Prescribing probiotic drugs in clinical practice - are they indicated?

Abstract

The past two decades will be remembered for the rapid advances in our understanding of the significant role that the human microbiome plays in health, illness and longevity, but it remains a vast concept, one that is largely uncharted. Its contribution to human health is brought about by a myriad microbiome-associated physiological mechanisms complemented by its genetic ability, which is around 150 times that of the human genome. Many strategies are being devised to ‘engineer’ or augment an unfavourable microbiome. The use of probiotic products represents one of these strategies since they can augment the gut microbiome and improve health. However, their correct, effective and safe use is clouded by many variables. Probiotic drugs are used for two main reasons: mostly to improve general health but also in some illnesses for which evidence has been generated. The use of probiotic products to maintain general health is in most instances not supported by scientific evidence. Precision in the reconstitution of an unfavourable microbiome as in disease or the maintenance of a favourable microbiome is the ultimate goal. This is not possible at the bedside because of an incomplete understanding of the human microbiome. This could lead in turn to the overuse of unregulated probiotic products which may be ineffective or even harmful, as in the case of immunocompromised individuals. The aim of this article is to offer guidance on current best practices in prescribing probiotic drugs.