Table 2. Graded recommendations for probiotic formulations for the prevention or treatment of 19 different types of diseases.
| Type of disease | No. of study arms |
Strong evidence* (no. + RCTs/no. negative RCTs) |
Moderate evidence* (no. + RCTs/no. negative RCTs) |
Weak to not effective* (no. + RCTs/no. negative RCTs) |
|---|---|---|---|---|
| Prevention | ||||
| Allergy | 3 | None | None | L. rhamnosus GG (1+/2-) |
| Antibiotic-Associated Diarrhea (AAD) | 61 |
S boulardii I-745 (18+/9-) LaLcLr mix (3+/1-) L casei DN114001 (2+/0-) |
E. faecalis SF38 (2+/1-) | LhLr mix (3+/3-) L. rhamnosus GG (4+/6-) C. butyricum 588 (1+/2-) L. acidophilus La5 + B. lactis Bb12 (1+/5-) |
| Prevention C. difficile infections (CDI) | 23 | None | None |
S. boulardii (1+/11-) LaLcLr mix (2+/2-) L. rhamnosus GG (1+/4-) L casei 114001 (1+/1-) |
| H. pylori (side effects of therapy) | 16 |
S. boulardii I-745 (7+/2-) LhLr mix (2+/0-) |
L. rhamnosus GG (3+/2-) | None |
| Enteral feed associated diarrhea | 3 | S. boulardii I-745 (3+/0-) | None | None |
| Necrotizing Enterocolitis (NEC) |
17 |
L. rhamnosus GG + lactoferrin (2+/0-) B. infantis+ B. lactis+ Strept. thermophilus (2+/0-) |
None |
L. rhamnosus GG (0+/2-) S. boulardii (0+/3-) L. reuteri 17938 (1+/3-) B. lactis Bb12 (0+/2-) L. acidophilus+ B. bifidum (1+/1-) |
| Nosocomial infections | 2 | None | None | L. rhamnosus GG (1+/1-) |
| Respiratory tract infections | 10 | None | None |
L. rhamnosus GG (3+/3-) L. casei 114001 (2+/2-) |
| Surgical infections | 8 | Synbiotic PpLmLpLp (4+/1-) | None | L. plantarum 299v (1+/2-) |
| Traveler’s diarrhea | 7 | S. boulardii I-745 (4+/1-) | None | L rhamnosus GG (1+/1-) |
| Urinary Tract Infections | 3 | None | None | L rhamnosus GG (0+/3-) |
| Treatment | ||||
| Adult acute diarrhea | 9 | S. boulardii I-745 (4+/2-) | E. faecalis SF68 (2+/1-) | None |
| C. difficile recurrence | 4 | S. boulardii I-745 (2+/0-) | None | L. rhamnosus GG (0+/2-) |
| Colic | 4 | L. reuteri 17938 (4+/0-) | None | None |
| Constipation | 3 | None | B. lactis 173010 (2+/1-) | None |
| H. pylori eradication | 35 | LhLr mix (4+/1-) | L. acidophilus La5 + B. lactis Bb12 mix (3+/2-) |
S. boulardii I-745 (4+/11-) L. rhamnosus GG (0+/4-) L. acidophilus LB (1+/2-) C. butyricum 588 (0+/3-) |
| Inflammatory Bowel Disease (IBD) |
25 | 8-strain mix (8+/2-) | S. boulardii I-745 (2+/1-) |
L. rhamnosus GG (1+/6-) E. coli Nissle (0+/5-) |
| Irritable Bowel Syndrome (IBS) | 23 |
L. plantarum 299v (4+/1-) B. infantis 35624 (3+/1-) |
None |
L. rhamnosus GG (2+/2-) S. boulardii I-745 (2+/2-) 8-strain mix (2+/2-) B. lactis 173010 (1+/1-) |
| Pediatric acute diarrhea | 61 |
S. boulardii I-745 (25+/4-) L. rhamnosus GG (10+/3-) L. reuteri 17938 (3+/0-) L. acidophilus LB (3+/1-) L. casei DN114001 (3+/0-) Bac. clausii mix (O/C, N/R84, T84, Sin8 (3+/1-) 8-strain mix (2+/0-) |
LhLr (2+/1-) | None |
*Strong evidence: net of ≥2 more RCT with significant findings; moderate evidence net of 1 more RCT with significant findings; weak, same number of significant and non-significant trials and not effective, net of >1 RCT with non-significant findings compared to studies with significant findings.
Abbreviations: B., Bifidobacterium; Bac., Bacillus; C., Clostridium; E., Enterococcus; H., Helicobacter; LaLcLr mix, L. acidophilus CL1285 +L. casei Lbc80r + L. rhamnosus CLR2 (Bio-K+); LhLr mix, L. helveticus R52 (CNCM I-1722) + L. rhamnosus R11 (CNCM I-1720), Lacidofil; S., Saccharomyces; Synbiotic PpLmLpLp, Pediococcus pentosaceus 5–33:3, Leuconostoc mesenteroides 77:1, L. paracasei ssp. paracasei F19, L. plantarum 2362 and four fibers (inulin, oat bran, pectin, starch); 8-strain mix (Bifido.longum BL03, Bifido. infantis subsp. lactis BI04, Bifido. breve BB02, L. acidophilus BA05, L. plantarum BP06, L. paracasei BP07, L. helveticus BD08, Strept thermophiles BT01, VSL#3)