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.

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.

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

• Regular consumption should promote the accumulation of bacteria in the intestinal flora and have a positive influence on the course of intestinal diseases.
• Probiotics are said to have digestive properties, in particular, food components should be better absorbed.
• The defences of the immune system in the intestinal wall are to be strengthened by probiotics.
• Probiotics are available today in different dosages (capsules, dietary products). Often prebiotics are added to them, i.e. certain indigestible oligosaccharides such as inulin and oligofructose, which are supposed to promote the growth of the probiotic bacteria in the colon.
• To be used as a probiotic, micro-organisms must meet the following criteria:
• harmlessness to health
• Proof of a health benefit
• unharmed passage of the gastrointestinal tract
• technological suitability.
• Additional criteria include the prevention or reduction of pathological adherence, persistence and multiplication of probiotics, production of acids, hydrogen peroxide, bactericides and the ability to cell adherence.
• According to available study results, the preventive or direct therapeutic effect of probiotics in atopic eczema is questionable. A significant difference in clinical symptoms was not observed.

Probiotics containing Saccharomyces boulardi (e.g. Perenterol®), which are mainly used for the treatment of diarrhoeal diseases, pose a risk of potentially fatal fungaemia in immunocompromised severely ill patients. They are contraindicated in these patients (a-t 2018; 49: 23).

Caution is advised in severe abdominal inflammation: A double-blind, placebo-controlled study demonstrated excess mortality in the probiotics group compared to the placebo group. showed excess mortality of 16% in nearly 300 patients with acute pancreatitis compared to the placebo group at 9%.

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

1. Folster-Holst R et al (2006) Prospective, randomized controlled trial on 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 global market. Pak J Pharm Sci 20: 76-82
3. Kopp MV (2008) Probiotics in the prevention and therapy of atopy. Monatsschr Kinderheilk 156: 1084-1092

4. Gießelmann K (2019) Probiotics: not always beneficial. Dtsch Arztebl 116: 33-34