Choosing an appropriate probiotic product for your patient: An evidence-based practical guide

source extracted confidence: high 2026-04-09
#evidence-based-medicine #humans #probiotics #randomized-controlled-trials-as-topic

Choosing an appropriate probiotic product for your patient: An evidence-based practical guide

Sniffen et al., 2018 | PLoS One | Systematic Review

Citation

Sniffen Jason C, McFarland Lynne V, ... Goldstein Ellie J C. Choosing an appropriate probiotic product for your patient: An evidence-based practical guide. PLoS One. 2018;13(12):e0209205. doi:10.1371/journal.pone.0209205

Abstract

INTRODUCTION: Clinicians and patients face a daunting task when choosing the most appropriate probiotic for their specific needs. Available preparations encompass a diverse and continuously expanding product base, with most available products lacking evidence-based trials that support their use. Even when evidence exists, not all probiotic products are equally effective for all disease prevention or treatment indications. At this point in time, drug regulatory agencies offer limited assistance with regard to guidance and oversight in most countries, including the U.S. METHODS: We reviewed the current medical literature and sources on the internet to survey the types of available probiotic products and to determine which probiotics had evidence-based efficacy data. Standard medical databases from inception to June 2018 were searched and discussions with experts in the field were conducted. We graded the strength of the evidence for probiotics having multiple, randomized controlled trials and developed a guide for the practical selection of current probiotic products for specific uses. RESULTS: We found the efficacy of probiotic products is both strain-specific and disease-specific. Important factors involved in choosing the appropriate probiotic include matching the strain(s) with the targeted disease or condition, type of formulation, dose used and the source (manufacturing quality control and shelf-life). While we found many probiotic products lacked confirmatory trials, we found sufficient evidence for 22 different types of probiotics from 249 trials to be included. For example, several types of probiotics had strong evidence for the prevention of antibiotic-associated diarrhea [Saccharomyces boulardii I-745, a three-strain mixture (Lactobacillus acidophilus CL1285, L. casei Lbc80r, L. rhamnosus CLR2) and L. casei DN114001]. Strong evidence was also found for four types of probiotics for the prevention of a variety of other diseases/conditions (enteral-feed associated diarrhea, travellers' diarrhea, necrotizing enterocolits and side-effects associated with H. pylori treatments. The evidence was most robust for the treatment of pediatric acute diarrhea based on 59 trials (7 types of probiotics have strong efficacy), while an eight-strain multi-strain mixture showed strong efficacy for inflammatory bowel disease and two types of probiotics had strong efficacy for irritable bowel disease. Of the 22 types of probiotics reviewed, 15 (68%) had strong-moderate evidence for efficacy for at least one type of disease. CONCLUSION: The choice of an appropriate probiotic is multi-factored, based on the mode and type of disease indication and the specific efficacy of probiotic strain(s), as well as product quality and formulation. TRIAL REGISTRATION: This review was registered with PROSPERO: CRD42018103979.

Key Findings

We found the efficacy of probiotic products is both strain-specific and disease-specific. Important factors involved in choosing the appropriate probiotic include matching the strain(s) with the targeted disease or condition, type of formulation, dose used and the source (manufacturing quality control and shelf-life). While we found many probiotic products lacked confirmatory trials, we found sufficient evidence for 22 different types of probiotics from 249 trials to be included. For example, se

Outcomes Measured

  • inflammatory markers

Population

Field Value
Population See abstract
Sample Size 249
Age Range See abstract
Condition See abstract

MeSH Terms

  • Evidence-Based Medicine
  • Humans
  • Probiotics
  • Randomized Controlled Trials as Topic

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Journal Article, Research Support, Non-U.S. Gov't, Systematic Review
  • Vertical: probiotics

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09