Recommended Prescription for Lactobacillus Supplementation in Adults
For adults requiring Lactobacillus supplementation, the recommended prescription is Lactobacillus rhamnosus GG at a dosage of 1×10^10 colony forming units (CFU) twice daily for 28 days. 1
Specific Strain Recommendations Based on Clinical Indication
For Prevention of Clostridioides difficile Infection
- VSL#3 (a probiotic mixture containing 450 billion CFU of 8 lactic acid bacteria including Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus delbrueckii, Lactobacillus plantarum, and others) is recommended for prevention of C. difficile infection during antibiotic therapy 2, 3
- Alternative options include:
For Irritable Bowel Syndrome (IBS)
- Lactobacillus acidophilus DDS-1 at 1×10^10 CFU/day for 6 weeks has shown significant improvement in abdominal pain severity and IBS symptomatology 4
- Bifidobacterium lactis UABla-12 at 1×10^10 CFU/day for 6 weeks is an alternative option 4
For Pouchitis
- VSL#3 at a dose of 3600 billion CFU/day for 8 weeks is recommended for treatment of chronic pouchitis 2
- For prevention of pouchitis, VSL#3 has shown efficacy in maintaining remission (90% effectiveness over 12 months) 2
General Dosing Guidelines
- For general health maintenance in adults: Lactobacillus rhamnosus GG at 1×10^10 CFU twice daily 1
- For multi-strain formulations: 2.1×10^11 CFU once daily containing a combination of Lactobacillus and Bifidobacterium strains 5
- Duration of therapy typically ranges from 7-28 days depending on the indication, with longer courses (up to 8 weeks) for chronic conditions 2, 5
Safety Considerations
- Lactobacillus supplementation is generally well-tolerated in healthy adults, including elderly populations 1, 6
- Most common adverse events are mild gastrointestinal symptoms including bloating, gas, and nausea 1, 5
- Contraindicated in immunocompromised patients due to risk of bacteremia or fungemia 3
- Should be started at the beginning of antibiotic therapy when used for prevention of antibiotic-associated diarrhea 3
Specific Formulations to Consider
- For general use: Lactobacillus rhamnosus GG (1×10^10 CFU twice daily) 1
- For multiple health benefits: Multi-strain formulation containing Lactobacillus acidophilus NCFM, Lactobacillus paracasei Lpc-37, Lactobacillus plantarum Lp-115, Lactobacillus rhamnosus GG, Lactobacillus rhamnosus HN001, Bifidobacterium lactis Bi-07, Bifidobacterium lactis Bl-04, and Bifidobacterium lactis HN019 (2.1×10^11 CFU once daily) 5
- For specific digestive disorders: Lactobacillus acidophilus LB (non-living pharmabiotic) for acute diarrhea, chronic diarrhea, and antibiotic-associated diarrhea 7
Clinical Pearls
- Efficacy of probiotics is both strain-specific and disease-specific; not all probiotics are equally effective for all conditions 3
- Probiotics should be stored according to manufacturer recommendations to maintain viability 5
- When prescribing for antibiotic-associated conditions, separate administration of antibiotics and probiotics by at least 2 hours 3
- Consider continuing probiotic therapy for 1-2 weeks after completion of antibiotic course when used for prevention of antibiotic-associated diarrhea 3