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Recommendations for Probiotic Use—2008

Floch, Martin H. MD*; Walker, W. Allan MD; Guandalini, Stefano MD; Hibberd, Patricia MD§; Gorbach, Sherwood MD; Surawicz, Christina MD; Sanders, Mary Ellen PhD; Garcia-Tsao, Guadalupe MD*; Quigley, Eamonn M. M. MD**; Isolauri, Erika MD, PhD††; Fedorak, Richard N. MD‡‡; Dieleman, Levinus A. MD, PhD‡‡

Journal of Clinical Gastroenterology: July 2008 - Volume 42 - Issue - p S104-S108
doi: 10.1097/MCG.0b013e31816b903f

Recommendations for the clinical use of probiotics were published after a Yale University Workshop in 2005. A similar workshop was held in 2007, and the recommendations were updated and extended into other areas. The recommendations are graded into an “A,” “B,” “C” or no category based on the expert's opinion and review by the workshop participants. An “A” recommendation is made for acute childhood diarrhea, prevention of antibiotic-associated diarrhea, preventing and maintaining remission in pouchitis, and in an immune response for the treatment and prevention of atopic eczema associated with cow's milk allergy. The group maintained several “B” recommendations in other areas of treating inflammatory bowel disease and irritable bowel syndrome. Although there are significant studies in the “B” group, most “B” recommendations did not reach an “A” level because of some negative studies or a limited number of studies. Many reports in the “C” recommendations were significant but fell short of receiving stronger ratings because of the size of reported patient studies, and also the factors that limited categories to the “B” rating.

*Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT

Pediatric Gastroenterology and Nutrition Unit, Harvard Medical School, Mass General Hospital for Children

§Pediatric and Public Health

Division of Nutrition and Infection, Tufts University School of Medicine, Boston, MA

Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, IL

Division of Gastroenterology, University of Washington, Seattle, WA

Dairy and Food Culture Technologies, Centennial, CO

**Alimentary Pharmabiotic Centre, National University of Ireland, Cork, Ireland

††Department of Pediatrics, University of Turku, Turku, Finland

‡‡Division of Gastroenterology, University of Alberta, Alberta, Canada

The authors declare no conflict of interest.

No funding for any authors. Quigley is a consultant for Procter & Gamble; Fedorak is a consultant to Biocodex and Procter & Gamble; Sanders is a consultant for Yakult and The Dannon Company; Floch is a consultant for Procter & Gamble and The Dannon Company; Surawicz is on the speakers bureau for Biocodex.

Reprints: Martin H. Floch, MD, Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, PO Box 208019, New Haven, CT 06520-8019 (e-mail:

Received for publication January 31, 2008; accepted January 31, 2008

© 2008 Lippincott Williams & Wilkins, Inc.