Online citations, reference lists, and bibliographies.
← Back to Search

Probiotic Use In Clinical Practice: What Are The Risks?

R. Boyle, R. Robins-Browne, M. Tang
Published 2006 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
Share
Probiotics have been advocated for the prevention and treatment of a wide range of diseases, and there is strong evidence for their efficacy in some clinical scenarios. Probiotics are now widely used in many countries by consumers and in clinical practice. Given the increasingly widespread use of probiotics, a thorough understanding of their risks and benefits is imperative. In this article we review the safety of probiotics and discuss areas of uncertainty regarding their use. Although probiotics have an excellent overall safety record, they should be used with caution in certain patient groups-particularly neonates born prematurely or with immune deficiency. Because of the paucity of information regarding the mechanisms through which probiotics act, appropriate administrative regimens, and probiotic interactions, further investigation is needed in these areas. Finally, note that the properties of different probiotic species vary and can be strain-specific. Therefore, the effects of one probiotic strain should not be generalized to others without confirmation in separate studies. Careful consideration should be given to these issues before patients are advised to use probiotic supplements in clinical practice.
This paper references
10.1007/S12016-002-0011-0
Probiotics in clinical conditions
P. Marteau (2002)
10.1126/SCIENCE.1104816
Host-Bacterial Mutualism in the Human Intestine
F. Bäckhed (2005)
10.1086/514766
Liver abscess due to a Lactobacillus rhamnosus strain indistinguishable from L. rhamnosus strain GG.
M. Rautio (1999)
10.1136/adc.72.1.51
Viable versus inactivated lactobacillus strain GG in acute rotavirus diarrhoea.
M. Kaila (1995)
10.1097/00017285-199611001-00004
Effects of Lactobacillus GG Yogurt on Human Intestinal Microecology in Japanese Subjects
Y. Benno (1996)
10.1007/BF01975049
Nosocomial bacteremia caused byBacillus species
V. Richard (2005)
Prokaryotic regulation of epithelial responses by inhibition of IkappaB-alpha ubiquitination.
A. Neish (2000)
10.1111/J.1574-695X.2001.TB01583.X
Good adhesion properties of probiotics: a potential risk for bacteremia?
E. Apostolou (2001)
10.1016/J.JPEDS.2004.06.068
Effect of probiotics on gastrointestinal symptoms and small intestinal permeability in children with atopic dermatitis.
V. Rosenfeldt (2004)
10.1128/IAI.65.8.3345-3351.1997
Colonization of congenitally immunodeficient mice with probiotic bacteria.
R. D. Wagner (1997)
10.1179/acb.2004.032
SACCHAROMYCES CEREVISIAE FUNGEMIA IN A HEAD AND NECK CANCER PATIENT: A CASE REPORT AND REVIEW OF THE LITERATURE
S. Henry (2004)
10.1086/517685
Saccharomyces boulardii fungemia in a patient receiving Ultra-levure therapy.
I. Fredenucci (1998)
10.1136/adc.69.5_Spec_No.488
Effects of feeding premature infants with Lactobacillus GG on gut fermentation.
E. M. Stansbridge (1993)
Effects of Lactobacillus GG yoghurt on RISKS OF PROBIOTIC TREATMENT 1263 by gest on O cber 14, 2017 ajcn.trition.org D ow nladed fom human intestinal microecology in Japanese subjects
Y Benno (1996)
10.1203/00006450-199604000-00011
Gut Flora Allows Recovery of Oral Tolerance to Ovalbumin in Mice after Transient Breakdown Mediated by Cholera Toxin or Escherichia coli Heat-Labile Enterotoxin
V. Gaboriau-Routhiau (1996)
10.1007/s100960050003
Possible Role of Catheters in Saccharomyces boulardii Fungemia
C. Hennequin (2000)
10.1097/01.inf.0000154588.79356.e6
LACTOBACILLUS RHAMNOSUS GG BACTEREMIA ASSOCIATED WITH PROBIOTIC USE IN A CHILD WITH SHORT GUT SYNDROME
M. A. De Groote (2005)
10.1067/MAI.2003.389
Effect of probiotic Lactobacillus strains in children with atopic dermatitis.
