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American Gastroenterological Association practice guidelines for the use of probiotics
Clinical Question
According to the American Gastroenterological Association, when should probiotics be used to treat gastroenterological problems?
Bottom line
Based on a thorough review of the literature and an unwillingness (unlike other groups) to make recommendations when evidence is not available, the group gives a conditional recommendation to the use of probiotics only to prevent necrotizing enterocolitis in preterm infants and to treat adults and children with pouchitis. 5
Reference
Study design: Practice guideline
Funding: Self-funded or unfunded
Setting: Various (guideline)
Synopsis
These guidelines were developed based on a systematic review of the available literature. The guideline developers focused on whether probiotics improved the outcomes patients care about. The Chair of the working group and most of the group members declared no conflicts of interest. The group also included a methodologist. The available research was evaluated for quality, and the guidelines were determined by the strength of the evidence and were to be labeled as either strong (recommended for most patients) or conditional (the benefits and risks should be discussed with patients). The group had no strong recommendations. The recommendations are appropriately conservative, given either the lack of studies or the low quality of the available research. The group gave conditional recommendations to use combination probiotics (2 or more species) for preterm, low-birth-weight infants to prevent necrotizing enterocolitis. They suggest using an 8-strain combination for adults and children with pouchitis, though this recommendation is based on very-low-quality evidence. They sugggest probiotics to prevent, but not treat, Clostridioides difficile overgrowth for people receiving antibiotic treatment. The group recommends against the use of probiotics for children with infectious gastroenteritis. Citing the lack evidence, they make no recommendation regarding the use of probiotics for patients with C. difficile infection, Crohn's disease, ulcerative colitis, or irritable bowel disease.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
probiotics
slow and useful progress in this area
Guidelines for the use of probiotics
I am surprised about the complete absence for or against the use of probiotics when taking antibiotics.