CAVEATS: Limited data on the safety of probiotics exist
There was some heterogeneity among the studies in the meta-analysis by Hempel et al, and some of the studies were of poor quality. Because of this, the authors used subgroup and sensitivity analysis, which supported their initial conclusion.
Probiotics have generally been considered safe; however, there have been rare reports of sepsis and fungemia associated with probiotic use, especially in immunosuppressed patients.1 Fifty-nine of the included studies did not assess adverse events, which limited the ability of this meta-analysis to assess safety.1 Patients taking probiotics should be monitored for adverse effects.
CHALLENGES TO IMPLEMENTATION: Lack of guidance on dosing and duration
Since probiotics are considered food supplements, health insurance will not cover the cost (which will likely be more than $20 per month; www.walgreens.com). No single probiotic strain has high-quality evidence; however, most of the RCTs included in the meta-analysis used combinations of Lactobacillus species, which are usually found in over-the-counter antidiarrheal probiotic supplements. No standard dose exists, but dose ranges in RCTs are 107 to 1010 colony-forming units per capsule (taken one to 3 times daily);1 however, product labels have variable accuracy.11 The duration of treatment ranges from one to 3 weeks—or as long as the patient continues to take antibiotics.
Acknowledgement
The PURLs Surveillance System was developed with support from Grant Number UL1RR024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
