Lack of Probiotic Benefit for Acute Pediatric Gastroenteritis

COMMENTARY

A Microbiome Bust? Lack of Probiotic Benefit for Acute Pediatric Gastroenteritis

William F. Balistreri, MD

Disclosures

January 31, 2019

5
In This Article

Probiotics, live microorganisms administered with the intent of inducing a beneficial effect in the host, have been recommended by healthcare professionals to treat a wide variety of diseases in clinical practice.[1,2,3] Probiotic preparations are also commonly consumed by healthy individuals simply in hopes of achieving various health benefits, improved quality of life, and disease prevention. The market for probiotics has therefore expanded into a multibillion-dollar industry offering an increasing variety of preparations.

The rationale for the use of these products is based in part on the observation that the composition of the microbiome (endogenous microflora) has broad effects on health and disease. It is postulated that in ailments as varied as obesity, autoimmune disorders, and infectious diseases, harmful bacteria predominate.[4]Thus, probiotics have become a primary tool for realizing the therapeutic goal of reversing presumed "dysbiosis"—replace harmful microflora with beneficial microorganisms.

It may not be a simple matter of "good bugs in, bad bugs out," however; there clearly are strain-specific effects. For example, a specific probiotic strain, Lactobacillus rhamnosus, has been reported to be beneficial in a wide variety of conditions, including antibiotic-associated diarrhea, Clostridium difficile–associated diarrhea, weight loss, and necrotizing enterocolitis in preterm babies.[1,2,3,5] Thus, when interpreting the results of a clinical trial, consideration must be given to the composition and content of the probiotic strain administered.

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