Use Of Probiotics In Prevention Research Articles

A Randomized Controlled Trial to Evaluate the Use of Probiotics in Prevention of Ventilator-Associated Pneumonia in Critically Ill ICU Patients

Abstract Context Ventilator-associated pneumonia (VAP) is one of the most common causes of morbidity and mortality in mechanically ventilated patients. Curing and preventing effects of probiotics in promoting the growth of Bifidobacterium in the digestive system and the central role of bacteria colonization in the pathogenesis of VAP are evident. Aims The purpose of this study was to evaluate the effects of administration of commercially available probiotics, that is, orodispersible probiotic sachets on VAP prevention and clinical outcomes in critically ill patients. Settings and Design Randomized control trials. Methods and Materials In this study, 120 mechanically ventilated patients were randomly divided into two groups (n = 60 per group). Group 1 was given orodispersible probiotic sachets by gavage, twice a day in addition to routine care, while group 2 received only routine care. Demographic and clinical data were analyzed and clinical outcomes to the primary component (prevalence of VAP) and secondary component (other clinical factors) were interpreted. Statistical Analysis Used In this study, data were analyzed via SAS statistical software version 9.4, using Student's t-test, chi-squared test, repeated measure analysis of variance, and Wilcoxon test. Results There was a significant reduction in VAP diagnosed patients, as well as Clostridium difficile-associated diarrhea and some complications of mechanical ventilation, in group 1 in comparison to group 2. The improvement in VAP was significantly greater for group 1 as compared with group 2. However, the mortality rate was similar between two groups. Conclusions This study demonstrated that a daily diet with orodispersible probiotic sachets can be used as add-on therapy with other medications in the prevention of VAP. As a result, the use of orodispersible probiotic sachets in the treatment plan of patients undergoing long-term intubation is recommended.

Cytotoxicity, apoptosis, and IL-8 gene expression induced by some foodborne pathogens in presence of Bacillus coagulans in HT-29 cells

Food poisoning caused by bacteria is one of the most important concerns in food hygiene. The use of probiotics in prevention, control, and treatment of these infections has been considerably increased in recent years. This study evaluated the effect of B. coagulans cell free supernatant (CFS) on growth of Bacillus cereus, Listeria monocytogenes, Staphylococcus aureus, non-pathogenic Escherichia coli, and Escherichia coli 0157:H7 by the broth dilution method. The cytotoxicity, and apoptosis induced by pathogens alone and in co-culture with B. coagulans or its CFS were measured by trypan blue, and fluorescence staining methods. The expression level of interleukin-8 (IL-8) cytokine-encoding genes was also investigated by a qRT-PCR assay in all pathogens and co-cultured groups in HT-29 cells. Our results showed that 4% B. coagulans CFS reduced pathogen growth. The highest rate of growth inhibition was observed in L. monocytogenes. We also found that B. coagulans, and its 4% CFS reduced the cytotoxic effects of pathogens, with the exception of S. aureus. Non-pathogenic E. coli also had no significant cytotoxic effect on the cells. Examination of the treated cells with acridine orange/ethidium bromide staining showed reductions in the rate of cell damage (including early apoptosis, late apoptosis, and necrosis) in pathogen-probiotic co-cultures. Furthermore, we showed that co-culture of pathogens with B. coagulans significantly down-regulated IL-8 gene expression (P < 0.05). The greatest down-regulation compared with pathogen alone was observed in S. aureus. Hence, B. coagulans can be considered as an appropriate probiotic to diminish cytotoxicity, and inflammatory response of enteropathogenic bacteria.

