Table 1.
Summary of trials using probiotics with Helicobacer pylori eradication treatment (2012 to date)
| Treatment (oral administration) | Probiotic(s) (oral administration) | Region |
Eradication rates |
% side effects | Probiotic(s) efficacy | Ref. | |
| Intention to treat | Per protocol | ||||||
| Esomeprazole 20 mg, levofloxacin 500 mg, amoxicillin 1 g, all bid, 7 d | 108 CFU Lactobacillus reuteri, during therapy + further 7 d | Italy | 80% (36/45) | 80% (36/45) | 66.7 | Significant increase of eradication rates and reduction of side effects (nausea and diarrhea) | [44] |
| Control | 62.2% (28/45) | 62.2% (28/45) | 100.0 | ||||
| Esomeprazole 20 mg and amoxicillin 1 g, both bid, 5 d; then esomeoprazole 20 mg, clarithromycin 500 mg, tinidazole 500 mg, all bid, 5 d (sequential therapy) | 109 CFU L. Acidophilus, 109 CFU L. bulgaricus, 5 × 108 CFU Bifidobacterium bifidum, 109 CFU Streptococcus thermophilus, bid, during therapy | Italy | 89% (65/73) | 92.9% (65/70) | 39.7 | Eradication rates unaffected; significant decrease of side effects (metallic taste, abdominal/epigastric pain, diarrhea). Addition of lactoferrin did not influence the results achieved with probiotics | [45] |
| Probiotics as above + 200 mg lactoferrin | 88.5% (69/78) | 93.2% (69/74) | 38.5 | ||||
| Control | 88.2% (67/76) | 94.4% (67/71) | 65.8 | ||||
| Omeprazole 1 mg/kg sid, amoxicillin 50 mg/kg bid, clarithromycin 15 mg/kg bid, 7 d | 5 × 109 CFU L. plantarum, 2 × 109 CFU L. reuterii, 2 × 109 CFU L. casei subsp. rhamnosus, 2 × 109 CFU B. infantis and B. longum, 109 CFU L. salivarius, 109 CFU L. acidophilus, 5 × 109 CFU S. thermophilus, 109 CFU L. sporogenes, sid., during therapy | Italy | 88.2% (30/34) | 88.2% (30/34) | 14.5 | Non-significant increase of eradication rates; significant reduction of side effects (epigastric pain, nausea, vomiting, diarrhea) | [46] |
| Control | 76.4% (26/34) | 76.4% (26/34) | 61.5 | ||||
| Omeprazole 20 mg, clarithromycin 500 mg, amoxicillin 1 g, all bid, 7 d | L. acidophilus 14 d after therapy | China | 79.2% (61/77) | 82.4% (61/74) | 89.2 | Significant increase of eradication rates; no influence on side effects | [47] |
| 3 × 107 L. acidophilus 14 d before therapy | 79.5% (62/78) | 81.6% (62/76) | 85.5 | ||||
| Control | 60.8% (48/79) | 61.5% (48/78) | 87.2 | ||||
| Omeprazole 20 mg, bismuth subcitrate 240 mg, amoxicillin 1 g, clarithromycin 500 mg, all bid, 14 d (quadruple therapy) | L. casei, L. rhamnosus, L. acidophilus, L. bulgaricus, B. breve, B. longum, S. thermophilus, total viable count 108 CFU, bid, during therapy | Iran | 76.6% (69/90) | 82.1% (69/84) | 18.8 | No significant differences in efficacy and overall side effects (decrease of diarrhea but increase of abdominal pain) | [48] |
| Control | 81.1% (73/90) | 84.8% (73/86) | 16.6 | ||||
| Standard triple therapy (details not disclosed) | 3 × 109 CFU B. infantis, bid, during therapy | United Arab Emirates | 83% (83/100) | 3.0 | Significant increase of eradication rates, and reduction of incidence of antibiotic-induced side effects (diarrhea, loose bowel motion) | [49] | |
| 3 × 109 CFU B. infantis, bid, 14 d before therapy, then during therapy | 90.5% (86/95) | 2.1 | |||||
| Control | 68.9% (73/106) | 14.2 | |||||
| Sequential therapy (details not disclosed), 10 d | 3 × 109 CFU B. infantis, bid, during therapy | 90.8% (69/76) | 1.3 | ||||
| Amoxicillin 50 mg/kg, furazolidone 6 mg/kg, both bid, 7 d, plus omeprazole 1 mg/kg sid 28 d | L. casei, L. rhamnosus, L. acidophilus, L. bulgaricus, B. infantis, B. breve, S. thermophilus, total viable count 109 CFU, sid, during therapy | Iran | 90.1% (30/33) | 21.2 | Significant increase of eradication rates, and reduction of side effects (nausea, vomiting, diarrhea) | [50] | |
| Control | 69.7% (23/33) | 63.6 | |||||
| Furazolidone 200 mg, tetracycline 500 mg, lansoprazole 30 mg, bid, 7 d | L. acidophilus, L. rhamnosus, B. bifidum, S. faecium, 1.25 × 109 CFU each, sid,during therapy and further 23 d | Brazil | 81.8% (45/55) | 89.8% (44/49) | 59.3/44.9 | Non-significant increase of eradication rates and non-significant reduction of side effects (at 7 and 30 d) | [51] |
| control | 76.9% (40/52) | 85.1% (41/48) | 71.2/60.4 | ||||
| Standard triple therapy | L. acidophilus, B. bifidum during and after therapy | China | 83.7% (36/43) | Increase of eradication rates | [52] | ||
| Control | 64.4% (29/45) | ||||||
| Omeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg, all bid, 14 d | 2 × 108 CFU L. reuteri, sid, during therapy and further 14 d | Egypt | 74.3% (26/35) | 74.3% (26/35) | 28.6% | Non-significant increase of eradication rates; significant decrease of side effects (taste disorders, diarrhea) | [53] |
| Control | 65.7% (23/35) | 65.7% (23/35) | 68.6% | ||||
CFU: Colony forming unit; Control: Group that received the eradication treatment without probiotics or with placebo; the term “significant” was used when P < 0.05 was reported in the corresponding paper.