Probiotics

More than 90 years ago, the Russian bacteriologist Ilya Metschnikoff postulated the immune-promoting effect of lactic acid bacteria in dairy products. As a result, he was awarded the Nobel Prize in 1908.

Probiotics are preparations made from live microorganisms that occur, for example, in the natural gut flora, the microbiome. The gut microbiome plays a key role in the development of many chronic diseases. It is now scientifically established that the intestinal mucosa and its microbiome influence the body’s most important organ systems, such as the nervous, metabolic, and immune systems.

Probiotics are commercially available in capsule or powder form. Foods such as sauerkraut, yogurt, and kefir also contain live microorganisms and are classified as probiotics. 

Probiotics approved as medications; see “Microbiological Therapy.”

A distinction must be made between “highly effective, state-of-the-art probiotics” and lifestyle products—foods that contain live microorganisms (e.g., Lactobacillus casei; Saccharomyces boulardii) and are intended to have a health-promoting effect when consumed in sufficient quantities.

Indications include, for example, the prevention of Clostridioides difficile infection (CDI) during antibiotic therapy. In this case, the probiotic should be added to the antibiotic within 48 hours. Currently, the efficacy of probiotics is considered proven exclusively in the symptomatic treatment of antibiotic-associated diarrhea (AAD).

E. coli (^{Mutaflor® capsules} ), for example, are approved for use in ulcerative colitis.

The combination of prebiotics and probiotics is known as a synbiotic. 

Probiotics are also used topically to regulate the skin microbiome, e.g. , in atopic dermatitis; one example is the product^{AktivaDerm®ND}, which contains 9 live bacterial strains.

• Regular consumption is said to promote the colonization of bacteria in the gut flora and have a beneficial effect on the course of intestinal diseases.
• Probiotics are said to have digestive benefits; in particular, they are believed to improve the absorption of nutrients.
• Probiotics are said to strengthen the immune system’s defenses in the intestinal wall.
• Probiotics are now available in various forms (capsules, dietary products). Prebiotics are often added to them—that is, certain indigestible oligosaccharides such as inulin and oligofructose, which are believed to promote the growth of probiotic bacteria in the large intestine. The combination of probiotics and prebiotics is called a synbiotic.
• To be used as a probiotic, microorganisms must meet the following criteria:
  • Safety for human health
  • Evidence of health benefits
  • unimpeded passage through the gastrointestinal tract
  • technological suitability.
• Additional criteria include the prevention or reduction of pathological adhesion, persistence, and proliferation of the probiotics, as well as the production of acids, hydrogen peroxide, and bactericides, and the ability to adhere to cells.
• Based on available study results, the preventive or direct therapeutic effect of probiotics in atopic eczema is questionable. No significant difference in clinical symptoms was observed.

Probiotics containing Saccharomyces boulardii (e.g., Perenterol®), which are primarily used to treat diarrhea, pose a risk of potentially fatal fungemia in immunocompromised, critically ill patients. They are contraindicated in these patients (a-t 2018; 49:23)      

Caution is advised in cases of severe abdominal inflammation: In a double-blind, placebo-controlled study, an excess mortality rate was observed in the probiotic group compared to the placebo group. In a study of nearly 300 patients with acute pancreatitis, an excess mortality rate of 16% was observed in the probiotic group compared to 9% in the placebo group.

"pro bios" (Greek) means "for life."

Numerous probiotic products are introduced to the market every year.  Symbiopharm products have been established on the market for decades; the best-known are Symbioflor® 1 and 2 and Prosymbioflor® (see also https://www.symbiopharm.de/produkte/pro-symbioflor).

For intestinal restoration, there are various Innovall® products available depending on the indication, e.g., RDS for irritable bowel syndrome, ATOP for atopic conditions, and CU for ulcerative colitis; see also https://innovall.de/

Mutaflor® is approved for ulcerative colitis, for example

Other products include, for example, Omniflora®

Topical preparations for the skin include, for example, Aktivaderm® ND; topical preparations for gynecological use include, for example, Vagiflor® or Gynella® flora

1. Fölster-Holst R et al. (2006) Prospective, randomized controlled trial of Lactobacillus rhamnosus in infants with moderate to severe atopic dermatitis. Br J Dermatol 155: 1256-1261
2. Khan SH et al. (2007) Review: Probiotics—the friendly bacteria with market potential in the global market. Pak J Pharm Sci 20: 76–82
3. Kopp MV (2008) Probiotics in the prevention and treatment of atopic conditions. Monatsschr Kinderheilk 156: 1084–1092

4. Gießelmann K (2019) Probiotics: Not Always Beneficial. Dtsch Arztebl 116: 33–34