immune conditions and skin health conditions and skin health probiotic supplements contain...

A Practitioner’s Guide to Probiotics

Immune Conditions and Skin Health

AN INTRODUCTION: The Use of Probiotics in

Immune Conditions and Skin Health Probiotic supplements contain beneficial microorganisms, similar to those found in the human gastrointestinal tract. When ingested, these live microorganisms confer a number of health benefits to the host. In recent years, extensive research has been conducted on the role of probiotics in modulating the body’s innate and adaptive immune responses as a means to prevent or treat a wide variety of health conditions. Maintaining immune function through modulation of the gut microbiome can help to prevent or treat a wide variety of conditions, including gastrointestinal, respiratory and urogenital infections, inflammatory conditions (e.g., inflammatory bowel disease and rheumatoid arthritis), and other immune conditions such as cancer and allergies. Probiotic supplements may support a healthy composition of bacteria in the gastrointestinal tract and improve immune function by a number of mechanisms, including:

● Modulation of innate immunity through non-specific responses to pathogens with neutrophils, monocytes, macrophages, and natural killer (NK) cells

● Modulation of adaptive immunity using lymphocytes such as B and T cells, which act via long-term mechanisms to recognize and destroy recurrent pathogens of the body

● Regulation of the GI/mucosal immune system to produce innate or adaptive immune activity in protection of the oral-pharyngeal cavity, respiratory tract, gastrointestinal tract, urogenital tract, and exocrine glands

● Regulation of anti-inflammatory or pro-inflammatory cytokines, such as interleukins, tumor necrosis factors, interferons, transforming growth factor, and chemokines (e.g., lymphocytes, granulocytes, macrophages, mast cells, epithelial cells, and dendritic cells)

While probiotics are now commonly prescribed therapeutically and clinical research examining the relationship between the gut microbiome and immune disorders is becoming increasingly available, clear guidelines for clinical application have yet to be established. This is particularly important as the effectiveness of probiotic supplementation may be dependent on the condition, strain, dosing, and duration of therapy.


This guide provides an overview of the available research for the clinical application of probiotics in developing and maintaining immune function in healthy individuals, and in immunodeficiency-related disorders. It includes dosing and administration for single-strain and multi-strain probiotics. Note: It is important to note that immune processes relating to the GI tract and of the neurological system have been reviewed in previous articles: Gastrointestinal Conditions and Neurological Conditions. Upcoming publications will review immunity in cardiometabolic conditions, and in conditions specific to urogenital, and oral health.

Dosing and administration conversions

1 x 10(6) = 1 million CFU



1 x 10(9) = 1 billion CFU

1 x 10(10) = 10 billion CFU

1 x 10(11) = 100 billion CFU

1 x 10(12) = 1 trillion CFU




Condition or Use Strain or Combination Dosing & Administration Outcomes

Acute Otitis Media (AOM) General Outcome Probiotics may be beneficial in children not prone to AOM, and can decrease the use of antibiotics for infection.

Single Strain

Lactobacillus salivarius 24SMB Lactobacillus salivarius PS7

Infant & Pediatric: 5x10(9) CFU to each nostril twice per day as nasal spray for 5 consecutive days per month for 3 months after an initial 10-day amoxicillin treatment Infant & Pediatric: 1x10(8) CFU per day for 6 months

Tendency to reduce AOM incidence and need for antibiotics. In children colonized by S. salivarius, these observations were significant Reduces incidence of AOM episodes

Multistrain

Bifidobacterium lactis BB-12 & Lactobacillus rhamnosus GG

Infant: 2x10(9) CFU per day until age of 1

Reduces risk and need for antibiotics

Allergic Rhinitis General Outcome Adjuvant probiotics may improve Rhinitis Quality of Life scores, and nasal and ocular symptom scores.

Single Strain

Bacillus clausii (Enterogermina®)

Adult: 2x10(9) CFU three times per day for 4 weeks

Reduces IL-4; increases IFN-y, TGF-β, and IL-10



Prevention and improvement of immunologic parameters are less clear.

Bifidobacterium lactis NCC2818

Adult: 2x10(9) CFU twice per day for 8 weeks in seasonal allergic rhinitis

Reduces Th-2 cytokines IL-5 & IL-13, active CD63-basophils, and total nasal symptom scores during the second month

Bifidobacterium longum BB536

Adult: 5x10(10) CFU twice per day for 4 weeks in Japanese Cedar Pollinosis (JCP) 3.5x10(8) CFU twice per day in milk product for 14 weeks in Japanese Cedar Pollinosis

Reduces ocular, rhinorreal, nasal & composite symptom scores, normal activity disruption, allergy medical use, thymus- & activation-regulated chemokine, and JCP-specific IgE; increases Th2-skewed immune response Reduces eye symptoms; tendency to reduce nasal itch, rhinorrhea, blockage, IgE levels, and amounts of decreasing IFN-y & increasing eosinophil rates; increases IFN-y

Lactobacillus casei Shirota Lactobacillus casei DN-114 001

Adult: 4x10(10) CFU per day in milk product for 2-5 months in Japanese Cedar Pollinosis, or other seasonal allergies 1x10(10) CFU per day in milk product for 1 month in Birch pollen allergy 6.5x10(9) CFU per day for 4 months in seasonal allergic rhinitis Pediatric: 1x10(10) CFU per day in milk product for 1 year in allergic rhinitis

Reduces nasal symptom-medication scores in moderate to severe cases at weeks 4-5 Reduces the production of IL-5, IL-6 & IFN-y by antigens, and levels of sIgE; Increases sIgG Reduces sIgE levels, and CD16/CD56+ cells Increases release of IL-1 decoy receptor sIL-1RII in nasal mucosa, and IFN-γ in supernatants of peripheral blood; reduces sCD23,and TGF-β in supernatants of peripheral blood Reduced frequency of rhinitic episodes and duration of diarrhea



Allergic Rhinitis Lactobacillus gasseri OLL2809 Lactobacillus gasseri PM-A0005

Adult: 1x10(10) CFU per day for 8 weeks in Japanese Cedar Pollinosis Pediatric: 2x10(9) CFU twice per day for 8 weeks in persistent allergic rhinitis with asthma

Reduces nasal congestion and itch scores; increases IgE, Japanese cedar pollen-sIgE, eosinophils, and Th1/Th2 ratio Increases Bifidobacteria, which induce IL-12 & interferon; maintains Bifidobacterium: B. fragilis ratio during pollen season (B. fragilis induces IL-6) Improves FEV1, FVC, FEV1:FVC ratio and MEF; increases PEFR; reduces bronchial hyperreactivity, asthma & rhinitis symptom scores, and PBMC synthesis of TNF-α, IFN-γ, IL-12, & IL-13

Lactobacillus johnsonii EM1

Pediatric: 1x10(10) CFU per day for 12 weeks with levocetirizine in perennial allergic rhinitis

Reduces total symptom & PRQLQ scores, nasal expiratory flow, and IL-4; Increases FVC, FEV1, IFN-γ, IL-10, and TGF-β

