Safety
Although endocarditis has been reported following the consumption of L. rhamnosus,[47] no cases of systemic bacteraemia have been reported in trials using a probiotic test strain in otherwise healthy adults, including trials involving older people. Concerns remain about the use of probiotics in severely immunocompromised patients but the significance of this is not clear. In a multicentre study carried out in intensive care, 298 patients with severe pancreatitis were randomised to receive a multispecies probiotic preparation or placebo. The rate of intestinal ischaemia and mortality rate were higher in the active group versus placebo (16 versus 6% placebo, RR: 2.53 95% CI: 1.22–5.25).[48] However, in contrast, a study involving mechanically ventilated patients in a similar setting found no difference in 28-day mortality between the active multi-species probiotic group (25.3%) and placebo (23.7%).[49] Therefore, the exact nature of immune compromise may be significant as probiotics have been used in pre-term neonates and HIV patients with no reported serious adverse events.[50]
Funding
The trial evaluating the prevention of AAD using L. casei DN114001 is funded by an educational grant from Danone to the University of Sussex, which is the sponsor. C.R. has received honorarium for speaking for various Pharmaceutical companies. M.L. has received honorarium to speak for Astellas.
The very long list of references supporting this review has meant that only those most important are listed here and are represented by bold type throughout the text. The full list of references is available on Supplementary data in Age and Ageing online, Appendix 1.
Age Ageing. 2012;41(6):706-711. © 2012 Oxford University Press
Copyright 2007 British Geriatrics Society. Published by Oxford University Press. All rights reserved.
