Lrsquoeffectiveness di probiotici e prebiotici

Fabio Albano PdF ASL NA2Nord

DIMENSIONI DEL PROBLEMA hellip

DIMENSIONI DEL PROBLEMA hellip

bull Stati Uniti

Vendita di probiotici = 1 miliardo di dollari nel 2014

Nel mondo la vendita di probiotici ha un mercato di 25 miliardi di dollari

wwwstatistacom 2015

bull Italia

Vendita di probiotici solo nelle farmacie (n=1700)

Stima 60 milioni di euro

DIMENSIONI DEL PROBLEMA hellip

DIMENSIONI DEL PROBLEMA hellip

bull Stati Uniti

Vendita di probiotici = 1 miliardo di dollari nel 2014

Nel mondo la vendita di probiotici ha un mercato di 25 miliardi di dollari

wwwstatistacom 2015

bull Italia

Vendita di probiotici solo nelle farmacie (n=1700)

Stima 60 milioni di euro

DIMENSIONI DEL PROBLEMA hellip

bull Stati Uniti

Vendita di probiotici = 1 miliardo di dollari nel 2014

Nel mondo la vendita di probiotici ha un mercato di 25 miliardi di dollari

wwwstatistacom 2015

bull Italia

Vendita di probiotici solo nelle farmacie (n=1700)

Stima 60 milioni di euro

Questionario a 250 genitori di

bambini 12-36 mesi

bull Negli ultimi 10 mesi il bambino ha assunto

probiotici

Se si

bull Quali

bull Per quale motivo

bull Consigliati da chi

78

ALIMENTI FUNZIONALI PROBIOTICI

I piugrave comuni sono Lactobacillus Bifidobacterium e

Saccharomyces boulardii

Ceppi

probiotici

isolati

Mix di

probiotici

Alimenti con

aggiunta di

probiotici

QUALI

Quanti di questi preparati sono supportati da una letteratura scientifica

che ne suggerisce lrsquoefficacia

EFFICACIA CLINICA

ALIMENTO FUNZIONALE Contenuto Dose Formulazione

Lrsquoefficacia dei probiotici egrave correlata a

Ceppo probiotico utilizzato

Formulazione

Dose

ALIMENTI FUNZIONALI PROBIOTICI

I piugrave comuni sono Lactobacillus Bifidobacterium e

Saccharomyces boulardii

Ceppi

probiotici

isolati

Mix di

probiotici

Alimenti con

aggiunta di

probiotici

QUALI

Quanti di questi preparati sono supportati da una letteratura scientifica

che ne suggerisce lrsquoefficacia

EFFICACIA CLINICA

ALIMENTO FUNZIONALE Contenuto Dose Formulazione

Lrsquoefficacia dei probiotici egrave correlata a

Ceppo probiotico utilizzato

Formulazione

Dose

Quanti di questi preparati sono supportati da una letteratura scientifica

che ne suggerisce lrsquoefficacia

EFFICACIA CLINICA

ALIMENTO FUNZIONALE Contenuto Dose Formulazione

Lrsquoefficacia dei probiotici egrave correlata a

Ceppo probiotico utilizzato

Formulazione

Dose

EFFICACIA CLINICA

ALIMENTO FUNZIONALE Contenuto Dose Formulazione

Lrsquoefficacia dei probiotici egrave correlata a

Ceppo probiotico utilizzato

Formulazione

Dose

SICUREZZA DEI PROBIOTICI

Generalmente considerati come sicuri Problemi di tassonomia Traslocazione batterica Antibiotico-resistenza Sicurezza in pz cronici

COSA HANNO ASSUNTO REALMENTE QUESTI BAMBINI

Qualitagrave dei probiotici

bull Numerosi studi hanno dimostrato come spesso non ci sia

corrispondenza tra quantitagrave ceppo dichiarato e quello realmente

contenuto nella confezione del preparato

COMPOSIZIONE DEI PRODOTTI IN COMMERCIO

Lewis ZT et al Pediatric Res 201679445-52

Quality control is lacking

DNA-based method amp culture-

based techniques

Reality

Only one in 16

probiotic products tested exactly matched

the bifidobacterial

species claims on the

label in every sample

tested

Lewis ZT et al Pediatric Res 201679445-52

Claim

Reality

One of the products tested did not

appear to contain any of the label

species but contained a footnote from

the manufacturers re-classifying the

strains

Quality control is lacking

DNA-based method amp culture-

based techniques

Lewis ZT et al Pediatric Res 201679445-52

Claim

SICUREZZA DEI PROBIOTICI

Food and Agriculture Organization 2001

WHO 2002

European food Saftey Authority

J Food Prot 2007 Feb70(2)412-8

Antibiotic susceptibility profiles of Lactobacillus reuteri and Lactobacillus fermentum

Egervaumlrn M Danielsen M Roos S Lindmark H Lindgren S National Food Administration PO Box 622 SE-751 26 Uppsala Sweden miaegervarnslvse Lactobacillus reuteri and Lactobacillus fermentum which are commonly used as food processing aids and probiotics can potentially act as reservoirs of antibiotic resistance genes Acquired resistance genes may be transferred via the food chain or in the gastrointestinal tract to pathogenic bacteria Knowledge of the distributions of antibiotic MICs for a species is needed when using a phenotypic method to assess the presence of acquired resistance genes In the present study 56 L reuteri and 56 L fermentum strains that differed by source and spatial and temporal origin were assessed for antibiotic susceptibility using an Etest kit and a broth microdilution protocol L fermentum strains displayed a uniform distribution of MICs for all six antibiotics tested L reuteri strains had a bimodal distribution of MICs or a distribution with MICs above the test range for 7 of the 14 antibiotics tested Genetic relatedness was observed among L reuteri strains with high MICs for both ampicillin and tetracycline and among strains with high MICs for both erythromycin and clindamycin Results obtained with the Etest and the broth microdilution method corresponded well with each other Thus further research may make it possible to define microbiological breakpoints for distinguishing between strains with and without acquired resistance genes