Lactobacillus paracasei LP33 Lactobacillus paracasei HF.A00232

Adult: 2-5x10(9) CFU once or twice per day for 30 days in allergic rhinitis 2x10(9) CFU per day for 7 weeks with loratadine for grass pollen season symptoms 5x10(9) CFU per day for 8 weeks with levocetirizine in perennial allergic rhinitis

Improves overall QoL scores and frequency & bother level scales; reduces nasal & ocular symptom scores, QoL scores, and T-helper 1: T-helper 2 ratio, particularly in seasonal allergies Improves ocular symptoms and QoL scores Improves sneezing, itchy nose, swollen- puffy eye symptoms and maintains QoL scores after drug discontinuation



Allergic Rhinitis Lactobacillus plantarum No. 14 Lactobacillus plantarum WCFS1, NIZO3400 or CBS125632

Adult: 8.7x10(8 CFU per day for 6 weeks in Japonese Cedar Pollinosis Adult: 1x10(10) CFU per day in milk product for 1 month in Birch pollen allergy

Improves ocular symptom-medication score; increases Th1 cells; reduces the rise in eosinophil counts upon discontinuation Reduces sIgE levels, but only strain CBS125632 reduces IL-5 & IL-13, and increases IL-10. The IL-10:IL-5 ratio increases in WCFS1 and NIZO3400 strains

Lactobacillus rhamnosus GG Lactobacillus rhamnosus HN001

Adult: 1x10(10) CFU per day in pregnant women from the 2nd trimester, onwards. Infant: 1x10(10) CFU per day for 6 months Infant: 6x10(9) CFU per day to pregnant mothers from 35-weeks gestation to 6 months postpartum while breastfeeding, and to infant during first 2 years of life

Reduces maternal allergic symptom scores, especially in women with IgE > 100 kU/L. Improvements associated with increased IL-12 p70 levels Reduces number of aeroallergen sensitizations after therapy and 6 months after discontinuation Reduces prevalence of eczema at ages 2, 4, 6 and 11, atopic sensitization & wheeze over the lifetime, and hayfever at age 11

Lactobacillus salivarius PM-A0006

Pediatric: 2x10(9) CFU per day for 12 weeks in dust-sensitive px

Reduces rhinitis symptoms for eyes & nasal scores and medication scores

Saccharomyces cerevisiae (EpiCor®)

Adult: 500 mg per day for 12 weeks in px with seasonal allergies and allergic rhinitis

Reduces nasal congestion & rhinorrhea symptoms, and days with symptoms; increases QoL scores, and IgA



Allergic Rhinitis Multistrain

Bifidobacterium adolescentis 7007–05 & Lactobacillus delbrueckii subs. bulgaricus GR-1

Adult: 1.1x10(8) CFU/ml in milk product per day during allergy season in px with allergic rhinitis

Increases IL-10 & IL-12 during grass pollen season, and TGF-β during ragweed season

Bifidobacterium lactis Bl-04 (ATCC SD5219) & Lactobacillus acidophilus NCFM (ATCC 700396)

Pediatric: 5x10(9) CFU per day for 4 months in px with birch pollen allergy

Reduces eosinophil infiltration in nasal mucosa; prevents increases in fecal IgA during pollen season. Tended to reduce incidence of runny nose and nasal blockage, but tended to have increased eye symptom reports

Lactobacillus coryniformis CECT5711 & Lactobacillus gasseri CECT5714

Pediatric: 2x10(6) CFU/g in 200ml milk product for three months

Reduces plasma IgE; increases mucosal IgA, plasma CD4(+)/CD25(+) T regulatory cells, and NK cells

Bifidobacterium breve M-16V, Bifidobacterium infantis M-63, & Bifidobacterium longum BB536

Pediatric: 5x10(9) CFU per day for 8 weeks in px with allergic rhinitis and intermittent asthma due to Parietaria allergy

Reduces total symptom score; improves QoL in pollen induced allergic rhinitis and intermittent asthma

Bifidobacterium bifidum G9-1, Bifidobacterium longum MM-2, & Lactobacillus gasseri KS-13

Adult: 3x10(9) CFU per day for 8 weeks during allergy season in px with seasonal allergic rhinitis

Improves rhinoconjunctivitis-specific QoL score



Asthma General Outcome Lack of an effect of probiotics on preventing asthma or wheeze in pediatric and infant populations, but may reduce wheeze when atopic disease is present. May reduce asthma episodes and IL-4, and increase IFN-γ.

Single Strain

Lactobacillus gasseri PM-A0005

Pediatric: 2x10(9) CFU twice per day for 8 weeks in asthma with persistent allergic rhinitis

Improves FEV1, FVC, FEV1:FVC ratio and MEF; increases PEFR; reduces bronchial hyperreactivity, asthma & rhinitis symptom scores, and PBMC synthesis of TNF-α, IFN-γ, IL-12, & IL-13

Lactobacillus fermentum GM-090 (BCRC 910259, CCTCC M204055)

Pediatric: 2x10(9) per day for 3 months

Reduces asthma severity but higher C-ACT scores

Lactobacillus paracasei GMNL-133 (BCRC 910520, CCTCC M2011331)

Pediatric: 2x10(9) CFU per day for 3 months

Reduces asthma severity but higher C-ACT scores

Lactobacillus reuteri DSM 17038

Pediatric: 1x10(8) CFU per day for 60 days

Reduces FeNO, and IL-2; increases IL-10

Multistrain

Lactobacillus fermentum GM-090 (BCRC 910259, CCTCC M204055) & Lactobacillus paracasei GMNL-133 (BCRC 910520, CCTCC M2011331)


Reduces asthma severity but higher C-ACT scores, and IgE levels; increases PEFR



Atopic Dermatitis General Outcome Probiotics improve SCORAD particularly with Lactobacillus fermentum, Lactobacillus salivarius, or multistrain formulations in pediatric populations, and reduce risk of eczema in infants when provided to pregnant or breastfeeding mothers, when followed up with direct administration to infants. Provision may be most beneficial for long-term prevention when given before the age of 2 and as mixed Lactobacillus and Bifidobacteria strains.