V. Rosenfeldt (2003)
10.1086/368080
Safety of probiotics that contain lactobacilli or bifidobacteria.
S. P. Borriello (2003)
10.1093/AJCN/79.2.261
Long-term consumption of infant formulas containing live probiotic bacteria: tolerance and safety.
J. Saavedra (2004)
10.1111/J.1469-0691.1999.TB00144.X
Lactobacillus endocarditis caused by a probiotic organism.
Andrew D. Mackay (1999)
10.1016/0167-5699(93)90235-D
Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon?
T. Wegmann (1993)
10.1093/ajcn/73.2.465s
Probiotics and safety.
N. Ishibashi (2001)
[Fungemia after oral treatment with Saccharomyces boulardii in a patient with multiple comorbidities].
F. Lestin (2003)
10.1128/IAI.65.10.4165-4172.1997
Biotherapeutic effects of probiotic bacteria on candidiasis in immunodeficient mice.
R. D. Wagner (1997)
10.1067/MAI.2002.128528
Lactic acid bacteria inhibit TH2 cytokine production by mononuclear cells from allergic patients.
P. Pochard (2002)
Commission directive on processed cereal-based foods and baby foods for infants and young children
(1996)
10.1016/J.IJFOODMICRO.2004.05.004
Identification of probiotic microorganisms in South African products using PCR-based DGGE analysis.
J. Theunissen (2005)
10.1310/6F83-N39Q-9PPP-LMVV
The Efficacy and Safety of Probiotic Lactobacillus rhamnosus GG on Prolonged, Noninfectious Diarrhea in HIV Patients on Antiretroviral Therapy: A Randomized, Placebo-Controlled, Crossover Study
M. Salminen (2004)
10.3402/MEHD.V6I6.8150
Effect of Administration of Lactobacillus casei Strain GG on the Gastrointestinal Microbiota of Newborns
E. Sepp (1993)
10.1128/AEM.65.1.351-354.1999
Persistence of Colonization of Human Colonic Mucosa by a Probiotic Strain, Lactobacillus rhamnosusGG, after Oral Consumption
M. Alander (1999)
10.1128/AEM.64.10.3854-3859.1998
Temperature Gradient Gel Electrophoresis Analysis of 16S rRNA from Human Fecal Samples Reveals Stable and Host-Specific Communities of Active Bacteria
E. Zoetendal (1998)
10.1136/gut.52.6.827
Extracellular MUC3 mucin secretion follows adherence of Lactobacillus strains to intestinal epithelial cells in vitro
D. Mack (2003)
10.1016/S0278-6915(98)00090-8
Safety and tolerance of Lactobacillus reuteri supplementation to a population infected with the human immunodeficiency virus.
B. W. Wolf (1998)
10.1128/AEM.62.12.4608-4613.1996
Molecular analysis of the composition of the bifidobacterial and lactobacillus microflora of humans.
A. McCartney (1996)
10.1007/s100960000295
Fungemia with Saccharomyces cerevisiae in Two Newborns, Only One of Whom Had Been Treated with Ultra-Levura
J. Perapoch (2000)
10.1128/JCM.36.1.325-326.1998
Recurrent Septicemia in an Immunocompromised Patient Due to Probiotic Strains of Bacillus subtilis
M. Oggioni (1998)
10.1128/AEM.66.6.2578-2588.2000
Analysis of the Fecal Microflora of Human Subjects Consuming a Probiotic Product Containing Lactobacillus rhamnosusDR20
G. Tannock (2000)
10.1016/S0091-6749(97)70093-9
Probiotics: a novel approach in the management of food allergy.