Qualitagrave dei probiotici

bull Numerosi studi hanno dimostrato come spesso non ci sia

corrispondenza tra quantitagrave ceppo dichiarato e quello realmente

contenuto nella confezione del preparato

COMPOSIZIONE DEI PRODOTTI IN COMMERCIO

Lewis ZT et al Pediatric Res 201679445-52

Quality control is lacking

DNA-based method amp culture-

based techniques

Reality

Only one in 16

probiotic products tested exactly matched

the bifidobacterial

species claims on the

label in every sample

tested

Lewis ZT et al Pediatric Res 201679445-52

Claim

Reality

One of the products tested did not

appear to contain any of the label

species but contained a footnote from

the manufacturers re-classifying the

strains

Quality control is lacking

DNA-based method amp culture-

based techniques

Lewis ZT et al Pediatric Res 201679445-52

Claim

SICUREZZA DEI PROBIOTICI

Food and Agriculture Organization 2001

WHO 2002

European food Saftey Authority

J Food Prot 2007 Feb70(2)412-8

Antibiotic susceptibility profiles of Lactobacillus reuteri and Lactobacillus fermentum

Egervaumlrn M Danielsen M Roos S Lindmark H Lindgren S National Food Administration PO Box 622 SE-751 26 Uppsala Sweden miaegervarnslvse Lactobacillus reuteri and Lactobacillus fermentum which are commonly used as food processing aids and probiotics can potentially act as reservoirs of antibiotic resistance genes Acquired resistance genes may be transferred via the food chain or in the gastrointestinal tract to pathogenic bacteria Knowledge of the distributions of antibiotic MICs for a species is needed when using a phenotypic method to assess the presence of acquired resistance genes In the present study 56 L reuteri and 56 L fermentum strains that differed by source and spatial and temporal origin were assessed for antibiotic susceptibility using an Etest kit and a broth microdilution protocol L fermentum strains displayed a uniform distribution of MICs for all six antibiotics tested L reuteri strains had a bimodal distribution of MICs or a distribution with MICs above the test range for 7 of the 14 antibiotics tested Genetic relatedness was observed among L reuteri strains with high MICs for both ampicillin and tetracycline and among strains with high MICs for both erythromycin and clindamycin Results obtained with the Etest and the broth microdilution method corresponded well with each other Thus further research may make it possible to define microbiological breakpoints for distinguishing between strains with and without acquired resistance genes

COMPOSIZIONE DEI PRODOTTI IN COMMERCIO

Lewis ZT et al Pediatric Res 201679445-52

Quality control is lacking

DNA-based method amp culture-

based techniques

Reality

Only one in 16

probiotic products tested exactly matched

the bifidobacterial

species claims on the

label in every sample

tested

Lewis ZT et al Pediatric Res 201679445-52

Claim

Reality

One of the products tested did not

appear to contain any of the label

species but contained a footnote from

the manufacturers re-classifying the

strains

Quality control is lacking

DNA-based method amp culture-

based techniques

Lewis ZT et al Pediatric Res 201679445-52

Claim

SICUREZZA DEI PROBIOTICI

Food and Agriculture Organization 2001

WHO 2002

European food Saftey Authority

J Food Prot 2007 Feb70(2)412-8

Antibiotic susceptibility profiles of Lactobacillus reuteri and Lactobacillus fermentum

Egervaumlrn M Danielsen M Roos S Lindmark H Lindgren S National Food Administration PO Box 622 SE-751 26 Uppsala Sweden miaegervarnslvse Lactobacillus reuteri and Lactobacillus fermentum which are commonly used as food processing aids and probiotics can potentially act as reservoirs of antibiotic resistance genes Acquired resistance genes may be transferred via the food chain or in the gastrointestinal tract to pathogenic bacteria Knowledge of the distributions of antibiotic MICs for a species is needed when using a phenotypic method to assess the presence of acquired resistance genes In the present study 56 L reuteri and 56 L fermentum strains that differed by source and spatial and temporal origin were assessed for antibiotic susceptibility using an Etest kit and a broth microdilution protocol L fermentum strains displayed a uniform distribution of MICs for all six antibiotics tested L reuteri strains had a bimodal distribution of MICs or a distribution with MICs above the test range for 7 of the 14 antibiotics tested Genetic relatedness was observed among L reuteri strains with high MICs for both ampicillin and tetracycline and among strains with high MICs for both erythromycin and clindamycin Results obtained with the Etest and the broth microdilution method corresponded well with each other Thus further research may make it possible to define microbiological breakpoints for distinguishing between strains with and without acquired resistance genes

Lewis ZT et al Pediatric Res 201679445-52

Quality control is lacking

DNA-based method amp culture-

based techniques

Reality

Only one in 16

probiotic products tested exactly matched

the bifidobacterial

species claims on the

label in every sample

tested

Lewis ZT et al Pediatric Res 201679445-52

Claim

Reality

One of the products tested did not

appear to contain any of the label

species but contained a footnote from

the manufacturers re-classifying the

strains

Quality control is lacking

DNA-based method amp culture-

based techniques

Lewis ZT et al Pediatric Res 201679445-52

Claim

SICUREZZA DEI PROBIOTICI

Food and Agriculture Organization 2001

WHO 2002

European food Saftey Authority

J Food Prot 2007 Feb70(2)412-8

Antibiotic susceptibility profiles of Lactobacillus reuteri and Lactobacillus fermentum

Egervaumlrn M Danielsen M Roos S Lindmark H Lindgren S National Food Administration PO Box 622 SE-751 26 Uppsala Sweden miaegervarnslvse Lactobacillus reuteri and Lactobacillus fermentum which are commonly used as food processing aids and probiotics can potentially act as reservoirs of antibiotic resistance genes Acquired resistance genes may be transferred via the food chain or in the gastrointestinal tract to pathogenic bacteria Knowledge of the distributions of antibiotic MICs for a species is needed when using a phenotypic method to assess the presence of acquired resistance genes In the present study 56 L reuteri and 56 L fermentum strains that differed by source and spatial and temporal origin were assessed for antibiotic susceptibility using an Etest kit and a broth microdilution protocol L fermentum strains displayed a uniform distribution of MICs for all six antibiotics tested L reuteri strains had a bimodal distribution of MICs or a distribution with MICs above the test range for 7 of the 14 antibiotics tested Genetic relatedness was observed among L reuteri strains with high MICs for both ampicillin and tetracycline and among strains with high MICs for both erythromycin and clindamycin Results obtained with the Etest and the broth microdilution method corresponded well with each other Thus further research may make it possible to define microbiological breakpoints for distinguishing between strains with and without acquired resistance genes