Zastosowanie probiotyków w profilaktyce oraz leczeniu raka żołądka i raka jelita grubego

Zastosowanie probiotyków w profilaktyce oraz leczeniu raka żołądka i raka jelita grubego

P003 Young Investigator The role of probiotics in primary and secondary prevention of pouchitis: A systematic review and meta-analysis

BACKGROUND: Pouchitis is the most common long-term complication after ileal pouch anal anastomosis (IPAA) surgery. Its cumulative incidence is approximately 50% after a 10-year follow up. Several trials have looked at the use of probiotics in prevention of pouchitis, and showed a significant decrease in the development of pouchitis, but other showed no difference. Our data is very limited and the most recent Cochrane review in 2015 showed a possible benefit of probiotics in maintaining the remission, but it's not widely used in practice, especially in primary prevention. In this systematic review and meta-analysis, we aimed to discern whether probiotics are actually beneficial in primary and secondary prevention of pouchitis. METHODS: A comprehensive search of MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews was conducted from each database's inception to May 20, 2017 to search for comparative studies of probiotics use in the prevention of primary (first episode) and secondary (recurrent episodes) pouchitis. The outcome of interest was the development of pouchitis. RESULTS: Nine studies with a total of 376 patients were included. The use of probiotics in the primary prevention was associated with a decreased incidence of pouchitis (RR, 0.18; 95% CI, 0.08–0.39; P &lt; 0.01; heterogeneity I2: 0%) with a NNT of 3.2, and their use in the secondary prevention was associated with a decreased incidence of recurrent pouchitis compared to placebo (RR, 0.20; 95% CI, 0.11–0.36; P &lt; 0.01; heterogeneity I2: 0%). Overall risk of developing pouchitis was decreased with the use of probiotics use (RR, 0.19; 95% CI, 0.12–0.30; P &lt; 0.01; heterogeneity I2: 0%) with a NNT of 2. Sub-group analysis included only studies that used VSL#3 showed a significant decrease in pouchitis in both primary prevention (RR, 0.23; 95% CI, 0.10–0.50; P &lt; 0.01; heterogeneity I2: 0%), secondary prevention (RR, 0.17; 95% CI, 0.09–0.31; P &lt; 0.01; heterogeneity I2: 0%), and overall risk (RR, 0.19; 95% CI, 0.12–0.36; P &lt; 0.01; heterogeneity I2: 0%). CONCLUSION(S): The current systematic review and meta-analysis showed that probiotics are superior to placebo in the primary and secondary prevention of pouchitis with a very significant NNT. These findings suggest the use of probiotics in patients after ileal pouch anal anastomosis (IPAA) surgery for primary prevention, or in patients with recurrent pouchitis.

Effectiveness of the probiotic B. bifidum 1 for the prevention of recurrent respiratory infections in children of 7–11 years old with functional and chronic disorders of gastrointestinal tract

Background: Acute respiratory infections (ARI) are a significant public health problem worldwide due to their high incidence and lack of specific prevention for most of them. Previous systematic reviews have demonstrated the possibility to use probiotics to prevent ARI in children. The prophylactic efficacy of the B. bifidum 1 strain in patients with recurrent ARI has not been investigated specifically against the background of concomitant gastrointestinal disorders, which may affect the effectiveness of probiotic therapy. Aim: To evaluate the effectiveness and safety of the sorbed probiotic B. bifidum 1 for prevention of ARI in children of 7 to 11 years of age with functional intestinal disorders or gastritis / gastroduodenitis. Materials and methods : This prospective, randomized, open-label study was completed by 44 children divided into two parallel groups: with and without administration of the sorbed B. bifidum 1 at 5 × 10 7 CFU three times daily for 21 days as a component of a comprehensive sanatorium treatment for recurrent ARI. The children were followed up for three months after the end of the treatment in a winter season, with assessment of frequency, severity and duration of ARI episodes. Results: The use of B. bifidum 1 in children of 7–11 years old with functional and chronic gastrointestinal disorders reduced the incidence of upper respiratory tract infections (relative risk reduction 0.48, 95% confidence interval 0.15–0.68) and mean duration of respiratory diseases by 2.26 days (95% confidence interval 0.23–4.27). It also reduced fever, frequency of cases with cough and the need in antibiotic therapy. The efficacy was related mainly to a decrease in the number of children with more than one ARI episode during the three months of the winter season. Conclusion: The results of probiotics use should be evaluated with consideration of underlying disease, which can more clearly indicate the size of their effect. The use of probiotics for prevention of infectious diseases, including respiratory infections, in children with functional and chronic gastrointestinal disorders can be promising in reduction of the overall morbidity and requires further studies.