H. Majamaa (1997)
10.1038/nbt840
Biological containment of genetically modified Lactococcus lactis for intestinal delivery of human interleukin 10
L. Steidler (2003)
10.1097/00004836-200301000-00013
Saccharomyces cerevisiae fungemia after Saccharomyces boulardii treatment in immunocompromised patients.
A. Riquelme (2003)
10.1126/SCIENCE.291.5505.881
Molecular analysis of commensal host-microbial relationships in the intestine.
L. Hooper (2001)
ocomial bacteremia caused by Bacillus species
V Richard (1988)
10.1093/CLINIDS/22.3.564
Lactobacilli and bacteremia in southern Finland, 1989-1992.
M. Saxelin (1996)
10.1086/342912
Lactobacillus bacteremia during a rapid increase in probiotic use of Lactobacillus rhamnosus GG in Finland.
M. Salminen (2002)
10.1002/14651858.CD003048.PUB2
Probiotics for treating infectious diarrhoea.
S. Allen (2004)
10.1136/bmj.324.7350.1361
Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis
A. L. D'Souza (2002)
10.1080/00365540110026953
Endocarditis by Lactobacillus rhamnosus due to yogurt ingestion?
E. Presterl (2001)
10.1053/GAST.2000.9370
Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial.
P. Gionchetti (2000)
10.4049/jimmunol.168.1.171
Lactobacilli Differentially Modulate Expression of Cytokines and Maturation Surface Markers in Murine Dendritic Cells1
H. R. Christensen (2002)
10.1179/acb.2004.033
SACCHAROMYCES CEREVISIAE FUNGEMIA IN AN ELDERLY PATIENT WITH CLOSTRIDIUM DIFFICILE COLITIS
S. Cherifi (2004)
10.1542/peds.2004-1815
Effect of a Probiotic Infant Formula on Infections in Child Care Centers: Comparison of Two Probiotic Agents
Z. Weizman (2005)
10.1038/ni1018
Commensal anaerobic gut bacteria attenuate inflammation by regulating nuclear-cytoplasmic shuttling of PPAR-γ and RelA
D. Kelly (2004)
10.1126/SCIENCE.289.5484.1560
Prokaryotic Regulation of Epithelial Responses by Inhibition of IκB-α Ubiquitination
A. Neish (2000)
Effect of Lactobacillus casei strain GG administration on the gastrointestinal microbiota of newborns
E Sepp (1993)
Regulatory and clinical aspects of dairy probiotics
G. Reid (2001)
10.1542/peds.2004-2137
Lactobacillus Sepsis Associated With Probiotic Therapy
M. Land (2005)
Effect of Lactobacillus casei strain GG administration on the gastrointestinal microbiota of newborns. Microbial Ecol
E Sepp (1993)
10.1016/S0140-6736(00)04259-8
Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial
M. Kalliomäki (2001)
10.1097/00005176-199507000-00022
Fungemia with Saccharomyces boulardii in a 1-year-old girl with protracted diarrhea.
M. Pletincx (1995)
Guidelines for the evaluation of probiotics in food
M Kaila (2002)
10.1007/s00134-002-1267-9
Seven cases of fungemia with Saccharomyces boulardii in critically ill patients
T. Lherm (2002)
10.1016/S0168-1605(98)00051-8
Vancomycin resistance factor of Lactobacillus rhamnosus GG in relation to enterococcal vancomycin resistance (van) genes.
S. Tynkkynen (1998)
10.1046/j.1365-2222.1998.00449.x
Probiotic bacteria down‐regulate the milk‐induced inflammatory response in milk‐hypersensitive subjects but have an immunostimulatory effect in healthy subjects
Pelto (1998)
10.1086/517255
Fungemia due to Saccharomyces species in a patient treated with enteral Saccharomyces boulardii.
