Presenter: Robert Martindale, MD

Original Date: February 11, 2017

The clinical manipulation of the microbiome by the use of pre and probiotics in the USA has seen an exponential rise in the past 5 years. Despite the recent expansion of information the wide spread support by major medical societies the use of pre and probiotics is significantly hampered by the lack large randomized prospective studies. The lack of strain-specific data sets, lack of dose response, poor understanding of clear links to mechanism, and general misinformation about pre and probiotic products has limited the therapeutic use.

As the use of probiotics grows beyond general claims of overall gut health to more targeted health claims data is starting to emerge to support use in not only clinical setting but in programs supporting health lifestyles. Much of the focus in medical and surgical practice now revolves around the protection from gut barrier disruption and alterations in intestinal permeability as well as immunologic compromise.

Large prospective randomized trials have now reported benefits in prevention of Ventilator Associated Pneumonia, antibiotic associated diarrhea, and Clostridium difficile diarrhea. Smaller prospective trials have shown use of probiotics to decrease total infectious complications actually shorten hospital stays. Determining a clinically effective dose (potency) for administration of a probiotic is a key but it appears that positive data is now available in pneumonia, antibiotic associated diarrhea, and a variety of other routine clinical challenges. This presentation reviews the current clinical perspective and possible use strategy for optimizing use of “probiotics” in a medical and surgical practice as well as the use to prevent acute surgical and chronic medical diseases.

1.5 General CEUs approved by OBNM