Probiotics: A Promising Role in Dental Health.

Probiotics have a role in maintaining oral health through interaction with oral microbiome, thus contributing to healthy microbial equilibrium. The nature and composition of any individual microbiome impacts the general health, being a major contributor to oral health. The emergence of drug resistance and the side effects of available antimicrobials have restricted their use in an array of prophylactic options. Indeed, some new strategies to prevent oral diseases are based on manipulating oral microbiota, which is provided by probiotics. Currently, no sufficient substantial evidence exists to support the use of probiotics to prevent, treat or manage oral cavity diseases. At present, probiotic use did not cause adverse effects or increased risks of caries or periodontal diseases. This implicates no strong evidence against treatment using probiotics. In this review, we try to explore the use of probiotics in prevention, treatment and management of some oral cavity diseases and the possibilities of developing designer probiotics for the next generation of oral and throat complimentary healthcare.

A Study on the Antifungal Effects of Lactobacillus Spp. on Candida Species

Background: Yeast infections represents one of the most important hospital acquired infections. The use of Probiotics in prevention and treatment of different bacterial infections reduce the risk of emerging resistant bacterial strains to antibiotics that commonly used. Objective: This study investigates the antifungal effect of Lactobacillus on candida isolated from blood cultures. Methodology : Ten Lactobacilli strains were isolated from the children stool using MRS agar and biochemically identified by API 50CHL. Fifty Candida strains were isolated from blood cultures using Sabouraud dextrose agar. The test of antifungal effect of Lactobacilli strains on Candida was done by using plate well diffusion technique on SD agar. Results: The Lactobacillus acidophilus had the most effective antifungal effect on C. albicans and non albicans.

P478 The current place of probiotics in treatment of pouchitis: systematic review