Single Strain

Bifidobacterium animalis subsp. lactis LKM512 Bifidobacterium animalis subsp. lactis BB12

Adult: 1x10(10) CFU twice per day for 8 weeks Infant: 1x10(9) CFU/g in hydrolyzed formula

Reduces itch; increases kynurenic acid expression in px with itch improvement; improves dermatology QoL score Improves skin condition and SCORAD; reduces serum CD4 and urinary eosinophilic protein X

Lactobacillus fermentum VRI-033 PCC or GM-090

Infant & Pediatric: 1x10(9) CFU twice per day for 8 weeks

Reduces AD severity and QoL index scores

Lactobacillus paracasei GMNL-133

Infant & Pediatric: 2x10(9) CFU per day for 3 months

Reduces SCORAD scores and is maintained after discontinuation; increases IL-4; improves QoL scores

Lactobacillus plantarum CJLP133 or IS-10506

Infant & Pediatric: 0.5-1x10(10) CFU twice per day for 12 weeks

Reduces SCORAD, eosinophil, IFN-y, IL-4, and IL-17; increases Foxp3+: IL-10 ratio

Lactobacillus reuteri ATCC 55730

Infant: 1x10(8) CFU per day to pregnant mothers from week 36 to delivery and to infants for 1 year Pediatric: 1x10(8) CFU per day for 8 weeks

Reduces IgE-associated eczema in 2nd year of life, and skin reactivity, but not total eczema incidence Reduces likelihood of sensitization and IgE-associated eczema during first 2 years of life when TGF-β2 in breast milk is low (associated with probiotic intake) Associated with reduced Th2-related CC-chemokine ligand CCL17 & CCL22, and increased Th1-related CCX-chemokine CXCL11 Increases IFN-γ; reduces IL-4



Atopic Dermatitis Lactobacillus rhamnosus HN001 Lactobacillus rhamnosus GG (ATCC 53103) Lactobacillus rhamnosus MP108 (ComProbi®)

Infant: 6×10(9) CFU per day - Mother: 35w gestation until 6 months if breastfeeding and; Infant: from birth to 2 years of age Infant; 2x10(10) CFU per day to pregnant mothers for 2-4 weeks before expected delivery and for 3-6 months while lactating, or directly to infants 3-3.4x10(8-9) CFU/g in hydrolyzed whey or casein formula for 1-3 months 5x10(9) CFU twice per day for 4 weeks with elimination diet in px with suspected cow’s milk allergy 2x10(10) CFU per day for 4 weeks Infant & Pediatric: 350 mg per day for 8 weeks

Prevents and reduces severity, and alters genetic predisposition to eczema Reduces prevalence of eczema and rhinoconjunctivitis 2 years after discontinuation Reduces 12-month prevalence by age 11; Associated reduction in lifetime prevalence of atopic sensitization & eczema Prevents and reduces severity; increases TGF-β2 in breast milk; reduces risk for atopic eczema during first 2 years of life, especially in infants with higher IgE in cord blood Reduces risk of developing atopic dermatitis by age of 4 and by age 7 Improves skin condition and SCORAD; reduces serum CD4 and urinary eosinophilic protein X Reduces proportions of cells that secrete IgA & IgM, and CD19(+)CD27(+) B cells Increases CRP in IgE-associated AD, and IL-6 & soluble E-selectin in IgE-mediated cow’s milk allergy Reduces SCORAD in IgE-sensitized infants only Increases serum IL-10 between 4-8 weeks Reduces SCORAD, AD intensity



Atopic Dermatitis Lactobacillus salivarius LS01 (DSM 22775)

Adult: 1x10(9) CFU per day for 16-20 weeks Infant & Pediatric: 1x10(9) CFU twice per day for 8 weeks

Reduces SCORAD, fecal staphylococci, and Th2 cytokines; Improves QoL score Reduces SCORAD, itch scores by 4 weeks and persists after discontinuation

Multistrain

Bifidobacterium animalis subs. lactis BB12 & Lactobacillus rhamnosus GG

Infant & Pediatric; 2X10(9) CFU per day for 3-6 months

Reduces incidence of eczema; improves SCORAD score only in food-sensitized px

Bifidobacterium animalis subs. lactis BB12 & Streptococcus thermophilus TH-4

Infant: 1.1x10(9) CFU per day for 4 weeks

Improves SCORAD score in px with AD and cow’s milk allergy

Bifidobacterium breve M-16V (LMG 23729) & Bifidobacterium longum BB536 (ATCC BAA-999)

Infant: 5x10(9) CFU twice per day to pregnant mothers 4 weeks before expected delivery and once per day to infants for 6 months in breastmilk or formula

Reduces risk of developing AD during first 18 months of life, and proportion of Proteobacteria in mothers at delivery & in infants

Bifidobacterium breve BR03 (DSM 16604), & Lactobacillus salivarius LS01 (DSM 2275)

Adult: 2x10(9) CFU twice per day for 12 weeks

Improves SCORAD, DLQ index, and T-helper cell Th17: regulatory T cell & Th1:Th2 ratios; reduces microbial translocation, immune activity

Bifidobacterium longum BL999 (ATCC BAA-999) & Lactobacillus paracasei ST11 (CNCM 1-2116)

Infant: 1x10(9) CFU per day for 2 months before delivery and for 2 months during breastfeeding

Reduces risk of developing eczema during first 2-years of life and for chronically persistent eczema



Atopic Dermatitis Bifidobacterium longum BL999 (ATCC BAA-999) & Lactobacillus rhamnosus LPR (CGMCC 1.3724)

Infant: 1x10(9) CFU per day for 2 months before delivery and for 2 months during breastfeeding

Reduces risk of developing eczema during first 2-years of life and for chronically persistent eczema

Lactobacillus fermentum GM-090, & Lactobacillus paracasei GMNL-133

Infant & Pediatric: 4x10(9) CFU per day for 3 months

Reduces SCORAD up to 4 months after discontinuation; increases IL-4; improves QoL scores

Lactobacillus reuteri DSM 12246 & Lactobacillus rhamnosus 19090-2

Infant & Pediatric: 2x10(10) CFU twice per day for 6 weeks

Improves eczema (but did not change SCORAD score), especially in in px with higher IgE and positive allergy test; Reduces SCORAD in allergic px, reduces eosinophil cationic protein Positive association between eczema severity and lactulose:mannitol ratio, which decreases with probiotics; reduces GI symptoms

Bifidobacterium animalis subsp. lactis AD011, Bifidobacterium bifidum BGN4, and Lactococcus lactis AD031 Bifidobacterium animalis subsp. lactis W52, Bifidobacterium bifidum W23, and Lactococcus lactis W58 (Ecologic(®)Panda)

Infant: 4.8x10(9) CFU per day for 8 weeks to pregnant mothers before expected delivery, for 3 months after the delivery and then to infants from 4-6 months of age Infant: 3x10(9) CFU per day to pregnant mothers for 6 weeks until delivery and to infants during first year of life

Reduces prevalence of eczema before and at 1 year of age Reduces eczema reports & IL-5 during first 3 months of life and may carry preventative effects to first 2 years of life Reduces lactose and succinate; increases lactate and short chain fatty acids (a possible mechanism for eczema prevention)



Atopic Dermatitis Bifidobacterium animalis subs. lactis CECT 8145, Bifidobacterium longum CECT 7347 & Lactobacillus casei CECT 9104

Pediatric: 1x10(9) CFU per day for 12 weeks with topical methylprednisolone aceponate, moisturizer, and oral antihistamine

Reduces SCORAD more than standard treatment, and the use of topical steroids

Bifidobacterium animalis subs. lactis DGCC 420, Lactobacillus acidophilus 74-2, & Lactobacillus paracasei Lpc-37

Adult: ~4x10(8) CFU/g in 100ml milk product twice per day for 8 weeks

Tends to decrease SCORAD; reduces CD4(+)CD54(+)

Bifidobacterium animalis subs. lactis BB12, Lactobacillus acidophilus LA-5, & Lactobacillus rhamnosus GG

Infant: 1x10(11) CFU per day to mothers during pregnancy to 3-months after birth while breastfeeding

Reduces incidence of dermatitis by age 2, and reduces Th22

Bifidobacterium breve Bbi99, Lactobacillus rhamnosus GG & LC705, & Propionibacterium freudenreichii subs. shermanii JS

Infant: 5x10(9) CFU twice per day for 4 weeks with elimination diet in px with suspected cow’s milk allergy

Increases soluble E-selectin in px with IgE-mediated cow’s milk allergy, and IL-10



Colorectal Cancer Surgery Complications Support General Outcome Probiotics can decrease infection rates after colorectal surgery overall, and can specifically reduce incidence of incision infections, pneumonia and reduce recovery of bowel motility recovery time (flatus). Reducing site infection rates may be most effective with probiotic/ antibiotic therapy compared with antibiotics alone, and surgical inflammation can be particularly reduced when Lactobacillus and Bifidobacterium strains are combined.

