Probiotics – a blessing for some, a burden for others. The positive and negative effects of their use among different groups of patients – journal review
DOI:
https://doi.org/10.12923/2083-4829/2025-0011Keywords:
probiotics, prebiotics, sepsis, antibiotics, microflora, acute diarrhea, preterm infants, SIBO, IBS, acute pancreatitisAbstract
Introduction. The increasing interest in the use of bacterial cultures and complex microbial products in medical treatment has become more and more noticeable. Each year, a growing number of such products are introduced to the pharmaceutical market. With the development of methods for isolating and culturing specific bacterial strains, numerous concepts have emerged on the potential benefits of supplementation. We agree that probiotic supplementation yields scientifically proven positive effects in certain medical conditions. However, our attention is drawn to the tendency to expand the use of probiotics to vulnerable populations. This raises important questions concerning the safety, efficacy, and potential risks associated with probiotic use among the most sensitive patient groups. In our work, we focused on reviewing the current scientific literature, and we would like to propose several insights into safe probiotic administration among different groups of patients.
Materials and methods. We reviewed the literature from early 2000 to 2025 for articles on the probiotics in different groups of patients. The review of the available literature was conducted by searching official databases such as PubMed and Google Scholar using the following keywords: probiotics, prebiotics, antibiotics, microflora, sepsis, acute diarrhea, preterm infants, SIBO, IBS, acute pancreatitis etc.. We also queried references cited from original research, meta-analyses, and reviews in both Polish and English language, published in scientific journals and articles.
Results. Probiotics demonstrate therapeutic benefits in preventing antibiotic-associated diarrhea and reducing necrotizing enterocolitis in preterm infants. They may also support treatment of ulcerative colitis, pouchitis, travelers’ diarrhea and acute childhood diarrhea, as well as possibly prevent atopic dermatitis when taken maternally. However, the evidence remains inconclusive for several other conditions, including IBS and Crohn’s disease. Probiotic use remains not recommended in immunocompromised states, such as ICU settings, due to the risk of sepsis. Safety concerns include antibiotic resistance and microbiota disruption, which requires thorough data from high-quality clinical trials, including strain-specific assessments. Finally, the available data suggests that synbiotics may offer enhanced benefits, while postbiotics are emerging as safer alternatives.
Conclusions. The available data and existing studies do not provide sufficient grounds to unequivocally support the use of probiotics and related products in clinical treatment. There is a lack of robust evidence based on well-designed clinical trials. Current recommendations regarding the use of probiotics for the management of travelers’ diarrhea and antibiotic-associated diarrhea remain in place, as do contraindications for their use in individuals with sepsis or compromised immune function. However, for other medical conditions, stronger evidence and formal guidelines from scientific societies are still awaited.
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