Lactic-acid-producing Organisms

Synonyms: Láctico, organismos productores de ácido.
Cyrillic synonym: МолочноКислые Бактерии.

💊 Chemical information

ATC Vet — QA07FA01.

💊 Profile

Lactic-acid-producing organisms were first introduced as potential therapeutic agents with the idea of acidifying the intestinal contents and thus preventing the growth of putrefactive organisms. Lactobacillus bulgaricus (Lactobacillus delbrueckii subsp. bulgaricus), which occurs in naturally soured milk, was the organism originally used but it can be difficult to obtain growth of this organism in the intestines. Natural yogurt is a common source of lactic-acid-producing organisms. It is now thought that the gastrointestinal tract may play a wider part in host defences and consequently there is increasing interest in the use of live non-pathogenic microbial cultures to optimise the enteric microbiota, including in neonates. These are referred to as probiotics and are generally commensal lactic-acid producing bacteria, although some yeasts are also used. Organisms currently being used in probiotic preparations include Lactobacillus spp. and Bifidobacterium spp. Other organisms that may be used are Enterococcus and Streptococcus spp., and the yeast Saccharomyces boulardii. Probiotics are promoted to restore or maintain a healthy microbial flora, and are widely available as yogurts or other fermented milk products, as well as oral dosage forms such as tablets, capsules, and powders. They are being investigated in the management of several gastrointestinal disorders including diarrhoea and inflammatory bowel disorders. Probiotics are also being investigated in vaginal disorders and allergic disorders such as atopic eczema. A vaccine produced from strains of lactobacillus found in women with trichomoniasis has been used in the prophylaxis of recurrent trichomoniasis.

Adverse effects.

Metabolic acidosis has occurred after use of tablets containing Lactobacillus acidophilus.1 Cases of infection associated with the use of lactic-acid-producing organisms seem to be very rare,2 although fungaemia associated with the use of Saccharomyces boulardii,3 and sepsis associated with Lactobacillus spp.4 have been reported. Reviews5,6 on the safety of probiotics concluded that their overall safety record is good. However, the authors recommend caution in certain patient groups such as the elderly and premature or immunocompromised neonates because of occasional reports of sepsis that have rarely occurred in previously healthy patients.5 Use of enterococci and streptococci as probiotics give a theoretical cause for concern since these genera include pathogenic bacteria.5 Properties of probiotics are specific to species and strain and therefore reports on safety for one probiotic cannot be generalised to others.5
1. Oh MS, et al. -Lactic acidosis in a man with short-bowel syndrome. N Engl J Med 1979; 301: 249–52
2. Borriello SP, et al. Safety of probiotics that contain lactobacilli or bifidobacteria. Clin Infect Dis 2003; 36: 775–80.
3. Piarroux R, et al. Are live saccharomyces yeasts harmful to patients? Lancet 1999; 353: 1851–2
4. Land MH, et al. Lactobacillus sepsis associated with probiotic therapy. Pediatrics 2005; 115: 178–81
5. Boyle RJ, et al. Probiotic use in clinical practice: what are the risks? Am J Clin Nutr 2006; 83: 1256–64
6. Hammerman C, et al. Safety of probiotics: comparison of two popular strains. BMJ 2006; 333: 1006–8.

Composition and viability.

Some preparations of probiotics have been found to contain smaller quantities or different species of organisms to those specified on the label.1 An FAO/WHO working group2 published some guidelines that should be followed in order to claim that a food has a probiotic effect. These include the genus, species, and strain of the organisms in the preparation to be stated on the product label using currently recognised systematic nomenclature, and a statement of the minimum number of viable organisms remaining at the end of the product shelf-life.
1. Hamilton-Miller JMT, et al. "Probiotic" remedies are not what they seem. BMJ 1996; 312: 55–6
2. FAO/WHO. Guidelines for the evaluation of probiotics in food. London Ontario, Canada: Food and Agriculture Organization of the United Nations, 2002. Also available at: http:// foodsafety/fs_management/en/probiotic_guidelines.pdf (accessed 11/02/08)