Abstract Background: Pouchitis is a common complication in patients undergoing restorative proctocolectomy for ulcerative colitis. Therapeutic attempts include manipulations of pouch flora composition. In this systematic review, we aimed to score the evidence supporting the use of probiotics and prebiotics in pouchitis patients, to clarify the place of these treatments in current therapeutic regimens. Methods: We conducted extensive electronic searches of the PubMed and SCOPUS databases, from their earliest records through Nov 2016, for MESH terms “probiotics” and “pouchitis”. Results: The electronic search retrieved 20 citations [1–20]. Six published RCTs [2,3,9,10,13,14] and a RCT presented as an abstract [12] evaluated clinical, endoscopic end/or histological effect of probiotics as a primary outcome; other reports ranged in level of evidence between meta-analyses [16–19] (4), open-labeled trials [1,4–8,11,15] (8) and letters [20] (1). Conclusions: Prevention of onset of pouchitis/Primary prevention. Three studies examined the ability of various probiotic regimens to prevent the onset of pouchitis after the restorative proctocolectomy [1–3]. Primary preventive effect of VSL#3 was indicated by a single RCT, with calculated effect ratio of 1.50 [1.02, 2.21] [16]. Table 1. Use of probiotics for prevention of onset of pouchitis Study No. of patients Duration (months) probiotic strain Strain Control Pouchitis-free survival Gosselink (2004) 117 36 LGG No treatment (historical control) 93% vs. 71% (p=0.011) Gionchetti (2003) [2] 40 12 VSL#3 Placebo 90% vs. 60% (p&amp;lt;0.05) Yasueda (2015) [3] 17 24 Clostridium butyricum Placebo 89% vs. 50% (NS) Treatment of acute episode. Seven – mostly open-labeled and uncontrolled – trials examined the use of probiotics for treatment of acute pouchitis episode [4–10]. Efficacy of probiotics in acute episodes of pouchitis needs to be proved in randomized controlled trials. Table 2. Use of probiotics for treatment of active pouchitis Study No. of patients Duration (months) Strain Control Outcome Gionchetti et al. (2007) [4] 23 1 VSL#3 Open-labeled; uncontrolled 69% remission rate Laake et al. (2005) [5] 51 (10 with active disease) 1 Cultura® fermented milk product Open-labeled; uncontrolled Symptomatic and endoscopic improvement in patients with active disease Laake et al. (1999) [21] Cultura® fermented milk product Open-labeled; uncontrolled Symptomatic improvement Laake et al. (2003) [7] 10 ½ month Cultura® fermented milk product Open-labeled; uncontrolled Endoscopic improvement Laake et al. (2004) [8] 41 UC + 10 FAP 1 Cultura® fermented milk product Open-labeled; uncontrolled Symptomatic remission and endoscopic improvement Tomasz et al. (2014) [9] 43 (14 with active disease) 9 Lactobacillus acidophilus, Lactobacillus delbrueckii subsp. Bulgaricus, Bifidobacterium bifidus Placebo 43% remission rate vs 0% on placebo Kuisma (2003) [10] 20 3 LGG Placebo No benefit Seven studies aimed to determine the efficacy of probiotic strains in preventing recurrences in patients with previous episode/s of pouchitis [4,9,11–15]. Probiotic mixture VSL#3 effectively prevents relapses after successful antibiotic treatment of active inflammation, with calculated effect ratio of 20.24 [4.28, 95.81] [16]. Side effects may affect the adherence of the patients with the long-term treatment [15,16]. Table 3. Use of probiotics for prevention of recurrences of pouchitis Study No. of patients Duration (months) Probiotic strain Control Outcome Pronio (2008) [11] 31 12 VSL#3 No treatment Small reduction of PDAI scores Brown (2004) [12] (abstract) 17 6 Bifidobacterium longum BB-536 Placebo Pouchitis-free survival 86% vs. 60% on placebo (NS); small reduction of PDAI scores Tomasz et al. (2014) [9] 43 9 Lactobacillus acidophilus, Lactobacillus delbrueckii subsp. Bulgaricus, Bifidobacterium bifidus Placebo 43% in remission vs 0% on placebo Gionchetti et al. (2007) [4] 16 6 VSL#3 Open-labeled; uncontrolled 69% remission rate Gionchetti (2000) [13] 40 9 VSL#3 Placebo Pouchitis-free survival 85% vs. 0% on placebo (P&amp;lt;0.001) Mimura (2004) [14] 36 12 VSL#3 Placebo Pouchitis-free survival 85% vs. 6% on placebo (P&amp;lt;0.0001) Shen (2005) [15] 31 8 VLS#3 (self administration) Open-labeled compliance trial 80% non-adherence; 74% self-reported recurrence of symptoms

The Use of Probiotics in Respiratory Allergy

There is a high and steadily increasing prevalence of respiratory allergy throughout the world, especially in paediatric population and in industrialized and developing countries. A complex interplay between genetic and environmental factors has been implicated to explain this dramatic increase in prevalence of allergic diseases. It has been suggested that exposure to microbes plays a critical role in the development of the early immune system and may contribute to allergic diseases through their effect on mucosal immunity. Probiotics, microorganisms exerting beneficial effects on the host, are used in a great number of paediatric and adult diseases, mainly gastrointestinal disorders, but they have been proposed to be beneficial also in allergic diseases. Different trials have been published finding benefits in the use of probiotics in prevention and treatment of atopic dermatitis, but to date, studies have yielded inconsistent findings to support a protective association between their use on prevention of allergic rhinitis or asthma. However, probiotics may be beneficial in improving symptoms and quality of life in patients with allergic rhinitis although it remains limited due to study heterogeneity and variable outcome measures. As a result of these controversies, future investigations with a better standardization are needed. In this review, we summarize recent clinical research to elucidate the mechanisms of probiotics and their effect in respiratory allergy. According to published data, probiotics could emerge as a novel, complementary treatment option for allergic rhinitis but not for asthma.

