The use of probiotics in medical practice

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Abstract

Probiotics are defined as living organisms, beneficial to health when ingested. Different species of microorganisms such as lactic acid bacteria or yeasts have been proposed for human use. These microorganisms differ from each other and it is, therefore, unlikely that they will act in the same way. Probiotics could be used for several conditions such as diarrhoea, candidal vaginitis, urinary tract infections, immune disorders, lactose intolerance, hypercholesterolaemia and food allergy. The effects of probiotics in some of these conditions have been directly observed, in others it has been only suggested on the basis of in vitro studies and from experimental animal models. Controlled trials are needed to determine the scientific basis for their use, the correct formulation and ways of administration in different clinical situations.

Section snippets

Probiotics and their properties

In an era in which we need new ways to control and treat of infections, strategies may include the use of probiotics. The old definition of probiotics as viable micro-organisms (bacteria or yeast) beneficial to the host [1], has to be broadened as different forms of administration and applications are developed. The concept of probiotic defines also the use of competitive exclusion for improving a specific ecology. Probiotic therapy or prevention, intentionally introduces strains of beneficial

Probiotics therapy

There are different ways to administer probiotics: oral administration is the most used. The use of rectal therapy has some advantages as a more varied selection of micro-organisms that do not have to be resistant to pH can be used and can be deposited at the site of action in the case of gut disorders [15]. There are very limited studies on this and there is a risk of spreading faecal pathogens. Vaginal administration may be a good way to obtain lactobacilli recolonisation, and has been

Diarrhoea

The use of probiotics in diarrhoea is a wide and controversial field. Different types of diarrhoeas can benefit from probiotics use — in its prevention, treatment or recovery. Travellers diarrhoea, antibiotic associated diarrhoea, other infectious diarrhoeas or AIDS related diarrhoea are a few examples. Infectious diarrhoea lacks a microflora balance as a consequence or cause, promoting the development of dismicrobism, which is the alteration of the optimal rate between different types of

Urinary tract infections

The use of probiotics in the prophylaxis of recurrent urinary tract infections (UTI) is theoretically the same as that in its use in diarrhoea; the displacement of pathogen by probiotics colonisation. Studies in vitro demonstrated interference by lactic acid bacteria with growth and adhesion of urinary pathogens [28]. In a mouse model, Lactobacillus fermentum was effective in the treatment of E. coli urinary tract infection when orally administered with low doses of ampicillin [29], while L.

Vaginal dismicrobism

Antibiotic treatment may be a cause of vaginal symptomatic dismicrobism. The physiologic presence of high loads of lactobacilli in the vaginas of fertile woman suggests that this condition could prevent vaginosis. The use of yoghurt in treating women with vaginal discharge has been described [31], which suggests further investigations in non-parasitic vaginal infections. A controlled trial described by Hilton reported that the oral administration of L. johnsonii significantly (P=0.001) reduced

Immune disorders

Although the effects of probiotics on immunomodulation are promising, the mechanisms are not well understood. There are indications that specific wall components or surface layers may be involved. The specific humoral response seems to be elicited locally against food allergens and pathogens. An increase of IgM secreting cells, IgA and IgM seroconversion with Lactobacillus GG (LGG) has been shown [37], and the induction of IgA in mice and in vitro by bifidobacteria has been reported by Yasui et

Bladder and colon cancer

Bladder cancer is a tumour whose origin is still controversial, but the nitroso compound of bacterial origin that could promote carcinogenesis in bladder mucosa, has been considered [42]. The use of probiotics in this disease has been evaluated mainly by Japanese researchers, using L. casei strain Shirota, which demonstrated an inhibition of chemically induced bladder cancer in mice or rats [43], [44]. The efficacy of oral administration of L. casei in preventing the recurrence of superficial

Food allergy

A more specific application of lactic acid bacteria would be for allergic reactions in milk-fed infants due to casein. Some lactobacilli degrade this protein to smaller peptides and amino acids. Sutas et al. demonstrated that hydrolysis of different casein proteins by LGG decreased the proliferation of mitogen–induced human lymphocytes compared to non-treated caseins [48]. The effect of LGG supplement in infants with atopic eczema after elimination of cow milk from the diet has been studied.

Lactose intolerance

The disaccharide lactose can cause severe intestinal distress, characterised by bloating, flatulence and abdominal pain in subjects with low levels of beta galactosidase or lactase. This condition increases in severity with age and restricts the use of dairy products. Probiotics can be useful in this condition, as lactobacilli produce lactase which hydrolyses the lactose in dairy products. The marker for bacterial metabolism of lactose in the large bowel is the production of hydrogen in breath

Hypercholesterolemia

The ability of probiotics to reduce serum cholesterol levels is still a matter for debate. This ability may be linked to the activity of some lactobacilli strains in deconjugating bile salts through the production of bile salt hydrolase [52]. However, faecal loss of bile acids may result in an increased requirement of cholesterol for de novo synthesis of bile salts, thereby reducing cholesterol levels. The oral administration of L. johnsonii and L. reuterii in pigs resulted in a decrease in

Conclusion

The use of probiotics in different diseases or conditions is attractive. However, there are still many questions to be answered before probiotics can be used routinely as therapy. Studies in humans have to prove the efficacy of different species, the conditions for their use, the optimal administration route and the formulation. The right probiotics should be suitable from a microbiological and clinical perspective, and proper use can only be attempted with the strict co-operation of

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