Quality control is lacking

DNA-based method amp culture-

based techniques

Reality

Only one in 16

probiotic products tested exactly matched

the bifidobacterial

species claims on the

label in every sample

tested

Lewis ZT et al Pediatric Res 201679445-52

Claim

Reality

One of the products tested did not

appear to contain any of the label

species but contained a footnote from

the manufacturers re-classifying the

strains

Quality control is lacking

DNA-based method amp culture-

based techniques

Lewis ZT et al Pediatric Res 201679445-52

Claim

SICUREZZA DEI PROBIOTICI

Food and Agriculture Organization 2001

WHO 2002

European food Saftey Authority

J Food Prot 2007 Feb70(2)412-8

Antibiotic susceptibility profiles of Lactobacillus reuteri and Lactobacillus fermentum

Egervaumlrn M Danielsen M Roos S Lindmark H Lindgren S National Food Administration PO Box 622 SE-751 26 Uppsala Sweden miaegervarnslvse Lactobacillus reuteri and Lactobacillus fermentum which are commonly used as food processing aids and probiotics can potentially act as reservoirs of antibiotic resistance genes Acquired resistance genes may be transferred via the food chain or in the gastrointestinal tract to pathogenic bacteria Knowledge of the distributions of antibiotic MICs for a species is needed when using a phenotypic method to assess the presence of acquired resistance genes In the present study 56 L reuteri and 56 L fermentum strains that differed by source and spatial and temporal origin were assessed for antibiotic susceptibility using an Etest kit and a broth microdilution protocol L fermentum strains displayed a uniform distribution of MICs for all six antibiotics tested L reuteri strains had a bimodal distribution of MICs or a distribution with MICs above the test range for 7 of the 14 antibiotics tested Genetic relatedness was observed among L reuteri strains with high MICs for both ampicillin and tetracycline and among strains with high MICs for both erythromycin and clindamycin Results obtained with the Etest and the broth microdilution method corresponded well with each other Thus further research may make it possible to define microbiological breakpoints for distinguishing between strains with and without acquired resistance genes

Reality

One of the products tested did not

appear to contain any of the label

species but contained a footnote from

the manufacturers re-classifying the

strains

Quality control is lacking

DNA-based method amp culture-

based techniques

Lewis ZT et al Pediatric Res 201679445-52

Claim

SICUREZZA DEI PROBIOTICI

Food and Agriculture Organization 2001

WHO 2002

European food Saftey Authority

J Food Prot 2007 Feb70(2)412-8

Antibiotic susceptibility profiles of Lactobacillus reuteri and Lactobacillus fermentum

Egervaumlrn M Danielsen M Roos S Lindmark H Lindgren S National Food Administration PO Box 622 SE-751 26 Uppsala Sweden miaegervarnslvse Lactobacillus reuteri and Lactobacillus fermentum which are commonly used as food processing aids and probiotics can potentially act as reservoirs of antibiotic resistance genes Acquired resistance genes may be transferred via the food chain or in the gastrointestinal tract to pathogenic bacteria Knowledge of the distributions of antibiotic MICs for a species is needed when using a phenotypic method to assess the presence of acquired resistance genes In the present study 56 L reuteri and 56 L fermentum strains that differed by source and spatial and temporal origin were assessed for antibiotic susceptibility using an Etest kit and a broth microdilution protocol L fermentum strains displayed a uniform distribution of MICs for all six antibiotics tested L reuteri strains had a bimodal distribution of MICs or a distribution with MICs above the test range for 7 of the 14 antibiotics tested Genetic relatedness was observed among L reuteri strains with high MICs for both ampicillin and tetracycline and among strains with high MICs for both erythromycin and clindamycin Results obtained with the Etest and the broth microdilution method corresponded well with each other Thus further research may make it possible to define microbiological breakpoints for distinguishing between strains with and without acquired resistance genes

SICUREZZA DEI PROBIOTICI

Food and Agriculture Organization 2001

WHO 2002

European food Saftey Authority

J Food Prot 2007 Feb70(2)412-8

Antibiotic susceptibility profiles of Lactobacillus reuteri and Lactobacillus fermentum

Egervaumlrn M Danielsen M Roos S Lindmark H Lindgren S National Food Administration PO Box 622 SE-751 26 Uppsala Sweden miaegervarnslvse Lactobacillus reuteri and Lactobacillus fermentum which are commonly used as food processing aids and probiotics can potentially act as reservoirs of antibiotic resistance genes Acquired resistance genes may be transferred via the food chain or in the gastrointestinal tract to pathogenic bacteria Knowledge of the distributions of antibiotic MICs for a species is needed when using a phenotypic method to assess the presence of acquired resistance genes In the present study 56 L reuteri and 56 L fermentum strains that differed by source and spatial and temporal origin were assessed for antibiotic susceptibility using an Etest kit and a broth microdilution protocol L fermentum strains displayed a uniform distribution of MICs for all six antibiotics tested L reuteri strains had a bimodal distribution of MICs or a distribution with MICs above the test range for 7 of the 14 antibiotics tested Genetic relatedness was observed among L reuteri strains with high MICs for both ampicillin and tetracycline and among strains with high MICs for both erythromycin and clindamycin Results obtained with the Etest and the broth microdilution method corresponded well with each other Thus further research may make it possible to define microbiological breakpoints for distinguishing between strains with and without acquired resistance genes

J Food Prot 2007 Feb70(2)412-8

Antibiotic susceptibility profiles of Lactobacillus reuteri and Lactobacillus fermentum