A clinical reading on “World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics”

To the Editor Since the immunomodulatory properties of probiotics have been described, the effect of probiotic supplementation has been investigated in several trials and it has been also proposed as a preventive intervention for the development of allergic diseases. Recently two important evidence-based recommendations about the use of probiotics in the prevention of allergy were published [1, 2] with conflicting conclusions, in particular the most recent guideline [1] seems to be partially in contradiction with the previous statements about prevention of eczema. For these reasons, we tried to analyze the evidences leading to these recommendations [1] to highlight the aspects that can be more directly related or correlated with clinical practice. This clinical reading was addressed to offer some reflections about the methods used to formulate such recommendations, and the possibility to adopt in the clinical practice the proposed conclusions. We tried to retraces the path proposed by the Authors to analyse three important questions about the efficacy of probiotics in preventing allergic diseases if administrated to pregnant women (first question), to breastfeeding mothers (second question) and in healthy infants (third question). These questions have been investigated by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach [3], to perform a systematic review of randomized controlled trials and formulate recommendations. In summary, the GRADE method aims to define a rigorous and explicit method for the production of clinical recommendations. According to this method, the knowledge of advantages and disadvantages, benefits and risks of an intervention is necessary to make decisions in the health field. The GRADE approach also provides a three-phases decisional framework: a) formulation of a clinical question, with the choice and the formal evaluation of its related outcomes, and systematic evaluation of the scientific literature and the quality of the evidence; b) evaluation of the benefits and risks associated to the intervention, taking also in consideration its feasibility, the necessary resources and the patients’ preferences; c) formal definition of the strength of the recommendation. From a methodological point of view, it should be noted that the recommendations are directed to patients, clinicians and other health care professionals with different objectives, as clearly explained in the guidelines introduction. Each recommendation can have different levels of strength: strong recommendation indicates that patients would like to receive the intervention and that clinicians should actuate it. Conditional or weak recommendation indicates that the majority of patients would like to receive the intervention, but many other not, as well as they hope that clinicians would recognize that different choices may be appropriate for different patients, by taking advantage of decision-making tools to help patients to make consistent choices. In the results section of the guidelines we can read that “Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing * Correspondence: giampaolo.ricci@unibo.it Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Pad 16, via Massarenti 11, 40138 Bologna, Italy Full list of author information is available at the end of the article

Probiotics and Inhibition of Clostridium difficile Toxin

The definitions of international authorized probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. The scientific basis for the prevention and treatment of bowel disease among the functions of probiotics has only recently been established. Probiotics, which are actively studied, are lactic acid bacteria, especially Lactobacillus and Bifidobacterium species. The C. difficile toxin is controlled by quorum sensing, which causes intestinal disease and other gastrointestinal disorders, leading to antibiotic-associated diarrhea. The use of probiotics for prevention and treatment has been discussed in this review.

The role of probiotics in prevention and treatment for patients with allergic rhinitis: A systematic review.

Allergic rhinitis (AR) is a disease of respiratory allergy, and probiotics can provide a potential strategy for its management. The purpose of this study was to carry out a systematic review to investigate the role of probiotics in the prevention and treatment of AR. We searched for randomized controlled trials (RCTs) of the use of probiotics for the prevention and treatment of AR in the major electronic databases up to March 2014. The quality of the included RCTs was evaluated, and the data were independently extracted by two assessors. Meta-analyses were performed. Continuous data were expressed as the mean difference (MD) or standardized MD with 95% confidence interval (CI). Dichotomous data were expressed as odds ratio with the 95% CI. A p value <0.05 was considered significant. A total of 11 RCTs were included in the analysis. Probiotic intake was associated with a significant overall improvement of the quality of life scores and nasal symptom scores of patients with AR (MD -2.97 [95% CI, -4.77 to -1.16)]; p = 0.001). No improvements with regard to prevention or immunologic parameters were noted in the patients with AR. The current evidence is not sufficiently strong to verify a preventive role of probiotics in AR, but probiotics may improve the overall quality of life and nasal symptom scores. Because the available data were generated from only a few trials with a high degree of heterogeneity, routine use of probiotics for prevention and treatment in patients with AR cannot be recommended.

