Probiotics, Cautions
Probiotics: an obedient ally or an insidious enemy?
Contraindications:
Patients who are immunocompromised, or have a central venous catheter or critically ill should not take probiotics containing S. boulardii. Probiotics should not be given to newborns with very low birth weight, clinical instability, umbilical catheters, and to those with congenital abnormalities or stage III asphyxia.
Adverse Reactions:
Pediatric Case Reports:
Bacteremia associated with Escherichia coli and Bifidobacterium species: In pre-term infants as well as a newborn following probiotic therapy. Bifidobacterium longum bacteremia in preterm infants receiving probiotics
Bifidobacterium septicaemia in an extremely low-birthweight infant under probiotic therapy.
Probiotic-associated L. rhamnosus pneumonia: In a 11-month-old baby, secondary to a respiratory viral infection. She recovered after antibiotic therapy.
Probiotic-associated aspiration pneumonia due to Lactobacillus rhamnosus.
D-lactic acid encephalopathy, involving intermittent ataxia: In a 5-year old girl following use of probiotics to control diarrhea. She was treated with oral antibiotics. A case of D-lactic acid encephalopathy associated with use of probiotics.
Bacteremia associated with Lactobacillus: In a 17-year-old boy with ulcerative colitis. His symptoms, which included fever, flushing and chills resolved following treatment with antibiotics. Lactobacillus bacteremia associated with probiotic use in a pediatric patient with ulcerative colitis.
Adult Case Reports:
Fungemia involving Saccharomyces cerevisiae: In a patient with Clostridium difficile-associated diarrhea who was treated orally with the probiotic yeast Saccharomyces boulardii. Saccharomyces cerevisiae fungemia, a possible consequence of the treatment of Clostridium difficile colitis with a probioticum.
Sepsis associated with Saccharomyces cervesiae: In a 34-year-old woman with extensive burns, and administered Saccharomyces boulardii to improve the digestive tolerance to enteral feeding.
Probiotic sepsis due to Saccharomyces fungaemia in a critically ill burn patient.
Sever sepsis after probiotic treatment with Escherichia coli NISSLE 1917
Fungemia: In a 79-year-old woman following treatment with Sacchaflor (a probiotic consisting of S. boulardii) for Clostridium difficile-associated diarrhea. Her symptoms improved after discontinuing use of Sacchaflor. Saccharomyces boulardii fungemia caused by treatment with a probioticum.
Lactobacillus empyema: In a 54-year-old HIV-infected lung transplant patient, after taking a probiotic containing Lactobacillus rhamnosus GG. His symptoms resolved with antibiotic treatment.
Lactobacillus acidophilus bacteremia: In a patient with AIDS and Hodgkin’s disease following probiotic therapy containing L. acidophilus. Lactobacillus acidophilus bacteraemia after use of a probiotic in a patient with AIDS and Hodgkin’s disease
Sepsis due to preoperative administration of a probiotic containing Lactobacillus rhamnosus: In a 24-year-old woman following an aortic valve replacement. She was treated with antibiotics. . Lactobacillus rhamnosus administration causes sepsis in a cardiosurgical patient—is the time right to revise probiotic safety guidelines?
Bloodstream infection: In a critically ill 64-year-old patient with acute pancreatitis, following administration of a symbiotic formula containing Pediococcus pentosaceus. He was treated with antibiotics.
DRUG INTERACTIONS
Hepatic drug-metabolizing enzymes: In mice, administration of VSL3, a probiotic mixture of 8 bacterial strains, was shown to modify the expression of Cyp4v3, alcohol dehydrogenase 1, carboxyesterase 2a, and multiple phase II glutathione-S-transferases (57). Human data are lacking.