Egervaumlrn M Danielsen M Roos S Lindmark H Lindgren S National Food Administration PO Box 622 SE-751 26 Uppsala Sweden miaegervarnslvse Lactobacillus reuteri and Lactobacillus fermentum which are commonly used as food processing aids and probiotics can potentially act as reservoirs of antibiotic resistance genes Acquired resistance genes may be transferred via the food chain or in the gastrointestinal tract to pathogenic bacteria Knowledge of the distributions of antibiotic MICs for a species is needed when using a phenotypic method to assess the presence of acquired resistance genes In the present study 56 L reuteri and 56 L fermentum strains that differed by source and spatial and temporal origin were assessed for antibiotic susceptibility using an Etest kit and a broth microdilution protocol L fermentum strains displayed a uniform distribution of MICs for all six antibiotics tested L reuteri strains had a bimodal distribution of MICs or a distribution with MICs above the test range for 7 of the 14 antibiotics tested Genetic relatedness was observed among L reuteri strains with high MICs for both ampicillin and tetracycline and among strains with high MICs for both erythromycin and clindamycin Results obtained with the Etest and the broth microdilution method corresponded well with each other Thus further research may make it possible to define microbiological breakpoints for distinguishing between strains with and without acquired resistance genes

L Reuteri ATCC 55730 Antibiotic resistances

PROBIOTIC SAFETY

2001 2002 2004 2008

Strain Trials Quality of evidence

Grade of recommendation

Recommendation

LGG 15 RCTs LOW STRONG In adjunct to ORS

S boulardii 13 RCTs LOW STRONG In adjunct to ORS

L Reuteri (DSM 17938)

1 RCT VERY LOW WEAK In adjunct to ORS

L acidophilus LB (heat killed)

4 RCTs VERY LOW WEAK In adjunct to ORS

vancomycin resistance genes

E faecium (SF68) 7 RCTs LOW STRONG Should NOT be prescribed

Which strains are hellip

helliprecommended

hellip not recommended

JPGN 2014

298 adulti con pancreatite acuta severa randomizzati INTERVENTO Miscela di probiotici L acidophilus L casei L salivarius Lactococcus lactis Bifidobacterium bifidum Bifidobacterium lactisinfantum

Gastroenterite acuta Diarrea da antibiotici

MICI

Disturbi funzionali

Stipsi NEC

Obesitagrave

Sindrome metabolica

Steatosi epatica

Infezioni respiratorie

Infezioni genitali

Dermatite atopica

Allergie alimentari

Infezioni respiratorie Infezioni vie urinarie

TRATTAMENTO PREVENZIONE IN

TEST

INA

LI

EXTR

A -

INTE

STIN

ALI

PER QUALI MOTIVI

CONSIGLIATI DA CHI

prescrizioni

pediatri

farmacie

vari

19 41

40

LrsquoEFSA e lrsquoESPGHAN raccomandano di non aggiungere un elemento nel latte adattato solo percheacute questo egrave presente

anche nel latte materno prima si deve dimostrare che quando assunto con il latte adattato questo elemento apporti benefici

nutrizionali o altri vantaggi per il bambino Gli studi disponibili su nucleotidi LC PUFA probiotici e

prebiotici depongono per una sostanziale non efficacia di queste sostanze quando assunte tramite i latti adattati

Koletzko B et al Medical Position Paper J Pediatr Gastroenterol Nutr 2005

EFSA Journal 2014

GENITORI

Precedenti prescrizioni

consigli

MEDICO

Prescrizione del probiotico

Quale prodotto Quale dosaggio Per quanto tempo A quale paziente

Tasso p

rescrittiv

o d

i

pro

bio

tici in

co

rso d

i G

EA

PRESCRIZIONE AMBULATORIALE DI PROBIOTICI PER IL TRATTAMENTO DI BAMBINI CON GEA

Albano ndash J Pediatrics 2010

Kita ndash J Clin Phar Ther 2010

Weizman ndash J Clin Gastroenterol 2011

BELIEVE IN EFFICACY MAIN BARRIER TO USE

USA

Non - USA

Drugs vs foods vs supplements

bull However even top quality probiotic products may suffer

from some degree of product variability

bullProbiotics are live microorganisms that survive in the anaerobic

environment

bullFactors such as oxygen temperature and humidity may have

an impact on the maintaining the viability of the probiotic strains at

sufficiently high levels to ensure their therapeutic activity

throughout their shelf life

PROBIOTICI

microrganismi viventi che ingeriti in numero adeguato

esercitano benefici per la salute

PREBIOTICI

sostanze non digeribili che producono un effetto fisiologico

sullrsquoospite stimolando in maniera selettiva la crescita favorevole

o lrsquoattivitagrave di un numero limitato di batteri indigeni

638 3230 bambini in ambulatorio ---gt 20

PROBIOTICI PRESCRITTI IN BAMBINI ITALIANI

Drugs vs foods vs supplements

Products sold for medicinal purposes tend

to be a better quality than probiotics used

in dairy foods or probiotic supplements

Special care must be taken when using probiotics for vulnerable populations

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

PROBIOTIC SAFETY

2001 2002 2004 2008

Strain Trials Quality of evidence

Grade of recommendation

Recommendation

LGG 15 RCTs LOW STRONG In adjunct to ORS

S boulardii 13 RCTs LOW STRONG In adjunct to ORS

L Reuteri (DSM 17938)

1 RCT VERY LOW WEAK In adjunct to ORS

L acidophilus LB (heat killed)

4 RCTs VERY LOW WEAK In adjunct to ORS

vancomycin resistance genes

E faecium (SF68) 7 RCTs LOW STRONG Should NOT be prescribed

Which strains are hellip

helliprecommended

hellip not recommended

JPGN 2014

298 adulti con pancreatite acuta severa randomizzati INTERVENTO Miscela di probiotici L acidophilus L casei L salivarius Lactococcus lactis Bifidobacterium bifidum Bifidobacterium lactisinfantum