Probiotics in the dental practice: a review.

During the last decade an increased interest in alternative, preventive, and therapeutic strategies in dentistry has arisen. Probiotics are living microorganisms which, if administered in sufficient amounts, provide a health benefit to the host. Their precise mechanisms of action have not been identified, but they are able to interfere with the imbalance occurring in biofilm-associated infections. In other fields of medicine, mainly in gastroenterology, their usefulness is already proven. Concerning oral threats, probiotic bacteria may reduce the numbers of pathogens associated with dental caries (mutans streptococci). Clinically, results are encouraging, but further research is needed to demonstrate apparent effects of certain probiotic strains on oral health as well as their desired concentration and vehicle. The use of probiotics in prevention and treatment of caries, periodontal diseases, halitosis, and other oral diseases needs to be further investigated.

The Health Benefits of Probiotics

There has been a significant increase in research on probiotics-associated health benefits in the last 20 years. Many studies carried out in vitro and clinically show that consumption of probiotics inhibits the growth of pathogenic microorganisms. Furthermore, the consumption of probiotics also enhances the host immune response and decreases the levels of carcinogenesis-inducing enzymes. These positive outcomes have led to the use of probiotics in prevention and treatment of infectious diseases like bacterial or antibiotic associated diarrhea, chronic inflammatory bowel diseases and colon cancer. This review summarises literature pertaining to mechanistic actions of probiotics in improving the well-being of hosts. DOI : http://dx.doi.org/10.17576/JSKM-2014-1202-06

The Health Benefits of Probiotics

There has been a significant increase in research on probiotics-associated health benefits in the last 20 years. Many studies carried out in vitro and clinically show that consumption of probiotics inhibits the growth of pathogenic microorganisms. Furthermore, the consumption of probiotics also enhances the host immune response and decreases the levels of carcinogenesis-inducing enzymes. These positive outcomes have led to the use of probiotics in prevention and treatment of infectious diseases like bacterial or antibiotic associated diarrhea, chronic inflammatory bowel diseases and colon cancer. This review summarises literature pertaining to mechanistic actions of probiotics in improving the well-being of hosts. DOI : http://dx.doi.org/10.17576/JSKM-2014-1202-06

The role of probiotics in the poultry industry.

The increase of productivity in the poultry industry has been accompanied by various impacts, including emergence of a large variety of pathogens and bacterial resistance. These impacts are in part due to the indiscriminate use of chemotherapeutic agents as a result of management practices in rearing cycles. This review provides a summary of the use of probiotics for prevention of bacterial diseases in poultry, as well as demonstrating the potential role of probiotics in the growth performance and immune response of poultry, safety and wholesomeness of dressed poultry meat evidencing consumer’s protection, with a critical evaluation of results obtained to date.

Use of probiotics for prevention of radiation-induced diarrhea

To investigate the efficacy of a high-potency probiotic preparation on prevention of radiation-induced diarrhea in cancer patients. This was a double-blind, placebo-controlled trial. Four hundred and ninety patients who underwent adjuvant postoperative radiation therapy after surgery for sigmoid, rectal, or cervical cancer were assigned to either the high-potency probiotic preparation VSL#3 (one sachet t.i.d.,) or placebo starting from the first day of radiation therapy. Efficacy endpoints were incidence and severity of radiation-induced diarrhea, daily number of bowel movements, and the time from the start of the study to the use of loperamide as rescue medication. More placebo patients had radiation-induced diarrhea than VSL#3 patients (124 of 239 patients, 51.8%, and 77 of 243 patients, 31.6%; P<0.001) and more patients given placebo suffered grade 3 or 4 diarrhea compared with VSL#3 recipients (55.4% and 1.4%, P<0.001). Daily bowel movements were 14.7 +/- 6 and 5.1 +/- 3 among placebo and VSL#3 recipients (P<0.05), and the mean time to the use of loperamide was 86 +/- 6 h for placebo patients and 122 +/- 8 h for VSL#3 patients (P<0.001). Probiotic lactic acid-producing bacteria are an easy, safe, and feasible approach to protect cancer patients against the risk of radiation-induced diarrhea.

