Dosage Range

• As more information is gathered from probiotic research, it is becoming evident that certain strains or combination of strains are suitable for different conditions. Different strains of probiotics are chosen and combined to produce specific products for diarrhoea in children, antibiotic-induced diarrhoea, travellers' diarrhoea, inflammatory bowel diseases etc. Probiotics 957

• Probiotic doses are usually standardised In terms of the amount of living bacteria per unit of volume. A quality product may contain between 1 ■ 109and1 ■ 1011 colony-forming units/g; however, the dose required to achieve therapeutic effects varies between strains. If a product contains multiple strains then each strain should be present at levels of 109 to be effective. The viable bacteria are mixed in a suitable matrix, which may contain maltodextrin, amylase and prebiotics such as fructo-oligosaccharides and inulin.

• Supplements are best taken with meals to enhance bacterial survival.

• Diarrhoea: generally Saccharomyces boulardiiand sometimes lactobacilli.

• Atopic dermatitis: generally lactobacilli, sometimes together with bifidobacteria.

• Cholesterol-lowering: lactobacilli are used.

• Urinary tract infection: lactobacilli are used.

• Vaginal candidiasis: lactobacilli are used.

* A serving of yoghurt containing less than 108 viable bacteria is unlikely to have any therapeutic activity beyond acting as a nutritional source.

Clinical note — Dosages tailored to increase probiotic survival

Several attempts have been made to ensure the survival of the probiotics through the acid environment of the stomach and exposure to bile acid. Microencapsulating the probiotics is one method that has been used (Kailasapathy 2002). Enteric-coated tablets containing probiotics that are gastric-acid resistant have also been produced (Stadler & Viernstein 2003). More studies, however, are needed to examine the efficacy of these administration forms to deliver and release the probiotic at the appropriate target sites in the gastrointestinal tract. Studies are also needed to establish if such measures are actually necessary. With a suitable matrix, a probiotic powder may survive the passage through the digestive tract without either microencapsulation or enteric-coating of tablets.

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