ALLERGIC DISORDERS. Oral ingestion of probiotic bacteria may play a role in the development of the adaptive immune system1 and there has been some interest in their use in the management of allergic disorders such as atopic eczema.2-5 However, reviews6,7 of studies in allergic disorders have concluded that although there appears to be a reasonable theoretical basis for expecting benefit with probiotics, there are insufficient data to support their inclusion in routine treatment regimens for atopic eczema, perennial allergic rhinitis, or asthma.
1. Rinne M, et al. Effect of probiotics and breastfeeding on the Bifidobacterium and Lactobacillus/Enterococcus microbiota and humoral immune responses. J Pediatr 2005; 147: 186–91
2. Kalliomäki M, et al. Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet 2003; 361: 1869–71
3. Rosenfeldt V, et al. Effect of probiotics on gastrointestinal symptoms and small intestinal permeability in children with atopic dermatitis. J Pediatr 2004; 145: 612–16
4. Weston S, et al. Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child 2005; 90: 892–7
5. Fölster-Holst R, et al. Prospective, randomized controlled trial on Lactobacillus rhamnosus in infants with moderate to severe atopic dermatitis. Br J Dermatol 2006; 155: 1256–61
6. Anonymous. Probiotics for atopic diseases. Drug Ther Bull 2005; 43: 6–8
7. Prescott SL, Björkstén B. Probiotics for the prevention or treatment of allergic diseases. J Allergy Clin Immunol 2007; 120: 255–62.
GASTROINTESTINAL DISORDERS. Oral probiotics are under investigation for several gastrointestinal disorders and although they appear to be of benefit in some conditions, further study is required to confirm these findings. It is probable that efficacy depends on the species and strain of the organism as well as on the condition being treated.1,2 Conclusions from a systematic review3 suggest that probiotics might be a useful adjunct to oral rehydration therapy in the treatment of acute infectious diarrhoea in adults and children. A meta-analysis4 of studies of Lactobacillus therapy in children reached a similar conclusion. However, it was not possible to draw up definitive treatment guidelines because of a lack of standardisation in probiotic regimens, patient groups, or definition of acute diarrhoea between the available studies.3,4 Metaanalyses5,6 and a systematic review7 of studies investigating the use of probiotics in the prevention of antibiotic-associated diarrhoea in adults5 and children5-7 also suggest a beneficial effect, although again, further clinical confirmation is required before they can be routinely recommended.5-7 A review8 of studies that looked specifically at treatment or prevention of Clostridium difficile-associated diarrhoea with the probiotics Lactobacillus rhamnosus GG and Saccharomyces boulardii concluded that while these specific probiotics might be useful in patients at risk of recurrent C. difficile infection, the potential risks of bacteraemia or fungaemia in this particular patient group might outweigh any benefit. Probiotics have been investigated to correct aberrant intestinal microflora associated with chronic inflammatory bowel disease and reviews of such studies suggest some benefit in the prevention and treatment of ulcerative colitis9-11 and maintenance of remission in pouchitis,10-12 although the data are not so clear for Crohn’s disease.10,13 Larger controlled clinical studies, again with standardised probiotic preparations and treatment regimens, are necessary to establish the place of probiotics in the management of inflammatory bowel disease.9-13 Probiotics do not appear to improve abdominal pain in patients with irritable bowel syndrome but they may reduce bloating.14 Probiotics given to preterm neonates of very low birth-weight reduced the incidence and severity of necrotising enterocolitis in 2 randomised controlled studies.15,16 A systematic review17 of these and other controlled studies reached the same conclusion, although the authors called for confirmation of these results by a larger study to strengthen the case for routine use of probiotics in preterm neonates. Probiotics have also been tried in constipation18 and infantile colic.19
1. Anonymous. Probiotics for gastrointestinal disorders. Drug Ther Bull 2004; 42: 85–8
