiotics
      1. Whorwell (2006) Am J Gastroenterol 101(7): 1581-90
   4. Atopic Disease development risk may be reduced with Probiotics in infants
      1. Kalliomaki (2001) Lancet 357:1076-9
9. References
   1. Doron (2005) Gastroenterol Clin North Am 34(3): 483-98
   2. Kligler (2008) Am Fam Physician 78(9): 1073-8