From the Guidelines
Lactobacillus supplements are contraindicated in individuals with severely compromised immune systems, such as those with HIV/AIDS, undergoing chemotherapy, or taking immunosuppressive medications, as well as in patients with predicted severe acute pancreatitis, due to the increased risk of adverse effects, including bacterial sepsis and mortality, as reported in the literature 1.
Contraindications for Lactobacillus Supplementation
The following conditions are considered contraindications for lactobacillus supplementation:
- Severely compromised immune systems, such as HIV/AIDS, undergoing chemotherapy, or taking immunosuppressive medications
- Predicted severe acute pancreatitis
- Damaged intestinal mucosa or immune dysregulation, such as in patients with inflammatory bowel diseases, liver diseases, or other conditions
- Critically ill patients, particularly those in intensive care units
- Patients with central venous catheters or other indwelling medical devices, due to the risk of lactobacillus-associated bacteremia or endocarditis
- History of hypersensitivity to lactobacillus products
Rationale for Contraindications
The reason for these contraindications is that lactobacillus, while normally beneficial bacteria that support gut health, can potentially translocate from the intestines into the bloodstream in certain high-risk conditions, causing systemic infection, as noted in the study published in Clinical Gastroenterology and Hepatology 1.
Special Considerations
While generally considered safe during pregnancy and breastfeeding, consulting a healthcare provider before use is recommended, as the safety and efficacy findings associated with a specific probiotic formulation should not be generalized to other probiotic products, as emphasized in the study 1.
From the Research
Contraindications for Lactobacillus Supplementation
The following are contraindications for Lactobacillus (probiotic) supplementation:
- Critically ill patients: Probiotics should be used cautiously in patients who are critically ill or severely immunocompromised, as systemic infections may rarely occur 2.
- Severely immunocompromised patients: Patients with weakened immune systems should use probiotics with caution, as they may be more susceptible to systemic infections 2.
- Central venous catheters: Patients with central venous catheters should use probiotics with caution, as they may be at increased risk of systemic infections 2.
- Inflammatory disease-induced gut mucosa enhanced permeability: Great care is required in the choice of the proper Lactobacillus species, their genetic stability, and the translocation risk, mainly related to inflammatory disease-induced gut mucosa enhanced permeability 3.
Special Considerations
- HIV/AIDS patients: While there is no direct contraindication for Lactobacillus supplementation in HIV/AIDS patients, antiretroviral drugs used to treat HIV/AIDS may increase the risk of acute pancreatitis, which could be a concern for patients with pancreatic issues 4, 5, 6.
- Patients with underlying medical conditions: Patients with underlying medical conditions, such as inflammatory bowel disease, should use probiotics under the guidance of a healthcare professional, as the impact of HIV infection on the course of inflammatory bowel disease and drug safety profile is unclear 5.