2. Limdi JK, et al. Do probiotics have a therapeutic role in gastroenterology? World J Gastroenterol 2006; 12: 5447–57
3. Allen SJ, et al. Probiotics for treating infectious diarrhoea. Available in The Cochrane Database of Systematic Reviews; Issu
4. Chichester: John Wiley; 2003 (accessed 11/02/08)
4. Van Niel CW, et al. Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics 2002; 109: 678–84
5. D’Souza AL, et al. Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis. BMJ 2002; 324: 1361–6
6. Szajewska H, et al. Probiotics in the prevention of antibioticassociated diarrhea in children: a meta-analysis of randomized controlled trials. J Pediatr 2006; 149: 367–72
7. Johnston BC, et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Available in The Cochrane Database of Systematic Reviews; Issu
2. Chichester: John Wiley; 2007 (accessed 11/02/08)
8. Segarra-Newnham M. Probiotics for Clostridium difficile-associated diarrhea: focus on Lactobacillus rhamnosus GG and Saccharomyces boulardii. Ann Pharmacother 2007; 41: 1212–21
9. Bai A-P, Ouyang Q. Probiotics and inflammatory bowel diseases. Postgrad Med J 2006; 82: 376–82
10. Ewaschuk JB, Dieleman LA. Probiotics and prebiotics in chronic inflammatory bowel diseases. World J Gastroenterol 2006; 12: 5941–50
11. Chapman TM, et al. VSL#3 probiotic mixture: a review of its use in chronic inflammatory bowel diseases. Drugs 2006; 66: 1371–87
12. Sandborn W, et al. Pharmacotherapy for induction and maintenance of remission in pouchitis. Available in the Cochrane Database of Systematic Reviews; Issu
2. Chichester: John Wiley; 1998 (accessed 11/02/08)
13. Rolfe VE, et al. Probiotics for maintenance of remission in Crohn’s disease. Available in the Cochrane Database of Systematic Reviews; Issu
4. Chichester: John Wiley; 2006 (accessed 11/02/08)
14. Bausserman M, Michail S. The use of Lactobacillus GG in irritable bowel syndrome in children: a double-blind randomized control trial. J Pediatr 2005; 147: 197–201
15. Bin-Nun A, et al. Oral probiotics prevent necrotizing enterocolitis in very low birth weight neonates. J Pediatr 2005; 147: 192–6
16. Lin H-C, et al. Oral probiotics reduce the incidence and severity of necrotizing enterocolitis in very low birth weight infants. Pediatrics 2005; 115: 1–4
17. Deshpande G, et al. Probiotics for prevention of necrotising enterocolitis in preterm neonates with very low birthweight: a systematic review of randomised controlled trials. Lancet 2007; 369: 1614–20
18. Banaszkiewicz A, Szajewska H. Ineffectiveness of Lactobacillus GG as an adjunct to lactulose for the treatment of constipation in children: a double-blind, placebo-controlled randomized trial. J Pediatr 2005; 146: 364–9
19. Savino F, et al. Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study. Pediatrics 2007; 119: e124-e30. Available at: http:// cgi/reprint/119/1/e124 (accessed 11/02/08)
UROGENITAL INFECTIONS. Probiotic preparations given orally or intravaginally are under investigation for the prevention or treatment of vaginal infections. Reviews of studies in vulvovaginal candidiasis1 and bacterial vaginosis2 concluded that while there was some indication of benefit, larger controlled studies are required to confirm efficacy and the place of probiotics in therapy. A systematic review3 confirmed that probiotics may be of benefit in the prevention and treatment of bacterial vaginosis in pregnancy but due to insufficient data it was not possible to assess the effect that this might have in preventing preterm labour. A review4 of studies investigating probiotics for the prevention of urinary-tract infections in women has suggested some benefit.
1. Falagas ME, et al. Probiotics for prevention of recurrent vulvovaginal candidiasis: a review. J Antimicrob Chemother 2006; 58: 266–72
2. Falagas ME, et al. Probiotics for the treatment of women with bacterial vaginosis. Clin Microbiol Infect 2007; 13: 657–64
3. Othman M, et al. Probiotics for preventing preterm labour. Available in The Cochrane Database of Systematic Reviews; Issu
1. Chichester: John Wiley; 2007 (accessed 11/02/08)
4. Falagas ME, et al. Probiotics for prevention of recurrent urinary tract infections in women: a review of the evidence from microbiological and clinical studies. Drugs 2006; 66: 1253–61.

