How do you choose a probiotic for your patient?

Faced with a plethora of products on the market, it's not always easy for health professionals to suggest a product containing one or more high-quality probiotic strains adapted to the needs of their patients 1,2 . Recommendations from experts can make this easier.

Created 23 August 2023
Updated 08 November 2023

About this article

Created 23 August 2023
Updated 08 November 2023

Advising a patient to "take probiotics" is not necessarily sufficient for a patient looking for a probiotic for a specific disorder 3. However, an American study found that 40% of primary care professionals who recommend probiotics to their patients let them choose their own product 4. Although it is now generally accepted that probiotics contribute to healthy gut microbiota, experts agree that the vast majority of probiotic effects are strain-dependent 5,6.

It is therefore important to ensure that the strain is effective in terms of the targeted health need or disease 7. To do this, it is necessary to check that the product characteristics and information (strain, dosage, formulation) match in every respect those used in the clinical trials that proved the benefit ascribed to the product 3As such, particular attention should be paid to the following:

  • clear reference to the genus, species and probiotic strain contained in the product and the associated indication 8,9 ;
  • product dosage 3,8
  • clinical proof of the efficacy of the probiotic strain in the therapeutic area with which it is associated. at a dosage similar to and not lower than the one used in the clinical trial 8

Other factors should also be taken into account when choosing a probiotic, such as :

  • formulation type 3,;
  • remaining viability up to the expiration date, not from the date of manufacture 8;
  • product quality resulting from manufacturer requirements, i.e., quality controls and, preferably, certification by an independent body 8,9 .

Informing your patient

An infographic entitled "What are probiotics?” is provided below. It is designed to help you inform patients about probiotic-based products and facilitate your discussions during consultations.

Other infographics to share with your patients

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The Biocodex Microbiota Institute recommends the ISAPP website which also provides health professionals and consumers with resources on probiotics. (in English):

In the field of gastroenterology, you will find information on clinically proven indications for adults and children on the following websites: World Gastroenterology Organisation (WGO) and American Gastroenterological Association (AGA).

Contraindications and potential side effects :

Patients should be informed that taking a probiotic-based product orally may be accompanied by transient side effects such as gas and bloating 10.

It is important to bear in mind and inform the patient that the efficacy of a probiotic strain may vary from one patient to another 3.

Although the risks associated with probiotic strains are acknowledged to be low, it is prudent to avoid prescribing probiotics to premature newborns, people who are intolerant to any of the excipients used in the formulation of probiotic-based products, immunosuppressed patients, people with short bowel syndrome or those in critical condition 3,11,12.

See the other pages in our series dedicated to probiotics

Probiotics: what exactly are we talking about?

En savoir plus

Everything you need to know about probiotics

En savoir plus

1 McFarland LV, Evans CT, Goldstein EJC. Strain-Specificity and Disease-Specificity of Probiotic Efficacy: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2018;5:124.

2 Sniffen JC, McFarland LV, Evans CT, Goldstein EJC. Choosing an appropriate probiotic product for your patient: An evidence-based practical guide. PLoS One. 2018;13(12):e0209205.

3 Merenstein DJ, Sanders ME, Tancredi DJ. Probiotics as a Tx resource in primary care. J Fam Pract. 2020;69(3):E1-E10.

4 Draper K, Ley C, Parsonnet J. Probiotic guidelines and physician practice: a cross-sectional survey and overview of the literature. Benef Microbes. 2017; 8(4):507–519

5 Hill C, Guarner F, Reid G, et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506-514.

6 Kolaček S, Hojsak I, Berni Canani R, et al. Commercial Probiotic Products: A Call for Improved Quality Control. A Position Paper by the ESPGHAN Working Group for Probiotics and Prebiotics. J Pediatr Gastroenterol Nutr. 2017;65(1):117-124.

7 Sanders ME, Merenstein DJ, Reid G, Gibson GR, Rastall RA. Probiotics and prebiotics in intestinal health and disease: from biology to the clinic. Nat Rev Gastroenterol Hepatol. 2019;16(10):605-616.

Binda S, Hill C, Johansen E, et al. Criteria to Qualify Microorganisms as "Probiotic" in Foods and Dietary Supplements. Front Microbiol. 2020;11:1662.

ISAPP : Probiotic Checklist – Making a smart selection, 2018.

10 Ciorba MA. A gastroenterologist's guide to probiotics. Clin Gastroenterol Hepatol2012;10(9):960-968.

11 Williams NT. ”Probiotics”,  Am J Health Syst Pharm. 2010;67(6):449-458.

12 Sanders ME, Merenstein DJ, Ouwehand AC, et al. “Probiotic use in at-risk populations”. J Am Pharm Assoc (2003). 2016;56(6):680-686.

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