Gastroenterite acuta Diarrea da antibiotici

MICI

Disturbi funzionali

Stipsi NEC

Obesitagrave

Sindrome metabolica

Steatosi epatica

Infezioni respiratorie

Infezioni genitali

Dermatite atopica

Allergie alimentari

Infezioni respiratorie Infezioni vie urinarie

TRATTAMENTO PREVENZIONE IN

TEST

INA

LI

EXTR

A -

INTE

STIN

ALI

PER QUALI MOTIVI

CONSIGLIATI DA CHI

prescrizioni

pediatri

farmacie

vari

19 41

40

LrsquoEFSA e lrsquoESPGHAN raccomandano di non aggiungere un elemento nel latte adattato solo percheacute questo egrave presente

anche nel latte materno prima si deve dimostrare che quando assunto con il latte adattato questo elemento apporti benefici

nutrizionali o altri vantaggi per il bambino Gli studi disponibili su nucleotidi LC PUFA probiotici e

prebiotici depongono per una sostanziale non efficacia di queste sostanze quando assunte tramite i latti adattati

Koletzko B et al Medical Position Paper J Pediatr Gastroenterol Nutr 2005

EFSA Journal 2014

GENITORI

Precedenti prescrizioni

consigli

MEDICO

Prescrizione del probiotico

Quale prodotto Quale dosaggio Per quanto tempo A quale paziente

Tasso p

rescrittiv

o d

i

pro

bio

tici in

co

rso d

i G

EA

PRESCRIZIONE AMBULATORIALE DI PROBIOTICI PER IL TRATTAMENTO DI BAMBINI CON GEA

Albano ndash J Pediatrics 2010

Kita ndash J Clin Phar Ther 2010

Weizman ndash J Clin Gastroenterol 2011

BELIEVE IN EFFICACY MAIN BARRIER TO USE

USA

Non - USA

Drugs vs foods vs supplements

bull However even top quality probiotic products may suffer

from some degree of product variability

bullProbiotics are live microorganisms that survive in the anaerobic

environment

bullFactors such as oxygen temperature and humidity may have

an impact on the maintaining the viability of the probiotic strains at

sufficiently high levels to ensure their therapeutic activity

throughout their shelf life

PROBIOTICI

microrganismi viventi che ingeriti in numero adeguato

esercitano benefici per la salute

PREBIOTICI

sostanze non digeribili che producono un effetto fisiologico

sullrsquoospite stimolando in maniera selettiva la crescita favorevole

o lrsquoattivitagrave di un numero limitato di batteri indigeni

638 3230 bambini in ambulatorio ---gt 20

PROBIOTICI PRESCRITTI IN BAMBINI ITALIANI

Drugs vs foods vs supplements

Products sold for medicinal purposes tend

to be a better quality than probiotics used

in dairy foods or probiotic supplements

Special care must be taken when using probiotics for vulnerable populations

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

Strain Trials Quality of evidence

Grade of recommendation

Recommendation

LGG 15 RCTs LOW STRONG In adjunct to ORS

S boulardii 13 RCTs LOW STRONG In adjunct to ORS

L Reuteri (DSM 17938)

1 RCT VERY LOW WEAK In adjunct to ORS

L acidophilus LB (heat killed)

4 RCTs VERY LOW WEAK In adjunct to ORS

vancomycin resistance genes

E faecium (SF68) 7 RCTs LOW STRONG Should NOT be prescribed

Which strains are hellip

helliprecommended

hellip not recommended

JPGN 2014

298 adulti con pancreatite acuta severa randomizzati INTERVENTO Miscela di probiotici L acidophilus L casei L salivarius Lactococcus lactis Bifidobacterium bifidum Bifidobacterium lactisinfantum

Gastroenterite acuta Diarrea da antibiotici

MICI

Disturbi funzionali

Stipsi NEC

Obesitagrave

Sindrome metabolica

Steatosi epatica

Infezioni respiratorie

Infezioni genitali

Dermatite atopica

Allergie alimentari

Infezioni respiratorie Infezioni vie urinarie

TRATTAMENTO PREVENZIONE IN

TEST

INA

LI

EXTR

A -

INTE

STIN

ALI

PER QUALI MOTIVI

CONSIGLIATI DA CHI

prescrizioni

pediatri

farmacie

vari

19 41

40

LrsquoEFSA e lrsquoESPGHAN raccomandano di non aggiungere un elemento nel latte adattato solo percheacute questo egrave presente

anche nel latte materno prima si deve dimostrare che quando assunto con il latte adattato questo elemento apporti benefici

nutrizionali o altri vantaggi per il bambino Gli studi disponibili su nucleotidi LC PUFA probiotici e

prebiotici depongono per una sostanziale non efficacia di queste sostanze quando assunte tramite i latti adattati

Koletzko B et al Medical Position Paper J Pediatr Gastroenterol Nutr 2005

EFSA Journal 2014

GENITORI

Precedenti prescrizioni

consigli

MEDICO

Prescrizione del probiotico

Quale prodotto Quale dosaggio Per quanto tempo A quale paziente

Tasso p

rescrittiv

o d

i

pro

bio

tici in

co

rso d

i G

EA

PRESCRIZIONE AMBULATORIALE DI PROBIOTICI PER IL TRATTAMENTO DI BAMBINI CON GEA

Albano ndash J Pediatrics 2010

Kita ndash J Clin Phar Ther 2010

Weizman ndash J Clin Gastroenterol 2011

BELIEVE IN EFFICACY MAIN BARRIER TO USE

USA

Non - USA

Drugs vs foods vs supplements

bull However even top quality probiotic products may suffer

from some degree of product variability

bullProbiotics are live microorganisms that survive in the anaerobic

environment

bullFactors such as oxygen temperature and humidity may have

an impact on the maintaining the viability of the probiotic strains at

sufficiently high levels to ensure their therapeutic activity

throughout their shelf life

PROBIOTICI

microrganismi viventi che ingeriti in numero adeguato

esercitano benefici per la salute

PREBIOTICI

sostanze non digeribili che producono un effetto fisiologico

sullrsquoospite stimolando in maniera selettiva la crescita favorevole

o lrsquoattivitagrave di un numero limitato di batteri indigeni

638 3230 bambini in ambulatorio ---gt 20

PROBIOTICI PRESCRITTI IN BAMBINI ITALIANI

Drugs vs foods vs supplements

Products sold for medicinal purposes tend

to be a better quality than probiotics used

in dairy foods or probiotic supplements

Special care must be taken when using probiotics for vulnerable populations

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

298 adulti con pancreatite acuta severa randomizzati INTERVENTO Miscela di probiotici L acidophilus L casei L salivarius Lactococcus lactis Bifidobacterium bifidum Bifidobacterium lactisinfantum

