Safety of LcS

Further Reading

1. Srinivasan et al. (2006) Journal of Pediatric Gastroenterology and Nutrition 42:171-173.
2. Besselink et al. (2008) The Lancet 371(9613):651-659.
3. Whelan and Myers. (2010) American Journal of Clinical Nutrition 91:687-703.
4. Hempel et al. (2011) Evidence report/technology assessment 200:1-645.

Clinical safety in critically ill children – Srinivasan et al. (2006) Journal of Pediatric Gastroenterology and Nutrition 42:171-173.

Method

The objective of this study was to establish clinical safety of L. casei Shirota used as a probiotic in critically ill children. L. casei Shirota was administered three times a day at a dosage of 10⁷ CFU/day via an indwelling nasogastric tube for five days to children admitted to a paediatric intensive care unit in the UK. Safety was assessed by bacteriologic surveillance for the strain in surface swabs, endotracheal aspirates and blood, urine and sterile body fluid samples.

Results

From the 28 patients with available safety data, there was no evidence of either colonisation or bacteraemia with L. casei Shirota from this testing. The L. casei Shirota was well tolerated with no apparent side effects or adverse reactions, supporting the conclusion that L. casei Shirota as a probiotic in critically ill children fed via a nasogastric tube appears safe.

Although many of the case reports, intervention studies and meta-analyses that describe probiotic use in patients report no adverse events, most also caution that more research is needed. There are also cases where probiotic use is discourage, such as the administration of high dose probiotics by naso-jejunal tube together with enteral nutrition containing high concentration of fermentable sugars, especially in patients with non-occlusive mesenteric ischemia, common in critically ill patients such as acute pancreatitis patients.

When considering using probiotics for a specific patient where you may have safety concerns, it is important to consider (i) the quality and safety record of the particular probiotic; (ii) the administration mode and (iii) the patient’s condition.