Clinical Recommendation of Probiotic Uses by American Family Physician (AFP)

Probiotics contain microorganisms, most of which are bacteria similar to the beneficial bacteria that occur naturally in the human gut. Probiotics have an important role in the maintenance of immunologic equilibrium in the gastrointestinal tract through the direct interaction with immune cells.

Probiotics are safe for infants, children, adults, and older patients, but caution is advised in immunologically vulnerable populations.

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Key Recommendations for Practice

KEY RECOMMENDATIONS

Clinical recommendation	Evidence rating
Probiotic use reduces the risk of antibiotic-associated diarrhea in children and adults.	A
Probiotic use may reduce the incidence of Clostridium difficile–associated diarrhea.	B
Probiotic use significantly reduces the risk of hepatic encephalopathy, but there is insufficient evidence regarding the effect on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.	B
Probiotic use increases remission rates in adults with ulcerative colitis.	A
Probiotic use improves abdominal pain and global symptom scores in children and adults with irritable bowel syndrome.	B
Probiotic use reduces the incidence of necrotizing enterocolitis and mortality in preterm infants.	A
Probiotic use is ineffective for acute pancreatitis and Crohn disease.	B

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.

Clinical Uses and Effectiveness

Probiotic effectiveness can be species-, dose-, and disease-specific, and the duration of therapy depends on the clinical indication. There is high-quality evidence that probiotics are effective for acute infectious diarrhea, antibiotic-associated diarrhea, Clostridium difficile–associated diarrhea, hepatic encephalopathy, ulcerative colitis, irritable bowel syndrome, functional gastrointestinal disorders, and necrotizing enterocolitis.