Survey and Systematic Literature Review of Probiotics Stocked in Academic Medical Centers within the United States

Abstract

Background: Probiotics have a wide variation in their effectiveness in preventing or treating conditions due to the varying beneficial effects of specific probiotic strains. In other words, there is no ''generic equivalency'' between different probiotic species. However, it is has been noted that many practitioners consider probiotics in generic terms and may not realize the impact of these differences between probiotics. Objective: The aims of this study were to identify probiotics used in US academic medical centers and to determine whether those probiotics were supported by a reliable evidence base. Methods: A phone survey of 126 inpatient pharmacies in US academic medical centers was conducted to determine which probiotics were stocked. A systematic search was conducted to identify relevant studies that were then critically evaluated to determine whether the identified probiotics are supported by a reliable evidence base. Results: There was a 90.5% (114/126) response rate of academic medical centers that were contacted through the phone survey. Ten probiotic products were identified through the phone survey. The probiotic most often stocked in academic medical centers was Culturelle (27.2%) followed by Lactinex (25.4%). The systematic search identified evidence that evaluated Culturelle, Florastor, Lactinex, and VSL #3. Of those 4 probiotics, none were supported by a strong evidence base. However, the results suggested that both Culturelle and Florastor appear to be supported by more evidence compared to other probiotics. Conclusion: A majority of academic medical centers did not stock a probiotic that was supported by a reliable evidence base.

Prevalence of probiotic use among inpatients: A descriptive study of 145 U.S. hospitals

“…This finding is comparable with the aforementioned survey of probiotic use among U.S. academic medical centers in which 10 products were identified in stock or in use across 87% of the 114 responding centers, with 79% of the centers reported stocking or using only 1 product. 10 At the species level, the top 4 probiotic products most frequently reported across the centers 10 were also similar to those used in the current study, consisting of L rhamnosus, Lactobacillus gasseri and L bulgaricus, Lactobacillus acidophilus, and S boulardii.…”

“…9 A recent survey of U.S. academic medical centers found 87% of 114 respondents stocked or used at least 1 probiotic, with a total of 10 probiotic products among the centers. 10 In a separate study in an academic medical center, 0.4% of patients were prescribed a probiotic in 2007-2008, with 96% of these patients receiving a combination product (L acidophilus-Lactobacillus bulgaricus) and 4% receiving a product containing Saccharomyces boulardii. 11 Prevention and treatment of CDI, treatment for unspecified diarrhea, and prevention of AAD comprised 78.3% of the justifications for probiotic use in this center.…”

Probiotic supplementation and associated infant gut microbiome and health: a cautionary retrospective clinical comparison

“…However, another study found probiotics to be a significant risk factor for Vancomycin-resistant Enterococcus colonization and was suggested to mediate the acquisition and transfer of resistance genes of bacteria 14 . Despite this, surveys have shown that clinicians and naturopaths recommend probiotic consumption for patients with a variety of pathologies including diarrhea, ulcerative colitis, and infant colic due to their low cost, over-the-counter availability, and acceptable safety profile in healthy adults 15 – 18 . The typical probiotic strains manufactured include Bifidobacterium and lactic acid bacteria such as Lactobacillus species.…”

Probiotics as adjunctive therapy for preventing Clostridium difficile infection – What are we waiting for?

“…In the face of growing public interest, and despite outdated SHEA/IDSA guidelines 26 deterring the clinical use of probiotics in CDI due to “insufficient evidence”, clinicians are making general recommendations to patients on antibiotic therapy. 52–54 The World Gastroenterology Organization Global Guidelines 55 concur that there is strong evidence showing the efficacy of specific probiotics at preventing CDI, but agree with the FDA and others that more evidence based on randomized, placebo-controlled, blinded studies is required before specific products can be ranked with proven efficacy.…”

“…Extensive use of probiotics by physicians and patients in the absence of clear recommendations 52–54,56 was the basis for founding the Yale University Workshop on Probiotic Recommendations that assesses the scientific literature regarding the efficacy of probiotics. This panel of probiotic experts consistently reports that the literature substantiates the use of probiotics in the case of antibiotic-associated diarrhea.…”