Insights from CE - The Expanding Health Benefits of Prebiotics and Probiotics
- Probiotics are defined as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host."
- Prebiotics are food source for the good bacteria. Some examples are conjugated linoleic acid, polyunsaturated fatty acid, human milk oligosaccharides, and oligosaccharides (eg, fructooligosaccharides, galactooligosaccharides, inulin, mannan-oligosaccharide, and xylooligosaccharide).
- Members of a genus may share the same mechanism of action, in the same way drug classes share a mechanism of action. For example, all Bifidobacterium species produce short-chain fatty acids. Some mechanisms appear specific to a species or subspecies. For example, Bifidobacterium longum subsp infantis metabolizes human milk oligosaccharides while Bifidobacterium animalis subsp lactis does not, leading to better gut colonization in premature infants by B. longum subsp infantis.
- Probiotics pose a theoretical risk of infection for patients who are immunosuppressed, critically ill, and either very young or old.
- Development of the infant immune system requires stimulation from the gut microflora.
- The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) prefer L. rhamnosus GG or S. boulardii for the prevention of Antibiotic-Associated Diarrhea in children.
- Lactobacillus reuteri 17938 is the best-studied strain for reducing infant colic.
- Induction or maintenance of remission in ulcerative colitis: insufficient evidence to recommend for routine use.
- Coadministration of probiotics with antibiotics
- Intake with oral doxycycline did not impact survival of a probiotic containing Lactobacillus acidophilus LaCH-5 and Bifidobacterium animalis subsp lactis Bb-12. Empirically, a probiotic bacterial strain is unlikely to be killed if it is not susceptible to the antibiotic the patient is taking. In vitro susceptibility studies have found that most Lactobacilli are variably sensitive to penicillins, cephalosporins, fluoroquinolones, and macrolides. Most are not susceptible to cotrimoxazole, metronidazole, or (with the exception of L. acidophilus) vancomycin. Destruction of Saccharomyces boulardii by antibacterial agents is not a concern as it is an yeast.
- Benefit from a probiotic is not determined by the number of strains, but rather the right strains that have been shown to have benefit for a specific condition.
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