PROBIOTICS - A REVIEW

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About Authors:
V.Sankar1*, Akash kurian2
*1Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore.
2PHARM.D Intern, PSG College of Pharmcy, Coimbatore.
*akash.kurian8@gmail.com

Abstract:
The objective of review is to outline the probiotics use in medicine and to give insight in to the field for different applications. The use of probiotics in treatment regimen is increasing. Probiotics are live organisms and prebiotics are components of food that are not otherwise easily digested by humans and these food components essentially feed beneficial bacteria in the gut. Probiotics can be formulated to many different types of products including drugs, foods and dietary supplements. Species of lactobacillus and bifidobacterium are most commonly used as probiotics. Probiotics are intended to assist the body’s naturally occurring gut mitochondria. Some probiotic preparations have been used to prevent diarrhea caused by antibiotics or as part of treatment for antibiotic related dysbiosis. This article focus on the probiotics use,  clinical trials and its future.

REFERENCE ID: PHARMATUTOR-ART-2132

PharmaTutor (ISSN: 2347 - 7881)

Volume 2, Issue 4

Received On: 01/02/2014; Accepted On: 13/02/2014; Published On: 01/04/2014

How to cite this article: V Sankar, A Kurian, Probiotics - A Review, PharmaTutor, 2014, 2(4), 61-66

History:
A century ago, Elie metchnikoff postulated that lactic acid bacteria (LAB) offered health benefits capable of promoting longevity[1]. He suggested that intestinal auto intoxication and resultant aging could be suppressed by modifying the gut microbiota and replacing proteolytic microbes such as clostridium which produces toxic substances including phenols, indoles and ammonia from digestion of proteins with useful microbes. In 1917 the German professor Alfred nissle isolated a non pathogenic strain of Escherichia coli from feces of First World War soldier who didn’t develop enterocolitis during severe outbreak of shigellosis[2].

Bifidobacterium was isolated by Henry Tissier from a breast fed infant, and he named the bacterium Bacillus Bifidus communis. He claimed that Bifidobacteria would displace the proteolytic bacteria that cause diarrhea and recommended administration of bifidobacteria to infants suffering from this symptom[3]. The term robotics was introduced in 1965 by Lilly and Stillwell[4]. In 1989, Roy fuller emphasized the requirement of viability for Probotics and introduced the idea that they have beneficial effect on host[5].

Dose:
The doses needed for probotics varies greatly depending on strain and product. Although many OTC products deliver in range of 1-10 billion cfu/dose, some products shows efficous at low level, while some require more. Dose that is needed for probiotics, should be passed on human studies showing health benefits.

The minimum criteria that have to meet for probiotic products are probiotics must be:

  • Specified by genus and strain.
  • Alive.
  • Deliver adequate dose through end of shelf life.

Immunologic benefits:

  1. Activate local macrophages to increase antigen presentation to beta lymphocytes and increase secretory immunoglobin A (IgA) production both locally and systemically.
  2. Modulate cytokine profiles.
  3. Induce hypo responsiveness to food antigens.

Non-immunologic benefits:
a. Digest food and compete for nutrients with pathogens.
b. Modify pathogen derived toxins.
c. Stimulate epithelial mucin production.
d. Alter pH to create an unfavorable local environment for pathogen.

COMPLICATIONS

MAJOR
The safety of probiotic ingestion has been evaluated by examining infectivity, metabolic activity, pharamacokinetics, pathogenicity and virulence factors associated with toxicity in healthy people. Reports of harmful effects of probiotics ingestion are rare and overall probiotics are considered safe and well tolerated.

The potential for bacterial translocation, resulting in bacteremia is a concern in patients who are immunocompromised secondary to premature birth, malignancy, HIV virus infection or a chronic debilitated state. Bacterial translocation may develop when G.I tract barrier is diminished allowing bacteria to pass across mucous membrane and epithelium and be transported to mesenteric lymph nodes and others.

(b) MINOR:
Fungemia, G.I inflammation.

Products
Most common forms for probiotic are dairy products and probiotic –fortified foods. However tablets, capsules and sachets containing the bacteria in freeze dried form are available in Table n.o 1.

Information on suppliers of probiotics[6]:

Table n.o 1

      Sl.no

Company

Description

URL

         1

Bio Gaia

Lactobacillus reuteri culture comes in three different product friendly forms: freeze dried DVS (Direct Vat Set) granules and frozen pellets.

biogaia.com

         2

BIO K+

Producer and seller of probiotic mix including L.acidophilus and L.casei.

biokplus.com

         3

 

Cerbios pharma

Producer of enterococus  LAB SF 68

cerbios.com

         4

Danone

Producer of several brands of fermented dairy products containing probiotics.

danone.com

         5

GTC nutrition

Nutra flora short chains fructo oligo sacchrides are a cane sugar of beet sugar, derived natural prebiotic fiber.

gtc.nutrtion.com

        6

Lallemand

A Canadian supplier delivers probiotics and biosupplements to nutraceuticals, pharmaceutical industries.

lallemand.com

a ) Product Selection
Probiotics are sensitive to environmental conditions including pH, moisture, temperature, air and light. As soon as probiotic is manufactured the number of viable colony-forming units begins to decrease as a part of the natural life cycle of organism. For effective probiotic dose it should survive in G.I tract colonize and replicate.

The number of viable bacteria reaching and colonizing the G.I tract depends on several factors including dose, formulation, G.I motility, patient’s gastric acid pH and co administration of food or milk (which may aid in probiotic viability). A probiotic should contain at least 108 CFU. This dose will increase the likelihood that a sufficient amount will survive and colonize G.I tract. Probiotic products available in Indian market and its clinical applications are given in Table n.o 2 and Table n.o 3.

Products available in Indian market 7

Table n.o  2

S .n.o

Product

Strains

Package/(INR)

Manufacturer

1

VSL#3 capsule

S. thermophilus , B.breve , B.longum, B.infantis ,

L. acidophilus,

L.plantarum, L.delbrueckii spp bulgaricus, L.paracasei 

10’s (251.65)

Sun pharma

2

Prepro capsule

S.faecalis. C.butyricum B.mesentericus L.acidophilus

10’s ( 80)

Fourts india

3

Vizyl capsule

B.mesentericus C.butyricum S.faecalis L.sporogenes

10’s (77.05)

Unichem

4

Bifilac capsule

S.faecalis, L.clostridium butyricum, B.mesentericus

10’s (86.48)

Tablets india Ltd

5

Becelac –PB capsules

L.acidophilus L.calcium pantothenate, niacinamide vitamin B12, vitamin C folic acid, vitamin B6, vitamin B2 thiamine mononitrate

10’s (72)

Dr.Reddy’s Labs

6

Vibact capsules

S. faecalis, C butyricum B.mesentericus

10’s (790.2)

USV

7

Bifilac sachet

S faecalis  C.butyricum Mesentericus

0.5 g (9.75)

Tablets india Ltd

8

Econorm sachet

S.boulardii.

1’s (34.8)

Dr.Reddy’s Labs

9

Vizyl sachet

 B.mesentericus

C.butyricum S.faecalis L.sporogenes

1’s (8)

Unichem

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