Gastroenterite acuta Diarrea da antibiotici

MICI

Disturbi funzionali

Stipsi NEC

Obesitagrave

Sindrome metabolica

Steatosi epatica

Infezioni respiratorie

Infezioni genitali

Dermatite atopica

Allergie alimentari

Infezioni respiratorie Infezioni vie urinarie

TRATTAMENTO PREVENZIONE IN

TEST

INA

LI

EXTR

A -

INTE

STIN

ALI

PER QUALI MOTIVI

CONSIGLIATI DA CHI

prescrizioni

pediatri

farmacie

vari

19 41

40

LrsquoEFSA e lrsquoESPGHAN raccomandano di non aggiungere un elemento nel latte adattato solo percheacute questo egrave presente

anche nel latte materno prima si deve dimostrare che quando assunto con il latte adattato questo elemento apporti benefici

nutrizionali o altri vantaggi per il bambino Gli studi disponibili su nucleotidi LC PUFA probiotici e

prebiotici depongono per una sostanziale non efficacia di queste sostanze quando assunte tramite i latti adattati

Koletzko B et al Medical Position Paper J Pediatr Gastroenterol Nutr 2005

EFSA Journal 2014

GENITORI

Precedenti prescrizioni

consigli

MEDICO

Prescrizione del probiotico

Quale prodotto Quale dosaggio Per quanto tempo A quale paziente

Tasso p

rescrittiv

o d

i

pro

bio

tici in

co

rso d

i G

EA

PRESCRIZIONE AMBULATORIALE DI PROBIOTICI PER IL TRATTAMENTO DI BAMBINI CON GEA

Albano ndash J Pediatrics 2010

Kita ndash J Clin Phar Ther 2010

Weizman ndash J Clin Gastroenterol 2011

BELIEVE IN EFFICACY MAIN BARRIER TO USE

USA

Non - USA

Drugs vs foods vs supplements

bull However even top quality probiotic products may suffer

from some degree of product variability

bullProbiotics are live microorganisms that survive in the anaerobic

environment

bullFactors such as oxygen temperature and humidity may have

an impact on the maintaining the viability of the probiotic strains at

sufficiently high levels to ensure their therapeutic activity

throughout their shelf life

PROBIOTICI

microrganismi viventi che ingeriti in numero adeguato

esercitano benefici per la salute

PREBIOTICI

sostanze non digeribili che producono un effetto fisiologico

sullrsquoospite stimolando in maniera selettiva la crescita favorevole

o lrsquoattivitagrave di un numero limitato di batteri indigeni

638 3230 bambini in ambulatorio ---gt 20

PROBIOTICI PRESCRITTI IN BAMBINI ITALIANI

Drugs vs foods vs supplements

Products sold for medicinal purposes tend

to be a better quality than probiotics used

in dairy foods or probiotic supplements

Special care must be taken when using probiotics for vulnerable populations

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

Gastroenterite acuta Diarrea da antibiotici

MICI

Disturbi funzionali

Stipsi NEC

Obesitagrave

Sindrome metabolica

Steatosi epatica

Infezioni respiratorie

Infezioni genitali

Dermatite atopica

Allergie alimentari

Infezioni respiratorie Infezioni vie urinarie

TRATTAMENTO PREVENZIONE IN

TEST

INA

LI

EXTR

A -

INTE

STIN

ALI

PER QUALI MOTIVI

CONSIGLIATI DA CHI

prescrizioni

pediatri

farmacie

vari

19 41

40

LrsquoEFSA e lrsquoESPGHAN raccomandano di non aggiungere un elemento nel latte adattato solo percheacute questo egrave presente

anche nel latte materno prima si deve dimostrare che quando assunto con il latte adattato questo elemento apporti benefici

nutrizionali o altri vantaggi per il bambino Gli studi disponibili su nucleotidi LC PUFA probiotici e

prebiotici depongono per una sostanziale non efficacia di queste sostanze quando assunte tramite i latti adattati

Koletzko B et al Medical Position Paper J Pediatr Gastroenterol Nutr 2005

EFSA Journal 2014

GENITORI

Precedenti prescrizioni

consigli

MEDICO

Prescrizione del probiotico

Quale prodotto Quale dosaggio Per quanto tempo A quale paziente

Tasso p

rescrittiv

o d

i

pro

bio

tici in

co

rso d

i G

EA

PRESCRIZIONE AMBULATORIALE DI PROBIOTICI PER IL TRATTAMENTO DI BAMBINI CON GEA

Albano ndash J Pediatrics 2010

Kita ndash J Clin Phar Ther 2010

Weizman ndash J Clin Gastroenterol 2011

BELIEVE IN EFFICACY MAIN BARRIER TO USE

USA

Non - USA

Drugs vs foods vs supplements

bull However even top quality probiotic products may suffer

from some degree of product variability

bullProbiotics are live microorganisms that survive in the anaerobic

environment

bullFactors such as oxygen temperature and humidity may have

an impact on the maintaining the viability of the probiotic strains at

sufficiently high levels to ensure their therapeutic activity

throughout their shelf life

PROBIOTICI

microrganismi viventi che ingeriti in numero adeguato

esercitano benefici per la salute

PREBIOTICI

sostanze non digeribili che producono un effetto fisiologico

sullrsquoospite stimolando in maniera selettiva la crescita favorevole

o lrsquoattivitagrave di un numero limitato di batteri indigeni

638 3230 bambini in ambulatorio ---gt 20

PROBIOTICI PRESCRITTI IN BAMBINI ITALIANI

Drugs vs foods vs supplements

Products sold for medicinal purposes tend

to be a better quality than probiotics used

in dairy foods or probiotic supplements

Special care must be taken when using probiotics for vulnerable populations

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

CONSIGLIATI DA CHI

prescrizioni

pediatri

farmacie

vari

19 41

40

LrsquoEFSA e lrsquoESPGHAN raccomandano di non aggiungere un elemento nel latte adattato solo percheacute questo egrave presente