Single Strain

Saccharomyces boulardii

Adult: 100mg per day for 7 days prior to surgery

Reduces mucosal IL-1β, IL-10, and IL-23A mRNA levels during surgery

Multistrain

Bifidobacterium longum BB536 & Lactobacillus johnsonii La1

Adult: 1x10(9) CFU twice per day for 3 days prior to surgery and for 2 days post-surgery

Reduces enterobacteriaceae and enterococci colonization; increases expression of CD3, CD4, CD8, and naive & memory lymphocytes, CD83-123, CD83-HLA DR, and CD83-11c dendritic phenotypes with lactobacillus colonization

Bifidobacterium longum, Enterococcus faecalis, & Lactobacillus acidophilus

Adult: 6x10(7) CFU three times per day for 5 days prior to surgery and 7 days after

Reduces time to bowel motility recovery as measured by lower time to first flatus & defecation, and reduces incidence of diarrhea

Bifidobacterium longum-88, Lactobacillus acidophilus-11, & Lactobacillus plantarum CGMCC no.1258

Adult: 2.6 × 10(14) CFU per day for 6 days before surgery and 10 days after

Reduces infection rate, serum zonulin (protein that regulates intestinal permeability), plasma endotoxin, duration of post-surgery pyrexia, antibiotic use, and infectious complications; antagonizes p38 mitogen-activated protein kinase signaling pathway

Bifidobacterium lactis BB12, Lactobacillus acidophilus LA-5, Lactobacillus plantarum, & Saccharomyces boulardii

Adult: 5.5x10(9) CFU twice per day starting one day prior to surgery and for 15 days after

Reduces the rate of all post-surgery major complications, particularly for pneumonia, operative infection and anastomotic leakage; decreases time until hospital release. Positive association between SOCS3 gene expression and TNF & IL-6 expression



Common Cold General Outcome Probiotics may reduce colds, while having minor effects for cold prevention

Single Strain

Lactobacillus acidophilus NCFM (ATCC 700396)

Pediatric: 5x10(9) CFU twice per day for 6 months

Reduces the incidence of fever, coughing, antibiotics, and duration of antibiotic use

Lactobacillus delbrueckii subs. bulgaricus OLL1073R-1

Geriatric: 2.0–3.5x10(8) CFU per day for 8-12 weeks

Increases NK cell activity, and QoL score for eye/nose/throat systems

Lactobacillus paracasei CBA L74

Pediatric: 5.9x10(11) CFU per day in milk product for 3 months

Reduces risk of developing more than one common infectious disease (gastroenteritis, pharyngitis, laryngitis, or tracheitis); increases α-defensin, β-defensin, LL-37, and sIgA

Lactobacillus pentosus b240

Geriatric: 2x10(9-10) CFU per day for 20 weeks

Reduces incidence rates of common cold; increases general perception of health in dose-dependent manner

Multistrain

Bifidobacterium animalis subs. Lactis Bi-07 (ATCC PTA-4802) & Lactobacillus acidophilus NCFM (ATCC 700396)

Pediatric: 1x10(10) CFU twice per day for 6 months

Reduces incidence & duration of fever, coughing, rhinorrhea, need for antibiotics, and days absent from child care

Lactobacillus paracasei 8700:2 (DSM 13434) & Lactobacillus plantarum HEAL 9 (DSM 15312)

Adult: 1x10(9) CFU per day for 12 weeks

Reduces incidence, duration, total symptom scores & pharyngeal symptoms of cold, and B lymphocyte proliferation

Bifidobacterium bifidum MF 20/5, Bifidobacterium longum SP 07/3, & Lactobacillus gasseri PA 16/8

Adult: 5x10(7) CFU for 3 months (with daily multivitamins)

Reduces total symptoms score, cold duration, and days with fever; increases CD8+ and CD4+, lactobacilli and bifidobacteria more than multivitamins alone



Common Infectious Diseases General Outcome Probiotics can reduce risk for common acute infections and need for antibiotics in infant and pediatric populations.

Single Strain

Lactobacillus casei DN-114 001 (CNCM I-1518)

Geriatric: 1x10(10) CFU twice per day in milk product for 4-5 months Pediatric: 1x10(8) CFU/g in milk product per day for 3 months 1x10(10) CFU in milk product twice per day for 3 months

Reduces episode and cumulative durations of common infectious diseases, particularly for upper respiratory tract infections and rhinopharyngitis; shorter protocols may reduce cumulative duration of infection and max body temperatures but not the incidence Reduces the incidence of common infectious diseases (mainly gastrointestinal) Reduces incidence of rhinopharyngitis

Lactobacillus paracasei CBA L74

Infant & Pediatric: 5.9x10(11) CFU/g in 7g of milk product per day for 3 months

Reduces overall instances & risk of common diseases, gastroenteritis, and URTI; increase in α- & β-defensins, cathelicidin LL-37, and IgA

Cow’s Milk Allergy General Outcome Probiotics may alleviate symptoms of allergy in pediatric populations, and may specifically improve tolerance for 2-3 years in infants.

Single Strain

Lactobacillus rhamnosus GG (ATCC 53103)

Adult: 5x10(9) CFU twice per day for 4 weeks Infant & Pediatric: 5x10(8) CFU/g in hydrolyzed whey formula for 1 month

Prevents increases in receptor expression for CR1, FcγRI & FcαR in neutrophils, and CR1, CR3, & FcαR in monocytes after milk exposure in adults Improves atopic dermatitis score; reduces alpha 1-antitrypsin, TNF-ɑ, and soluble E-selectin Increases IFN-γ; long term use (over 3 years) may reduce time to IgE-mediated allergy tolerance and the incidence of other allergies



Cow’s Milk Allergy

Multistrain

Bifidobacterium lactis BB12 & Lactobacillus rhamnosus GG

Infant: 1x10(10) CFU in formula during the first year of life

Increases sCD14 and cow’s milk sIgA-producing cells

Bifidobacterium breve BBI99, Lactobacillus rhamnosus GG & LC705, & Propionibacterium freudenreichii subs shermanii JS

Infant: 1.22x10(10) CFU twice per day for 4 weeks

Increases IL-4, soluble E-selectin in px with IgE-mediated cow’s milk allergy, and IL-10

Exercise-induced Immuno- suppression General Outcome Specific probiotic strains and protocols can benefit athletes and physically active individuals for respiratory tract infections, GI distress and immunologic biomarkers, but that standardized protocols have not yet been established.