Probiotics for prevention of recurrent vulvovaginal candidiasis: a review

Vulvovaginal candidiasis (VVC) is a common infection affecting the quality of life of many women. Probiotics have been investigated as possible agents for the prevention of recurrences of VVC. We reviewed the available literature. In some studies the development of VVC was associated with either a low number of lactobacilli in the vagina or with the presence of H2O2-non-producing vaginal lactobacilli, although there are a few studies not supporting these statements. In addition, in vitro studies have shown that lactobacilli can inhibit the growth of Candida albicans and/or its adherence on the vaginal epithelium. The results of some clinical trials support the effectiveness of lactobacilli, especially Lactobacillus acidophilus, Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14, administered either orally or intravaginally in colonizing the vagina and/or preventing the colonization and infection of the vagina by C. albicans, while the results of a small number of clinical trials do not corroborate these findings. Nevertheless, most of the relevant clinical trials had methodological problems such as small sample size, no control group (placebo) and included women without confirmed recurrent VVC, and thus they are not reliable for drawing definitive conclusions. Thus, the available evidence for the use of probiotics for prevention of recurrent VVC is limited. However, the empirical use of probiotics may be considered in women with frequent recurrence of VVC (more than three episodes per year), especially for those who have adverse effects from or contraindications for the use of antifungal agents, since adverse effects of probiotics are very rare. In any case women should be clearly informed about the unproven usefulness of probiotics for this purpose. In conclusion, despite the promising results of some studies, further research is needed to prove the effectiveness of probiotics in preventing the recurrences of VVC and to allow their wide use for this indication.

Probiotics: their role in the treatment and prevention of disease

A probiotic is a “live microbial food ingredients that, when ingested in sufficient quantities, exerts health benefits on the consumer”. Probiotics exert their benefits through several mechanisms; they prevent colonization, cellular adhesion and invasion by pathogenic organisms, they have direct antimicrobial activity and they modulate the host immune response. The strongest evidence for the clinical effectiveness of probiotics has been in their use for the prevention of symptoms of lactose intolerance, treatment of acute diarrhea, attenuation of antibiotic-associated gastrointestinal side effects and the prevention and treatment of allergy manifestations. More research needs to be carried out to clarify conflicting findings on the use of probiotics for prevention of travelers’ diarrhea, infections in children in daycare and dental caries, and elimination of nasal colonization with potentially pathogenic bacteria. Promising ongoing research is being conducted on the use of probiotics for the treatment of Clostridium difficile colitis, treatment of Helicobacter pylori infection, treatment of inflammatory bowel disease and prevention of relapse, treatment of irritable bowel syndrome, treatment of intestinal inflammation in cystic fibrosis patients, and prevention of necrotizing enterocolitis in premature infants. Finally, areas of future research include the use of probiotics for the treatment of rheumatoid arthritis, prevention of cancer and the treatment of graft-versus-host disease in bone marrow transplant recipients.

Probiotic agents and infectious diseases: a modern perspective on a traditional therapy.

There is an increasing scientific and commercial interest in the use of beneficial microorganisms, or "probiotics," for the prevention and treatment of disease. The microorganisms most frequently used as probiotic agents are lactic-acid bacteria such as Lactobacillus rhamnosus GG (LGG), which has been extensively studied in recent literature. Multiple mechanisms of action have been postulated, including lactose digestion, production of antimicrobial agents, competition for space or nutrients, and immunomodulation. We have reviewed recent studies of probiotics for the treatment and control of infectious diseases. Studies of pediatric diarrhea show substantial evidence of clinical benefits from probiotic therapy in patients with viral gastroenteritis, and data on LGG treatment for Clostridium difficile diarrhea appear promising. However, data to support use of probiotics for prevention of traveler's diarrhea are more limited. New research suggests potential applications in vaccine development and prevention of sexually transmitted diseases. Further studies are needed to take full advantage of this traditional medical approach and to apply it to the infectious diseases of the new millennium.