💊 Preparations

Proprietary Preparations

Arg.: Acidofilofago; Flevic; Floratil; Lactinex; Tropivag; Austral.: Bioglan Acidophilus; Bioglan Superdophilus; Forbiotic; ProTract; Austria: Antibiophilus; Bioflorin; Lactofit; Reflor; Symbioflor Enterococcus; Yomogi; Belg.: Enterol; Lacteol; Braz.: Flomicin; Floratil; Floren; Florent; Lactipan; Leiba; Repoflor; Canad.: Bacid; Lacidofil; Chile: Bio-Flora; Biolactus; Econormotil; Gastrofloral; Lacteol Forte†; Lactil; Perenteryl; Perocur†; Cz.: Enterol; Santax S†; Solco-Trichovac†; Denm.: Paraghurt; Precosa; Fin.: Lactophilus; Precosa; Fr.: Bacilor; Bioprotus; Diarlac†; Gynophilus; Lacteol; Lyo-Bifidus; Ultra-Levure; Ultraderme†; Ger.: Acidophilus†; Hylak N; Hylak Plus; Infectodiarrstop GG†; Lacteol; Lyseen; Omnisept†; Paidoflor; Perenterol; Symbioflor 1; Vagiflor; Gr.: Ultra-Levure; Hong Kong: Bioflor; Lacteol; Reuteri; Hung.: Enterol; Gynevac; Symbioflor 1; India: Cefocef-LB; Myconip; Sporlac; Indon.: Lacbon; Rillus; Ital.: Bioflorin; Calagin; Codex; Dicoflor; Ecoflorina; Ferlactis†; Inulac; Lab/A†; Lacteol; Lactonorm; Ramno-Flor†; Regolact Plus; Reuflor; Mex.: Floratil; Lacteol Fort; Lactipan; Lactocil; Lactovita; Liolactil; Neoflor; Sinuberase; NZ: Blis K12 Throat Guard; Philipp.: Infloran; Pol.: Enterol; Lactovaginal; Lakcid†; Port.: Antibiophilus; Enterol†; Lacteol; UL 250†; Rus.: Enterol (Энтерол); Gastropharm (Гастрофарм); IRS 19 (ИРС 19); S.Afr.: Actiflora; Inteflora; Singapore: DiarrStope; Lacteol; Protexin; Reutefene; Spain: Casenfilus; Lacteol; Lactofilus; Ultra-Levura; Swed.: Precosa; Switz.: Bioflorin; Fiormil†; Florosan; Lacteol†; Lactoferment; Perenterol; SolcoTrichovac Lyophilisat; Ultra-Levure; Ventrux†; Thai.: Lacbon†; Lacteol†; Turk.: Reflor; UK: Bio Acidophilus; Biodophilus; Gum PerioBalance; Infacol Probiotic; USA: Acidophilus; Bacid; Florastor; Intestinex; Kala; Lactinex; Lacto-Key; MoreDophilus; Pro-Bionate; Superdophilus; Venez.: Florcidin; Florestor; Lacteol; Lactobacilos; Liolactil; Proflor. Multi-ingredient: Arg.: Bioflora; Biol Preo; Factor Bioenterico; Faelac†; Nilflux; Totalflora; Tropivag Plus; Austral.: Acidophilus Bifidus; Acidophilus Plus; Cyto-Bifidus; Austria: Gynoflor; Hylak; Hylak Forte; Infloran; Omniflora; Prosymbioflor†; Trevis; Belg.: Carbolactanose; Gynoflor; Canad.: Fermalac Vaginal; Chile: Bion 3; Cz.: Fermalac Vaginal; Gynoflor; Hylak Forte; Imudon; IRS 19†; Lacidofil; Solco-Urovac†; Fr.: Actyfilus; Biolactyl; Biotravel; Ergyphilus; Estrofort; Florgynal; Imgalt; Imudon†; IRS 19†; Maxi-Flore; Ophidus; Probionat; Triphidus; Trophigil; Ultrabiotique; Ger.: Antiprurit†; Gynoflor; InfectoDiarrstop LGG; IRS 19; Omniflora N; Perison; Pro-Symbioflor; StroVac; Hong Kong: Infloran; Lacspan; Protexin Balance; Protexin Balance+; Protexin Restore; Protexin Vitality; Shin-Biofermin S; Hung.: Gynoflor; Trevis; India: ABClox; Ampilox-LB; Amplus; Ampoxin-LB; Bicidal Plus; Bifilac; Biomoxil-LB; Campicillin Plus; Cefix LB; Cephadex LB; Clax; Imox-Clo LB; Lactisyn; LMX; Megaclox LB; Novaclox LB; Novamox LB; Nutrolin-B; Symbiotik; Symoxyl-LB; Vitazyme; Vizylac; Indon.: Dialac; GastroAd; Lacidofil; Lacto-B; Laktobion; Protexin; Synbio; Ital.: Al-Flor†; Altaflora Probiotici; Bifilact; Bio Fibralax Bi-Attivo; Bio Flora; Biolactine; Colifagina; Decon Lavanda; Ecofermenti; Endolac; Enterolactis; Enteroseven; Fermenturto-Lio; Floragermina 6; Florbiox†; Florelax; Floren; Floridral; Florvis GG; Gastroenterol; Genefilus F19; Giflorex; Ginil; Infloran; Infloran Bio; Kiri; Lactipan; Lactisporin; Lactivis; Lactogermine; Lactolife; Liozim; Liverton; Neo Lactoflorene; Neogyn; Nepiros; Ninfagin; Psyllogel Fermenti; Ramno Fix; Ramnoflor Plus; Rivuclin; Triacid; Vaxitiol; Yovis; Yovita; Jpn: The Guard Seichojo; Malaysia: Hexbio; Mex.: Neo-Panlacticos; Neo-Panlacticos Plus; Pro-T-Flor; Pol.: IRS 19; Lacidofil; Trilac; Port.: Coli-Fagina S; Gynoflor; Infloran†; Rus.: Acipol (Аципол); Bifiform (Бифиформ); Hylak Forte (Хилак Форте); Imudon (Имудон); Linex (Линекс); SolcoTrichovac (Солкотриховак); S.Afr.: Culturelle; Culturelle VC; Spain: Infloran; Switz.: Gynoflor; Infloran; Ribolac; SolcoTrichovac; Thai.: Infloran; Turk. : Gynoflor; UK: Acidophilus Plus; Beneflora; Culture Care; Fibre Dophilus; Natudophilus; Vinalac; USA: Acidophilus with Bifidus; Floranex; Pamine FQ Kit; SynBiotics-3; VSL#3; Venez.: Glutapak-R.
Published May 08, 2019.