Single Strain

Lactobacillus casei Shirota or DN-114 001

Athletes: 6.5x10(9) twice per day for 16-20 weeks

Reduces upper respiratory tract infection (URTI) frequency; increases IgA; prevents infection spread Reduces Epstein Barr virus and cytomegalovirus antibody titres in seropositive px

Lactobacillus fermentum VRI-003

Athletes: 1.26x10(10) CFU per day for 2 months

Reduces respiratory symptoms, and illness severity; increases IFN-γ

Lactobacillus gasseri OLL2809

Athletes: 1x10(10) inactivated CFU three times per day for 4 weeks

Reduces NK cell activity after exercise; improves mood. Addition of α-lactalbumin improves minor resting fatigue and reduces ROS & TGF-β1

Lactobacillus helveticus Lafti L10

Athletes: 2x10(10) CFU per day for 14 weeks

Reduces URTI duration and number of symptoms; increases self-rated vigor; maintains anti-Enterococcus faecalis IgG, total IgA, and anti-Lactobacillus rhamnosus IgA antibodies

Lactococcus lactis JCM 5805

Athletes: 1x10(11) inactivated CFU per day for 13 days

Reduces days of URTI and symptoms, days of fatigue; increases plasmacytoid dendritic cell activity



Exercise-induced Immuno- suppression

Multistrain

Bifidobacterium bifidum W23, Bifidobacterium lactis W51, Enterococcus faecium W54, Lactobacillus acidophilus W22, Lactobacillus brevis W63, and Lactococcus lactis W58


Prevents lowering of tryptophan after exercise; reduces incidence of URTI

HIV General Outcome There is inconclusive effects of probiotics alone for reducing CD4 counts overall as outcomes can be modulated by sex, origin, and protocol, however there may be benefits for related management of bacterial vaginosis, GI dysfunction and immune function, GI morphology and barrier integreity and, diarrhea.

Single Strain

Bacillus coagulans Adult: 2x10(9) CFU per day for 3 months with antiretroviral therapy

Reduces constipation and total GI symptom rating; associated increases CD+ T cells

Saccharomyces boulardii

Adult: 3000 mg per day for 7 days

Reduces associated diarrhea

Lactobacillus casei Shirota

Pediatric: 6.5x10(8) CFU per day for 8 weeks

Increases peripheral CD4⁺ T-cell, Th2 (CXCR3-CCR6-CD4⁺) and Th17 (CXCR3-CCR6⁺CD4⁺) counts; reduces regulatory T-cell (CD25highCD4⁺), & CD8⁺ cells (CD38⁺HLA-DR⁺CD8⁺) counts, and plasma HIV load

Lactobacillus rhamnosus

Adult: 6x10(9) CFU twice per day for 8 weeks

Reduces intestinal inflammation, Enterobacteriaceae, and Erysipelotrichaceae



HIV Multistrain

Lactobacillus reuteri RC-14 & Lactobacillus rhamnosus GR-1

Adult: 2x10(9) CFU twice per day for 25 weeks with 10 day metronidazole therapy

Increases chance of improved vaginal pH, tends to increase chance of normalized vaginal flora (ie. does not cure bacterial vaginosis but may be beneficial for prevention in HIV)

B. animalis subs. lactis, L. acidophilus, & L. rhamnosus

Adult: 5.25x10(8) CFU per day in milk for 8 weeks using antiretroviral therapy

Reduces D-dimers, and Bacteroides (positively correlated with LPS); increases Bifidobacteria (negatively correlated with LPS), and Lactobacilli

Bifidobacterium breve DSM24732, Bifidobacterium infantis DSM24737, Bifidobacterium longum DSM24736, Lactobacillus acidophilus DSM24735, Lactobacillus delbrueckii subs. bulgaricus DSM24734, Lactobacillus plantarum DSM24730, Lactobacillus paracasei DSM24733, Streptococcus thermophilus DSM24731 (Vivomixx®)

Adult: 9.0x10(11) CFU twice per day for 6 months in px on antiretroviral therapy

Reduces CD4+ & CD8+ T‐cell subsets that express CD38+, HLA‐DR+, or both; increases Th17 cell subsets (particularly central or effector memory phenotypes) in peripheral blood and gut-lymphoid tissue, Th1 cell subsets (in gut-lymphoid tissue); associated with gut barrier recovery, reduction in lymphocyte density, enterocyte apoptosis, and improved mitochondrial morphology via heat shock protein 60

B. breve, B. infantis, B. longum, L. acidophilus, L. casei, L. delbrueckii subs. bulgaricus L. plantarum, S. faecium & S. thermophilus

Adult: 3x10(11) CFU twice per day for 48 weeks with combined antiretroviral therapy

Reduces percentage of CD4+CD38+HLA-DR+ T cells, CD8+CD38+HLA-DR+ T cells, and hsCRPs; normalizes LBP



Immune Function General Outcome Probiotics may support many functions/ biomarkers for maintaining immunity. This may include: Antioxidative biomarkers including increases in GSH and total antioxidant capacity, while reducing malondialdehyde. Findings for specific biomarkers are not always consistent between meta-analyses, however. Inflammatory biomarkers including reductions in hs-CRP, TNF-ɑ, IL-6, IL-12, and IL-4, while increasing IL-10.

Single Strain

Bacillus coagulans GBI-30, 6086

Geriatric: 1x10(9) CFU per day for 28 days

Increases F. prausnitzii & Bacillus bacteria, and IL-10

Bacillus polyfermentus Bispan

Adult: 3.1 x 10(8) CFU per day for 8 weeks

Increases IgG, CD4+ helper T cells, CD8+cytotoxic T cells, CD56+ NK cells, and CD4+: CD8+ T cell ratio

Bifidobacterium animalis subsp. lactis BI-04 or BI-07 Bifidobacterium animalis subsp. lactis HN019 Note: Meta-analyses indicate that HN019 in doses ranging from 5x10(9)-3x10(11) CFU per day for 3-6 weeks can increase NK cell tumoricidal efficacy and polymorphonuclear cell phagocytic capacity in older healthy adults

Adult: 2x10(10) CFU per day for 3 weeks following vaccination Adult: 2x10(9) CFU per day for 4 weeks and then 5-days after rhinovirus-A39 challenge Geriatric: 1.5x10(11) CFU twice per day in milk product for 6 weeks Infant: 9x10(9) CFU per day to pregnant women 2-5 weeks before delivery and for 6 months during lactation

BI-04 increases IgG, BI-07 tended to increase IgG BI-04 increases nasal chemokine CXCL8 prior to rhinovirus introduction and reduces CXCL8’s response to the virus; associated with reduced nasal lavage titre and virus shedding from nasal mucous Increases interferon-ɑ during peripheral blood stimulation, and polymorphonuclear cell phagocytosis Increases TGF-β1 and IgA in breast milk from week 1; reduces sCD14 in neonate plasma