anche nel latte materno prima si deve dimostrare che quando assunto con il latte adattato questo elemento apporti benefici

nutrizionali o altri vantaggi per il bambino Gli studi disponibili su nucleotidi LC PUFA probiotici e

prebiotici depongono per una sostanziale non efficacia di queste sostanze quando assunte tramite i latti adattati

Koletzko B et al Medical Position Paper J Pediatr Gastroenterol Nutr 2005

EFSA Journal 2014

GENITORI

Precedenti prescrizioni

consigli

MEDICO

Prescrizione del probiotico

Quale prodotto Quale dosaggio Per quanto tempo A quale paziente

Tasso p

rescrittiv

o d

i

pro

bio

tici in

co

rso d

i G

EA

PRESCRIZIONE AMBULATORIALE DI PROBIOTICI PER IL TRATTAMENTO DI BAMBINI CON GEA

Albano ndash J Pediatrics 2010

Kita ndash J Clin Phar Ther 2010

Weizman ndash J Clin Gastroenterol 2011

BELIEVE IN EFFICACY MAIN BARRIER TO USE

USA

Non - USA

Drugs vs foods vs supplements

bull However even top quality probiotic products may suffer

from some degree of product variability

bullProbiotics are live microorganisms that survive in the anaerobic

environment

bullFactors such as oxygen temperature and humidity may have

an impact on the maintaining the viability of the probiotic strains at

sufficiently high levels to ensure their therapeutic activity

throughout their shelf life

PROBIOTICI

microrganismi viventi che ingeriti in numero adeguato

esercitano benefici per la salute

PREBIOTICI

sostanze non digeribili che producono un effetto fisiologico

sullrsquoospite stimolando in maniera selettiva la crescita favorevole

o lrsquoattivitagrave di un numero limitato di batteri indigeni

638 3230 bambini in ambulatorio ---gt 20

PROBIOTICI PRESCRITTI IN BAMBINI ITALIANI

Drugs vs foods vs supplements

Products sold for medicinal purposes tend

to be a better quality than probiotics used

in dairy foods or probiotic supplements

Special care must be taken when using probiotics for vulnerable populations

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

LrsquoEFSA e lrsquoESPGHAN raccomandano di non aggiungere un elemento nel latte adattato solo percheacute questo egrave presente

anche nel latte materno prima si deve dimostrare che quando assunto con il latte adattato questo elemento apporti benefici

nutrizionali o altri vantaggi per il bambino Gli studi disponibili su nucleotidi LC PUFA probiotici e

prebiotici depongono per una sostanziale non efficacia di queste sostanze quando assunte tramite i latti adattati

