Choosing an appropriate probiotic product for your patient: An evidence-based practical guide
Choosing an appropriate probiotic product for your patient: An evidence-based practical guide
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DOI：
10.1371/journal.pone.0209205
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发表时间：
2018-12-26
期刊：
影响因子：
3.7
通讯作者：
Goldstein, Ellie J. C.
中科院分区：
文献类型：
--
作者：
Sniffen, Jason C.;McFarland, Lynne V.;Goldstein, Ellie J. C.
前言临床医生和患者在选择最适合他们特定需求的益生菌时面临着一项艰巨的任务。可用的制剂包括多样化和不断扩大的产品基础，大多数可用的产品缺乏支持其使用的循证试验。即使存在证据，并不是所有的益生菌产品对所有疾病预防或治疗适应症都同样有效。在这一点上，药品监管机构在大多数国家提供的指导和监督方面提供的帮助有限，包括美国的方法我们回顾了当前的医学文献和互联网上的来源，以调查现有益生菌产品的类型，并确定哪些益生菌具有循证疗效数据。检索了从成立到2018年6月的标准医学数据库，并与该领域的专家进行了讨论。我们通过多项随机对照试验对益生菌证据的强度进行了分级，并为当前特定用途的益生菌产品的实际选择制定了指南。结果我们发现益生菌产品的疗效既有菌株特异性的，也有疾病特异性的。选择适当的益生菌的重要因素包括将菌株(S)与目标疾病或条件、制剂类型、使用剂量和来源(制造质量控制和保质期)相匹配。虽然我们发现许多益生菌产品缺乏验证性试验，但我们发现了来自249项试验的22种不同类型的益生菌被纳入的充分证据。例如，几种类型的益生菌对预防抗生素相关性腹泻有强有力的证据[布氏酵母菌I-745，三菌株混合物(嗜酸乳杆菌CL1285，干酪乳杆菌Lbc80r，鼠李糖CLR2)和干酪乳杆菌DN114001]。还发现了用于预防各种其他疾病/状况的四种益生菌的有力证据(与肠道喂养有关的腹泻、旅行者腹泻、坏死性肠炎和与幽门螺杆菌治疗有关的副作用)。根据59项试验，治疗儿童急性腹泻的证据最充分(7种益生菌具有较强的疗效)，而8种菌株多菌株混合物对炎症性肠病显示出强大的疗效，两种类型的益生菌对肠易激疾病具有强大的疗效。在所考察的22种益生菌中，15种(68%)对至少一种疾病具有强-中等疗效。结论选择合适的益生菌是多因素的，基于疾病的模式和类型，益生菌菌株(S)的特异性疗效，以及产品质量和配方。
IntroductionClinicians 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.MethodsWe 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.ResultsWe 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.ConclusionThe 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.