Immune Function Bifidobacterium animalis subsp. lactis BB12 Bifidobacterium breve CNCM I-4035 Bifidobacterium breve M-16V

Adult: 2.5x10(10) CFU twice per day in milk product for 3 weeks Geriatric: 5x10(9) CFU per day in milk product for 3 weeks Infant: 1x10(6) CFU/g in formula per day for 6 weeks 1.6x10(9) CFU on days 1-3, and 4.8x10(9) CFU from days 4-21 in preterm infants Adult: 9x10(9) CFU per day for 30 days Infant: 1x10(9) CFU in milk product twice per day during hospital stay in preterm infants

Increases polymorphonuclear cell phagocytosis and NK cell tumor killing activity Increases peripheral CD56-positive lymphocytes and PBMC tumoricidal activity for K562 cells, especially with ages greater than 70 Increases sIgA in vaginally-delivered infants, anti rotavirus-sIgA in cesarean-delivered infants, and anti poliovirus-sIgA in all infants Reduces calprotectin; increases IgA, acetate, and lactate. Higher weight gain observed with antibiotics Increases sIgA (reverts after discontinuation), and CD3+ CD4+ CD25+ CD127- T regulatory cells; reduces IL-12 Increases TGF-β, and SMAD7 mRNA expression; reduces SMAD7 mRNA expression


Infant: 1x10(7) CFU/g in formula for 6 months

Increases bifidobacteria, bifidobacteria:enterobacteria ratio (associated with increased Th1 response), IFN-γ producing cells, and IFN-γ:IL-4 producing cell ratio

Enterococcus faecium IS-27526

Pediatric: 2.3x10(8) CFU in milk per day for 90 days

Increases humoral immune response, salivary sIgA



Immune Function Escherichia coli Nissle 1917

Infant: 1 ml of 1x10(8) CFU/ml for 5 days and three times per week for 3 weeks thereafter

Increases blood cells with E. coli strains, anti-E. coli sIgA and non-specific IgM

Lactobacillus acidophilus La-14 or NCFM Lactobacillus acidophilus LAVRI-A1

Adult: 2x10(10) CFU per day for 3 weeks following vaccination Infants: 3x10(9) CFU per day for first 6 months of life

La-14 increases serum IgG and tends to decrease IgA. NCFM tends to increase serum IgA and IgM Reduces IL-5 and TGF-β response to polyclonal stimulation, and IL-10 response to TT vaccine, but reduces TNF-ɑ and IL-10 responses to allergens

Lactobacillus casei Shirota Lactobacillus casei DN 114 001

Adult: 1.3-4x10(10) CFU per day in milk product for 3-4 weeks Adult: 1x10(8-10) CFU in milk product 1-3 times per day for 4-8 weeks

Increases NK cell activity via enhanced IL-12 production and is sustained 3 weeks after discontinuation in middle aged px (particularly in px with low baseline NK activity). Maintains NK cell activity in elderly px, while controls had lower activity; reduces CD25 expression and tends to increase IL-10:IL-12 ratio Increases NK activity and CD16+ cells, T cell activation marker CD3+ CD69+, NK cell marker CD3+ CD16/56+, and salivary IIFN-γ, IgA1 & IgA2; reduces IL-4 in CD3+ β7+ integrin blood cells, IL-12 & TNF-ɑ in CD14+ blood cells, and prevents NK activity reduction in smokers Increases cytotoxic T lymphocytes (CD3+CD16+CD56+), monocytic oxidative burst capacity, NK cell tumoricidal function, and IFN-γ; reduces IL-10 (but increases upon discontinuation) Increases NK cells during the puerperium; reduces TNF-ɑ in breast milk and GI disturbances in breastfed infants



Immune Function Lactobacillus delbrueckii subs. bulgaricus 8481 or OLL1073R-1

Geriatric: 3x10(7) CFU three times per day for 6 months

Increases IgA, NK cells, the level of less- differentiated T cell subsets, antimicrobial peptide hBD-2 and improves immune risk profile; reduces IL-8. Effects revert upon discontinuation

Lactobacillus gasseri TMC0356


Increases CD8+ T cells and maintains CD8(+)CD28(+) T cell expression

Lactobacillus helveticus Lafti L10


Maintains anti-Enterococcus faecalis IgG, and total IgA, anti-Lactobacillus rhamnosus IgA antibodies

Lactobacillus johnsonii La1 (NCC533)

Geriatric: 1x10(9) CFU per day for 12 weeks

Reduces days of infection

Lactobacillus paracasei CNCM I-4034 Lactobacillus paracasei LF19

Adult: 9x10(9) CFU per day for 30 days Infant: 1x10(8) CFU/serving from 4-13 months of age

Increases CD3+ CD4+ (T helper cells) and IL-10/IL-12 ratio Increases IFN-γ:IL-2 & IL-17A/IL-2 polyclonal response ratios, and TT-specific IL17-A response

Lactobacillus plantarum Lpc-37 or LP-115 Lactobacillus plantarum CECT 7315/7316

Adult: 2x10(10) CFU per day for 3 weeks following vaccination Geriatric: 5x10(8) CFU per day for 12 weeks 5x10(9) CFU per day for 12 weeks

Lpc-37 tends to decrease serum IgM, and LP-115 tends to increases serum IgG Increases activated T-helper lymphocytes (CD4+CD25+), B lymphocytes (CD19+), and antigen presenting cells (HLA-DR+); reduces TGF-β1; lower trend of mortality Increases activated potentially T-suppressor (CD8+CD25+) and NK cells (CD56+ CD16+); reduces TGF-β1; lower trends of infection incidence and mortality



Immune Function Lactobacillus plantarum IS-10506

Infant: 1x10(10) CFU per day for 3 months

Increases sIgA

Lactobacillus rhamnosus CNCM I-4036 Lactobacillus rhamnosus GR-1 Lactobacillus rhamnosus GG (ATCC 53103) Lactobacillus rhamnosus HN001 or HN019 Lactobacillus rhamnosus HN001

Adult: 9x10(9) CFU per day for 30 days Adult: 1x10(10) CFU per day in milk product from third trimester of pregnancy Geriatric: 1x10(10) CFU twice per day for 28 days Infant: 1x10(10) CFU per day to pregnant mothers for 4 weeks before delivery and then to infants for first 6 months of life Geriatric: 5x10(9-10) CFU per day in milk product for 3 weeks Infant: 6x10(9) CFU per day to pregnant women 2-5 weeks before delivery and for 6 months during lactation

Increases IL-4, IL-10, and TNF-a/IL-10 ratio Protects against rises in blood mercury and arsenic levels Reduces IL-8, which returns to baseline after one month of discontinuation Increases IgM-, IgA-, and IgG-secreting cells with 3 months of breastfeeding but not formula Increases helper T lymphocytes (CD4(+)), & activated (CD25(+)), NK cells, peripheral CD56-positive lymphocytes, and PBMC tumoricidal activity for K562 cells, especially with ages greater than 70 or with low baseline immune responses Increases IFN-γ in cord blood & blood of neonates, and TGF-β1 & IgA in breast milk