M. Niault (1999)
10.1128/JCM.41.11.5340-5343.2003
Outbreak of Saccharomyces cerevisiae Subtype boulardii Fungemia in Patients Neighboring Those Treated with a Probiotic Preparation of the Organism
M. Cassone (2003)
10.1016/j.cell.2004.07.002
Recognition of Commensal Microflora by Toll-Like Receptors Is Required for Intestinal Homeostasis
S. Rakoff-Nahoum (2004)
10.1046/j.1365-2222.2000.00948.x
Interleukin‐10 generation in atopic children following oral Lactobacillus rhamnosus GG
Tanja Pessi (2000)
10.3402/MEHD.V4I4.7661
Dose Response Colonisation of Faeces after Oral Administration of Lactobacillus casei Strain GG
M. Saxelin (1991)
10.1111/j.1365-2672.2004.02340.x
Genetic heterogeneity and functional properties of intestinal bifidobacteria
J. Maettoe (2004)
10.1007/s001340051261
Saccharomyces fungemia complicating Saccharomyces boulardii treatment in a non-immunocompromised host
B. Rijnders (2000)
[Saccharomyces boulardii fungemia in a patient with severe burns].
M. Viggiano (1995)
10.1016/J.JACI.2004.03.036
Lactobacillus GG effect in increasing IFN-gamma production in infants with cow's milk allergy.
Emma Pohjavuori (2004)
10.1016/S0750-7658(05)80603-3
Fongémie à Saccharomyces boulardii chez un brûlé grave
M. Viggiano (1995)
10.1055/S-2003-44948
Fungämie nach oraler gabe von saccharomyces boulardii bei einem multimorbiden patienten
F. Lestin (2003)
10.1097/00005176-200404000-00017
Two cases of Lactobacillus bacteremia during probiotic treatment of short gut syndrome.
A. Kunz (2004)
10.1016/S0002-9343(98)00133-8
Fungemia with Saccharomyces cerevisiae after treatment with Saccharomyces boulardii.
S. Bassetti (1998)
10.1128/CDLI.11.4.686-690.2004
Bifidobacterial Species Differentially Affect Expression of Cell Surface Markers and Cytokines of Dendritic Cells Harvested from Cord Blood
S. Young (2004)
10.1097/00005176-200302000-00012
Probiotic Bacteria in the Management of Atopic Disease: Underscoring the Importance of Viability
P. Kirjavainen (2003)
10.3402/MEHD.V12I2.8115
The trouble in tracing opportunistic pathogens: cholangitis due to Bacillus in a French hospital caused by a strain related to an Italian probiotic?
M. Spinosa (2000)
[Saccharomyces boulardii fungemia. Apropos of a case].
P. Zunic (1991)



This paper is referenced by
10.1371/journal.pone.0059370
Cell-Free Culture Supernatant of Bifidobacterium breve CNCM I-4035 Decreases Pro-Inflammatory Cytokines in Human Dendritic Cells Challenged with Salmonella typhi through TLR Activation
Miriam Bermúdez-Brito (2013)
10.3945/ajcn.2009.28759
Safety of probiotics in patients receiving nutritional support: a systematic review of case reports, randomized controlled trials, and nonrandomized trials.
K. Whelan (2010)
10.1016/j.jaci.2008.07.042
Probiotics for the treatment or prevention of eczema.
R. Boyle (2009)
10.1016/j.anaerobe.2009.09.002
Evidence-based review of probiotics for antibiotic-associated diarrhea and Clostridium difficile infections.
