ABSTRACT
CONTENTS 5.1 Introduction ................................................................................................ 110 5.2 Desirable Properties for Therapeutic Probiotics................................... 111
5.2.1 Manufacturing Properties ............................................................ 111 5.2.1.1 Strain Identification ........................................................ 111 5.2.1.2 Potency Properties .......................................................... 111 5.2.1.3 Stability Properties.......................................................... 113 5.2.1.4 Formulation and Dose Concerns ................................. 113 5.2.1.5 Marketing Properties...................................................... 113 5.2.1.6 Commercial-Scale Production....................................... 113 5.2.1.7 Quality Control ............................................................... 114
5.2.2 Endogenous Properties ................................................................ 114 5.2.2.1 Transit to the Target Organ or Surface........................ 114 5.2.2.2 Persistence within the Target........................................ 114 5.2.2.3 Adherence to Mucosal Surfaces ................................... 115 5.2.2.4 Reproduction within the Target ................................... 115 5.2.2.5 Metabolic Pathway Interference................................... 115 5.2.2.6 Stimulation of the Immune System............................. 115 5.2.2.7 Safety................................................................................. 115
5.3 Properties of Evidenced-Based Probiotics ............................................. 116 5.3.1 By Microbial Species..................................................................... 116
5.3.1.1 Lactobacillus Species in General .................................... 116 5.3.1.2 Lactobacillus rhamnosus ................................................... 117 5.3.1.3 Lactobacillus reuteri .......................................................... 118 5.3.1.4 Bifidobacterium species .................................................... 119 5.3.1.5 Lactobacillus acidophilus ...................................................120 5.3.1.6 Lactobacillus casei..............................................................120 5.3.1.7 Other Lactobacilli..............................................................121 5.3.1.8 Saccharomyces boulardii....................................................122
5.4 Evidence-Based Probiotics .......................................................................124 5.4.1 Antibiotic-Associated Diarrhea...................................................125 5.4.2 Clostridium difficile Disease...........................................................126 5.4.3 Traveler’s Diarrhea .......................................................................126 5.4.4 Pediatric Diarrhea .........................................................................127 5.4.5 Treatment of Acute Diarrhea.......................................................127
5.5 Conclusions.................................................................................................128 References.............................................................................................................128