Immune Function Lactobacillus salivarius CECT5713 or UBL S22

Adult: 2x10(9) CFU per day for 4-6 weeks

Increases NK cells, monocytes, IgM, IgA, IgG, and IL-10; Reduces hs-CRP, IL-6, IL-β, and TNF-α

Pediococcus acidilactici K15

Adult: 5x10(10) inactivated CFU per day for 12 weeks

Increases salivary sIgA via dendritic cell secretion of IL-6 and IL-10

Saccharomyces cerevisiae

Adult: Single 500 mg dose

Reduces T cells and NK cell numbers; increases expression of CD25 & CD69 activation markers, and IFN-γ, antioxidants

Multistrain

Lactobacillus coryniformis CECT 5711 & Lactobacillus gasseri CECT 5714

Adult: 4x10(9) CFU per day in milk product for 2-4 weeks

Increases proportion of NK cells and IgA concentrations to greatest levels at 2 weeks, and fecal lactobacilli; reduces fecal cytotoxicity, S. choleraesuis adhesion to intestinal mucins

Bifidobacterium animalis subs. lactis DGCC 420 & Lactobacillus acidophilus 74-2

Adult: 2.79x10(11) CFU per day in milk product for 5 weeks

Increases granulocytes and phagocytic monocytes; reduces serum triacylglycerols

Bifidobacterium animalis subs. lactis BB12, Lactobacillus paracasei 431, & lactobacillus plantarum nF1


Increases NK cell activity, IFN-γ, and IgG1

Bifidobacterium animalis subs. lactis B420, Lactobacillus acidophilus 145, Lactobacillus rhamnosus GG (ATCC 53103), & Streptococcus thermophilus


Reduces upper respiratory tract pathogenic bacteria (Staphylococcus aureus, Streptococcus pneumoniae, beta-hemolytic streptococci, and Haemophilus influenzae), particularly for gram-positive bacteria



Immune Function Bifidobacterium breve BB99, Lactobacillus rhamnosus GG (ATCC 53103) & LC705, & Propionibacterium freudenreichii subs. Shermani

Infant: 11.22x10(9-10) CFU once or twice per day to pregnant mothers for 2-4 weeks before delivery, and once per day to infants for the first 6 months of life

Increases plasma CRP, total IgA, IgE, and IL-10. Raised CRP associated with reduced eczema (6 months) and allergic disease (2 years) risks Increases alpha1-antitrypsin and tends to increase IgA, which correlated with reduction in allergic disease risk

Bifidobacterium breve, Bifidobacterium infantis, Bifidobacterium longum, Lactobacillus acidophilus, Lactobacillus delbrueckii subs. bulgaricus, Lactobacillus paracasei, Lactobacillus plantarum, & Streptococcus thermophilus (VSL#3®)

Adult: 9x10(11) CFU twice per day for 7 days in the critically ill Infant: 9x10(11) CFU per day to lactating mothers for 4 weeks before delivery and 4 weeks after birth Infant & Pediatric: One sachet twice per day for 7 days in critically-ill px

Increases IgA and IgG Increases IL-10, and TGF-β1 in breast milk where TGF-β1 increases over treatment duration; Greater IL-6 in mother’s colostrum, which decreases over treatment duration; IgA increases in infants; reduces colic and regurgitation incidence Reduces IL-6, IL-12p70, IL-17, TNF-α levels, and Sequential Organ Failure Assessment score; increases IL-10, and TGF-β1 levels

Influenza General outcome Concomitant probiotics with influenza vaccination may improve vaccination efficacy for A/H1N1, A/H3N2 and B strain in adults and the elderly

Single Strain


Geriatric: 1x10(11) CFU per day for 19 weeks with vaccination at third week

Reduces incidence of influenza contraction, fever, NK cell activity and neutrophil bactericidal activity

Lactobacillus brevis KB290

Pediatric: 6x10(9) CFU per day for 5 days of the week over 8 weeks

Reduces incidence of influenza, especially in unvaccinated children



Influenza Lactobacillus coryniformis K8 CECT5711

Geriatric: 3x10(9) CFU per day for 2 weeks prior to vaccination

Increases vaccination response effectiveness; reduces incidence of respiratory infection symptoms and use of analgesics

Lactobacillus fermentum CECT5716

Adult: 1x10(10) CFU per day 2 weeks before and after vaccine

Increases natural killer cells, T-helper 1 response and IgA; reduces influenza illness incidence after vaccine

Lactobacillus paracasei MCC1849

Geriatric: 1x10(10) CFU per day for 6 weeks with vaccine administration after 3 weeks

Improves antibody response to A/H1N1 and B antigens only in px older than 85 years old

Lactobacillus plantarum CECT 7315 & CECT 7316

Geriatric: 5x10(8-9) CFU per day in milk product for 3 months (3-4 months after vaccination).

Increases influenza-specific IgA and IgG. Trends for increased IgM

Lactobacillus rhamnosus GG

Adult: 1x10(10) CFU twice per day for 4 weeks after vaccination

Increases seroprotection for the H3N2 strain during supplementation period

Lactococcus lactis JCM5805

Adult: 1x10(11) CFU in milk product per day for 10 weeks

Reduces days of cough and fever; Increases IFN-α and antiviral factor gene 15 in response to A/H1N1 virus

Saccharomyces cerevisiae (EpiCor®)

Adult: 500 mg per day for 12 weeks

Reduces cold/flu symptom incidence in non-vaccinated Px. Reduces cold/flu symptom incidence and symptom duration in vaccinated Px



Peanut Allergy Single strain

Lactobacillus rhamnosus CGMCC 1.3724 (NCC4007)

Infant & Pediatric: 2x10(10) CFU per day for 18 months with peanut oral immunotherapy (peanut flour, 50% peanut protein)

Peanut-therapy was associated with decreased peanut skin prick test responses and sIgE; increases likelihood of sustained responsiveness to peanut immunotherapy; reduces likelihood of desensitization Combination associated with improvements in Food Allergy Quality of Life Questionnaire and Food Allergy Independent Measure both at 3 and 12 months post-discontinuation

Poliomyelitis Single Strain

Lactobacillus acidophilus CRL431

Adult: 1x10(10) CFU in milk product for 5 weeks with polio vaccine administration during week 2

Increases poliovirus neutralizing antibody titers, sIgA and sIgG


Adult: 1x10(10) CFU in milk product for 5 weeks with polio vaccine administration during week 2

Increases poliovirus neutralizing antibody titers, sIgA ,and sIgG



Respiratory Tract Infection General Outcome Probiotics can reduce rates of upper respiratory tract infection (URTI), the duration, the use of antibiotics, and absence from school, daycare or work. Probiotics may reduce the incidence of respiratory tract infections (RTI), number of days of infection and days absent from school/care in children.