L. Mcfarland (2009)
10.14710/JNC.V1I1.386
PENGARUH PEMBERIAN KEFIR SUSU SAPI TERHADAP KADAR KOLESTEROL LDL TIKUS JANTAN SPRAGUE DAWLEY HIPERKOLESTEROLEMIA
Sandy Eka Pratama (2012)
10.12688/f1000research.7630.1
Probiotics in critically ill children
S. Singhi (2016)
10.1099/JMMCR.0.000060
Streptococcus thermophilus bacteraemia in a patient with transient bowel ischaemia secondary to polycythaemia
Joanna C Stephens (2015)
10.12938/bifidus.30.129
Early Probiotic Supplementation for the Prevention of Atopic Disease in Newborns—Probiotics and the Hygiene Hypothesis—
M. Cabana (2011)
Viabilité, propriétés technologiques et effets anti-inflammatoires et anti-obésité de nouvelles souches probiotiques dans les produits laitiers
Véronique Demers Mathieu (2015)
10.1155/2019/1684198
Modification of Immunological Parameters, Oxidative Stress Markers, Mood Symptoms, and Well-Being Status in CFS Patients after Probiotic Intake: Observations from a Pilot Study
L. Venturini (2019)
10.1016/B978-0-12-394598-3.00005-8
Modern Approaches in Probiotics Research to Control Foodborne Pathogens
M. A. Amalaradjou (2012)
10.1111/j.1398-9995.2010.02507.x
Lactobacillus GG treatment during pregnancy for the prevention of eczema: a randomized controlled trial
R. Boyle (2011)
10.4067/S0034-98872008000800004
Efecto del probiótico Saccharomyces boulardii en la prevención de la diarrea asociada con antibióticos en adultos ambulatorios en tratamiento con amoxicilina
M. Bravo (2008)
10.1016/j.cyto.2012.08.003
Microbial cell components induced tolerance to flagellin-stimulated inflammation through Toll-like receptor pathways in intestinal epithelial cells.
N. Li (2012)
10.1177/1756283X11399115
Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection
M. Hickson (2011)
10.3945/jn.109.117093
Dietary supplementation with lactobacilli and bifidobacteria is well tolerated and not associated with adverse events during late pregnancy and early infancy.
S. Allen (2010)
10.1097/SLA.0B013E31805D0868
Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized control trial.
J. Kinross (2007)
Authors and Disclosures
Nancy Toedter Williams (2010)
10.1177/1756283X10373814
Use of probiotics in gastrointestinal disorders: what to recommend?
E. Verna (2010)
TRABALHO FINAL DO 6º ANO MÉDICO COM VISTA À ATRIBUIÇÃO DO GRAU DE MESTRE NO ÂMBITO DO CICLO DE ESTUDOS DE MESTRADO INTEGRADO EM MEDICINA
Debora da Silva Melo (2011)
Probiotics in antibiotic associated diarrhea in children
Matjaž Homan (2013)
10.1038/ajg.2010.11
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
Xing Gao (2010)
10.1016/j.pop.2017.02.002
Integrative Medicine for Gastrointestinal Disease.
M. Dossett (2017)
10.3920/BM2018.0159
Dealing with the remaining controversies of probiotic safety.
M. van den Nieuwboer (2019)
10.4314/ajcem.v20i2.2
Histopathological studies on kidney and liver of albino rat infected with toxigenic Aspergillus flavus after treatment with isolated Lactobacillus species from Kunu
O. O. Olonisakin (2019)
10.1007/s11274-013-1499-6
A potential role of probiotics in colorectal cancer prevention: review of possible mechanisms of action
Esther Swee Lan Chong (2014)
10.1111/j.1399-3038.2009.00921.x
Probiotics for allergic respiratory diseases – Putting it into perspective
M. Singh (2010)
10.1155/2012/676585
Gastrointestinal Microbiota and Some Children Diseases: A Review
T. K. Weber (2012)
Effects of s. Cerevisiae var. Boulardii in gastrointestinal disorders
A. Profir (2015)
10.1099/jmm.0.000579
The function of probiotics on the treatment of ventilator‐associated pneumonia (VAP): facts and gaps
F. Karacaer (2017)
10.9790/3013-24404146
Probiotics for Management of Periodontal Disease: A Novel Therapeutic Strategy?
S. Lawande (2012)
10.3748/WJG.V16.I31.3970
Use of pre-, pro- and synbiotics in patients with acute pancreatitis: a meta-analysis.
M. Zhang (2010)
See more
Semantic Scholar Logo Some data provided by SemanticScholar