Koletzko B et al Medical Position Paper J Pediatr Gastroenterol Nutr 2005

EFSA Journal 2014

GENITORI

Precedenti prescrizioni

consigli

MEDICO

Prescrizione del probiotico

Quale prodotto Quale dosaggio Per quanto tempo A quale paziente

Tasso p

rescrittiv

o d

i

pro

bio

tici in

co

rso d

i G

EA

PRESCRIZIONE AMBULATORIALE DI PROBIOTICI PER IL TRATTAMENTO DI BAMBINI CON GEA

Albano ndash J Pediatrics 2010

Kita ndash J Clin Phar Ther 2010

Weizman ndash J Clin Gastroenterol 2011

BELIEVE IN EFFICACY MAIN BARRIER TO USE

USA

Non - USA

Drugs vs foods vs supplements

bull However even top quality probiotic products may suffer

from some degree of product variability

bullProbiotics are live microorganisms that survive in the anaerobic

environment

bullFactors such as oxygen temperature and humidity may have

an impact on the maintaining the viability of the probiotic strains at

sufficiently high levels to ensure their therapeutic activity

throughout their shelf life

PROBIOTICI

microrganismi viventi che ingeriti in numero adeguato

esercitano benefici per la salute

PREBIOTICI

sostanze non digeribili che producono un effetto fisiologico

sullrsquoospite stimolando in maniera selettiva la crescita favorevole

o lrsquoattivitagrave di un numero limitato di batteri indigeni

638 3230 bambini in ambulatorio ---gt 20

PROBIOTICI PRESCRITTI IN BAMBINI ITALIANI

Drugs vs foods vs supplements

Products sold for medicinal purposes tend

to be a better quality than probiotics used

in dairy foods or probiotic supplements

Special care must be taken when using probiotics for vulnerable populations

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

GENITORI

Precedenti prescrizioni

consigli

MEDICO

Prescrizione del probiotico

Quale prodotto Quale dosaggio Per quanto tempo A quale paziente

Tasso p

rescrittiv

o d

i

pro

bio

tici in

co

rso d

i G

EA

PRESCRIZIONE AMBULATORIALE DI PROBIOTICI PER IL TRATTAMENTO DI BAMBINI CON GEA

Albano ndash J Pediatrics 2010

Kita ndash J Clin Phar Ther 2010

Weizman ndash J Clin Gastroenterol 2011

BELIEVE IN EFFICACY MAIN BARRIER TO USE

USA

Non - USA

Drugs vs foods vs supplements

bull However even top quality probiotic products may suffer

from some degree of product variability

bullProbiotics are live microorganisms that survive in the anaerobic

environment

bullFactors such as oxygen temperature and humidity may have

an impact on the maintaining the viability of the probiotic strains at

sufficiently high levels to ensure their therapeutic activity

throughout their shelf life

PROBIOTICI

microrganismi viventi che ingeriti in numero adeguato

esercitano benefici per la salute

PREBIOTICI

sostanze non digeribili che producono un effetto fisiologico

sullrsquoospite stimolando in maniera selettiva la crescita favorevole

o lrsquoattivitagrave di un numero limitato di batteri indigeni

638 3230 bambini in ambulatorio ---gt 20

PROBIOTICI PRESCRITTI IN BAMBINI ITALIANI

Drugs vs foods vs supplements

Products sold for medicinal purposes tend

to be a better quality than probiotics used

in dairy foods or probiotic supplements

Special care must be taken when using probiotics for vulnerable populations

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

Tasso p

rescrittiv

o d

i

pro

bio

tici in

co

rso d

i G

EA

PRESCRIZIONE AMBULATORIALE DI PROBIOTICI PER IL TRATTAMENTO DI BAMBINI CON GEA

Albano ndash J Pediatrics 2010

Kita ndash J Clin Phar Ther 2010

Weizman ndash J Clin Gastroenterol 2011

BELIEVE IN EFFICACY MAIN BARRIER TO USE

USA

Non - USA

Drugs vs foods vs supplements

bull However even top quality probiotic products may suffer

from some degree of product variability

bullProbiotics are live microorganisms that survive in the anaerobic

environment

bullFactors such as oxygen temperature and humidity may have

an impact on the maintaining the viability of the probiotic strains at

sufficiently high levels to ensure their therapeutic activity

throughout their shelf life

PROBIOTICI

microrganismi viventi che ingeriti in numero adeguato

esercitano benefici per la salute

PREBIOTICI

sostanze non digeribili che producono un effetto fisiologico

sullrsquoospite stimolando in maniera selettiva la crescita favorevole

o lrsquoattivitagrave di un numero limitato di batteri indigeni

638 3230 bambini in ambulatorio ---gt 20

PROBIOTICI PRESCRITTI IN BAMBINI ITALIANI

Drugs vs foods vs supplements

Products sold for medicinal purposes tend

to be a better quality than probiotics used

in dairy foods or probiotic supplements

Special care must be taken when using probiotics for vulnerable populations

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

BELIEVE IN EFFICACY MAIN BARRIER TO USE

USA

Non - USA

Drugs vs foods vs supplements

bull However even top quality probiotic products may suffer

from some degree of product variability

bullProbiotics are live microorganisms that survive in the anaerobic

environment

bullFactors such as oxygen temperature and humidity may have

an impact on the maintaining the viability of the probiotic strains at

sufficiently high levels to ensure their therapeutic activity

throughout their shelf life

PROBIOTICI

microrganismi viventi che ingeriti in numero adeguato

esercitano benefici per la salute

PREBIOTICI

sostanze non digeribili che producono un effetto fisiologico

sullrsquoospite stimolando in maniera selettiva la crescita favorevole

o lrsquoattivitagrave di un numero limitato di batteri indigeni

638 3230 bambini in ambulatorio ---gt 20

PROBIOTICI PRESCRITTI IN BAMBINI ITALIANI

Drugs vs foods vs supplements

Products sold for medicinal purposes tend

to be a better quality than probiotics used

in dairy foods or probiotic supplements

Special care must be taken when using probiotics for vulnerable populations

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

Drugs vs foods vs supplements

bull However even top quality probiotic products may suffer

from some degree of product variability

bullProbiotics are live microorganisms that survive in the anaerobic

environment

bullFactors such as oxygen temperature and humidity may have

an impact on the maintaining the viability of the probiotic strains at

sufficiently high levels to ensure their therapeutic activity

throughout their shelf life

PROBIOTICI

microrganismi viventi che ingeriti in numero adeguato

esercitano benefici per la salute

PREBIOTICI

sostanze non digeribili che producono un effetto fisiologico

sullrsquoospite stimolando in maniera selettiva la crescita favorevole

o lrsquoattivitagrave di un numero limitato di batteri indigeni

638 3230 bambini in ambulatorio ---gt 20

PROBIOTICI PRESCRITTI IN BAMBINI ITALIANI

Drugs vs foods vs supplements

Products sold for medicinal purposes tend

to be a better quality than probiotics used

in dairy foods or probiotic supplements

Special care must be taken when using probiotics for vulnerable populations

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

PROBIOTICI

microrganismi viventi che ingeriti in numero adeguato

esercitano benefici per la salute

PREBIOTICI

sostanze non digeribili che producono un effetto fisiologico

sullrsquoospite stimolando in maniera selettiva la crescita favorevole

o lrsquoattivitagrave di un numero limitato di batteri indigeni

638 3230 bambini in ambulatorio ---gt 20

PROBIOTICI PRESCRITTI IN BAMBINI ITALIANI

Drugs vs foods vs supplements

Products sold for medicinal purposes tend

to be a better quality than probiotics used

in dairy foods or probiotic supplements

Special care must be taken when using probiotics for vulnerable populations

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

638 3230 bambini in ambulatorio ---gt 20

PROBIOTICI PRESCRITTI IN BAMBINI ITALIANI

Drugs vs foods vs supplements

Products sold for medicinal purposes tend

to be a better quality than probiotics used

in dairy foods or probiotic supplements

Special care must be taken when using probiotics for vulnerable populations

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

Drugs vs foods vs supplements

Products sold for medicinal purposes tend

to be a better quality than probiotics used

in dairy foods or probiotic supplements

Special care must be taken when using probiotics for vulnerable populations

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

Special care must be taken when using probiotics for vulnerable populations

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

LIVE KILLED

Number of trials 43 3

Number of Patientscontrols

20081982 121122

Duration of diarrhea (hours)

-2659 -1039

95 CI -3695 to -1616 -3075 to 997

Overall effect (p) lt000001 NS

Efficacia delle diverse formulazioni di probiotici

live vs killed

Allen et al Cochrane 2010

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici

Verificare la dose dei singoli ceppi inclusi

Verificare lrsquoefficacia clinica del prodotto testato come miscela

Efficacia delle diverse formulazioni di probiotici

Mix di probiotici