Single Strain

Bifidobacterium animalis subsp. lactis Bl-04 Bifidobacterium animalis subsp. lactis BB12

Adult: 2x10(9) CFU per day for 5 months Infant: 1x10(10) CFU per day for 2 years in two divided doses

Reduces URTI episode risk Reduces risk for respiratory tract infections



Reduces incidence of sore throat, and tends to reduce incidence of runny nose & cough during URTI

Enterococcus faecium L3

Infant: 1.5x10(9) CFU per day for three months

Reduces frequency in 1st month; Increases BMI in first month

Lactobacillus casei Shirota

Adult: 1x10(11) per day for 12 weeks

Reduces the incidence of URTI, URTI episodes and duration of symptoms. Inhibits reductions in NK cells and increases cortisol

Lactobacillus fermentum CECT5716

Infant: 2x10(8) CFU in formula per day for 6 months

Reduces URTI incidence

Lactobacillus paracasei N1115

Geriatric: 3.6x10(7) CFU/ml in 300ml milk product per day for 12 weeks

Reduces risk for and instances of acute URTI; increases CD3+ cells



Respiratory Tract Infection

Lactobacillus rhamnosus GG (ATCC 53103) Note: Meta-analysis suggest this LGG modestly reduces duration of RTIs

Geriatric: 2x10(10) CFU per day for 6 months Infant & Pediatric: 1x10(9) CFU per day for 1st month, then 2x10(9) CFU for 2nd month 1x10(9) CFU in milk product during hospitalization 1-2x10(8) CFU three times per day, for 5 days a week over 7 months in milk product

Reduces viral respiratory infection rates Reduces RTI and URTI incidence, rhinovirus-induced RTI episodes, acute otitis media incidence, and antibiotic use Reduces risk of respiratory tract infections and episodes enduring more than 3 days Reduces frequency of respiratory and lower respiratory tract infections, and need for antibiotics and days of illness

Multistrain

Bifidobacterium animalis subs. lactis BB12, & Lactobacillus rhamnosus GG

Adult: 2x10(9) CFU per day for 12 weeks Infant: 2x10(9) CFU per day until age of 1

Reduces duration and severity of upper respiratory infection Reduces risk of recurrent respiratory infections and need for antibiotics

Lactobacillus acidophilus & Lactobacillus casei

Infant: 1x10(7-8) CFU/ml per day for 3 months

Reduces frequency (max 3 per child vs. 7 in control), & severity of RTI episodes in pneumonia, bronchitis & recurrent obstructive bronchitis, and URTIs

Bifidobacterium bifidum, Bifidobacterium longum, & Lactobacillus gasseri

Athletes: 3x10(12) CFU per day for 28 days

Reduces incidence of URTI



Rheumatoid Arthritis General Outcome Probiotics may reduce IL-6 in rheumatoid arthritis (RA), they have limited effects on most inflammatory parameters in RA. Evidence on reducing disease activity scores also is currently conflicting.

Single strain

Bacillus coagulans GBI-30, 6086

Adult: 2x10(9) CFU per day for 60 days with antirheumatics or NSAIDs

Reduces pain, disability, CRP; Improves ability to walk and engage in functional activity

Lactobacillus casei 01 Adult: 1x10(10) CFU per day for 8 weeks adjunct to anti-rheumatics

Decreases disease activity, tender and swollen joint counts, TNF-ɑ, IL-6, IL-12, and hs-CRP; increases IL-10 and IL-10:IL-12 ratio

Multistrain

Lactobacillus reuteri RC-14 & Lactobacillus rhamnosus GR-1

Adult: 2x10(9) CFU twice per day for 3 months with anti-rheumatics

Improves functional assessment via Health Assessment Questionnaire but no clinical improvement

Bifidobacterium bifidum, Lactobacillus acidophilus, & Lactobacillus casei

Adult: 6x10(9) CFU/g per day for 8 weeks

Reduces disease activity, serum insulin, HOMA-B and HsCRP

Skin Health Single Strain

Lactobacillus johnsonii LA1

Adult: 1x10(10) CFU per day for 6 weeks prior to solar UV irradiation

Recovers skin cell allostimulatory capacity, which correlates with normalized CD1a expression in the skin

Lactobacillus paracasei NCC 2461 ST11

Adult: 1x10(9-10) CFU per day for 2 months

Reduces skin sensitivity; increases recovery of skin barrier Reduces free and adherent dandruff, erythema; improves global clinical score, scalp microbiota

Lactobacillus plantarum HY7714


Increases skin moisture; reduces transepidermal water loss, and wrinkle depth; improves skin gloss and elasticity



Skin Health Lactococcus lactis H61 Adult: 1x10(10) CFU in fermented milk per day for 4 weeks

Increases skin hydration in forearm, sebum content in cheek

Traumatic Brain Injury Complications

Single strain

Bifidobacterium longum, Lactobacillus bulgaricus, & Streptococcus thermophilus

Adult: 1x10(9) CFU per day for 21 days

Increases IL-12p70 and IFNγ; reduces IL-4, IL-10, nosocomial infections, ICU length of stay, and reduces blood glucose & need for insulin (facilitating blood glucose control)

Ventilator- associated Pneumonia General Outcome Probiotics may reduce the risk of ventilator- associated pneumonia (VAP) caused by Pseudomonas aeruginosa, but there is conflicting evidence on overall reductions in the incidence of VAP. The greatest benefit may be seen in critically-ill px.

Single Strain


Adult: 2x10(9) CFU twice per day during treatment of critically-ill Px

Reduces incidence of VAP, C. difficile associated diarrhea, and days of antibiotics

Multistrain

Bacillus subtilis & Enterococcus faecalis (Medilac-S®)

Adult: 0.5g three times per day with standard therapies for 14 days in critically-ill px

Reduces incidence of microbiologically confirmed pneumonia, and gastric pathogenic microorganisms; increases time to develop pneumonia

Bifidobacterium breve, Bifidobacterium longum, Lactobacillus acidophilus, Lactobacillus bulgaricus, Lactobacillus casei, Lactobacillus rhamnosus, & Streptococcus thermophilus (Lactocare®)

Adult: 1x10(10) CFU twice per day for 14 days in critically-ill px

Reduces incidence of microbiologically confirmed pneumonia, gastric residuals, and hospital/ICU stay duration



Ventilator- associated Pneumonia

Bifidobacterium breve, Bifidobacterium infantis, Bifidobacterium longum, Lactobacillus acidophilus, Lactobacillus bulgaricus, Lactobacillus casei, Lactobacillus plantaris, Lactobacillus rhamnosus, & Streptococcus thermophilus

Pediatric: 3.3x10(9) CFU twice per day for 7 days since ICU admission in critically-ill px

Reduces incidence of pneumonia, duration at ICU and hospital

Safety Considerations & Contraindications

While probiotics are considered safe, rare short term side effects, such as gas and bloating, may occur. Isolated cases of bacteremia or fungemia have been associated with probiotics, though population data also indicates that there is no widespread risk of these complications. There is some limited evidence that probiotics should not be administered in critically ill patients, as demonstrated by an increased risk of mesenteric ischemia and mortality in a trial of patients with predicted severe acute pancreatitis.


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