perinatologyРоссийский вестник перинатологии и педиатрииRossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)1027-40652500-2228Ltd. “The National Academy of Pediatric Science and Innovation”10.21508/1027-4065-2016-61-1-17-23perinatology-4Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWSПробиотики в педиатрии: за и против с позиции доказательной медициныProbiotics in pediatrics: Pros and cons in the context of evidence-based medicineМазанковаЛ. Н.MazankovaL. N.

д.м.н., проф., зав. кафедрой детских инфекционных болезней

РыбальченкоО. В.RybalchenkoO. V.

д.б.н., проф. кафедры физиологии медицинского факультета

КорниенкоЕ. А.KornienkoE. A.

д.м.н., проф., зав. кафедрой гастроэнтерологии факультета послевузовского и дополнительного профессионального образования

ПерловскаяС. Г.PerlovskayaS. G.

врач-педиатр

ГБОУ ДПО «Российская медицинская академия последипломного образования», МоскваРоссияRussian Medical Academy of Postgraduate Education, MoscowRussian FederationСанкт-Петербургский государственный университетРоссияSaint Petersburg State UniversityRussian FederationГБОУ ВПО «Санкт-Петербургский государственный педиатрический медицинский университет»РоссияSaint Petersburg State Pediatric Medical UniversityRussian FederationГБУЗ «Детская городская клиническая больница №9 им.Г.Н. Сперанского», МоскваРоссияG.N. Speransky City Children’s Clinical Hospital Nine, MoscowRussian Federation2016260220166111626Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20162016Ltd. “The National Academy of Pediatric Science and Innovation”Ltd. “The National Academy of Pediatric Science and Innovation”https://www.ped-perinatology.ru/jour/about/submissions#copyrightNoticehttps://www.ped-perinatology.ru/jour/article/view/4

Представлены современные данные о проблеме изучения микробиоты кишечника, дана классификация представителей микрофлоры кишечника, описаны ее позитивные и негативные функции. С клинических позиций описаны показания к назначению препаратов – пробиотиков при разных заболеваниях с позиций доказательной медицины в возрастном аспекте у детей. Особое внимание уделено побочным эффектам и противопоказаниям к применению пробиотиков у детей.

The paper gives an update on the problem of studying the gut microbiota and a classification of the representatives of the intestinal microflora and describes its positive and negative functions. The authors depict indications for the use of drugs, such as probiotics, to treat different childhood diseases from the clinical standpoint of evidence-based medicine in the age aspect. Particular attention is given to the side effects of probiotics and to contraindications to their use in children.

детимикробиотапробиотикилечениепрофилактикасhildrenmicrobiotaprobioticstreatmentpreventionReferencesCollins C.D., Purohit S., Podolsky R.H. et al. The application of genomic and proteomic technologies in predictive, preventive and personalized medicine. Vascul Pharmacol 2006; 45: 5: 258–267.Collins C.D., Purohit S., Podolsky R.H. et al. The application of genomic and proteomic technologies in predictive, preventive and personalized medicine. Vascul Pharmacol 2006; 45: 5: 258–267.Бондаренко В.М., Рыбальченко О.В. Анализ профилактического и лечебного действия пробиотических препаратов с позиций новых научных технологий. Журн микробиол 2015; 2: 90–104. (Bondarenko V.M., Rybalchenko O.V. Analysis of prophylactic and therapeutic action of probiotic preparations from the standpoint of new scientific technologies. Zh Mikrobiol 2015; 2: 90–104.)Бондаренко В.М., Рыбальченко О.В. Анализ профилактического и лечебного действия пробиотических препаратов с позиций новых научных технологий. Журн микробиол 2015; 2: 90–104. (Bondarenko V.M., Rybalchenko O.V. Analysis of prophylactic and therapeutic action of probiotic preparations from the standpoint of new scientific technologies. Zh Mikrobiol 2015; 2: 90–104.)Lederberg J. Infectious history. Science 2000; 444: 287–293.Lederberg J. Infectious history. Science 2000; 444: 287–293.Бондаренко В.М. Обоснование и тактика назначения в медицинской практике различных форм пробиотических препаратов. Фарматека 2012; 13: 77–87. (Bondarenko V.M. The rationale and tactics of destination in medical practice of different forms of probiotic preparations. Farmateka 2012; 13: 77–87).Бондаренко В.М. Обоснование и тактика назначения в медицинской практике различных форм пробиотических препаратов. Фарматека 2012; 13: 77–87. (Bondarenko V.M. The rationale and tactics of destination in medical practice of different forms of probiotic preparations. Farmateka 2012; 13: 77–87).Turnbaugh P.J., Hamady M., Yatsunenko T. et al. A core gut microbiome in obese and lean twins. Nature 2009; 457: 480– 484.Turnbaugh P.J., Hamady M., Yatsunenko T. et al. A core gut microbiome in obese and lean twins. Nature 2009; 457: 480– 484.Nielsen D.S., Mоller P.L., Rosenfeldt V. et al. Case study of the distribution of mucosa-associated Bifidobacterium species, Lactobacillus species, and other lactic acid bacteria in the human colon. Appl Environ Microbiol 2003; 69: 12: 7545–7548.Nielsen D.S., Mоller P.L., Rosenfeldt V. et al. Case study of the distribution of mucosa-associated Bifidobacterium species, Lactobacillus species, and other lactic acid bacteria in the human colon. Appl Environ Microbiol 2003; 69: 12: 7545–7548.Парфенов А.И., Бондаренко В.М. Что нам дал вековой опыт познания симбионтной кишечной микрофлоры. Тер архив 2012; 2: 5-10. (Parfenov A.I., Bondarenko V.M. That gave us a century of experience of knowledge of symbiotic intestinal microflora. Ter arkhiv 2012; 2: 5–10).Парфенов А.И., Бондаренко В.М. Что нам дал вековой опыт познания симбионтной кишечной микрофлоры. Тер архив 2012; 2: 5-10. (Parfenov A.I., Bondarenko V.M. That gave us a century of experience of knowledge of symbiotic intestinal microflora. Ter arkhiv 2012; 2: 5–10).Рыбальченко О.В. Электронно-микроскопическое исследование межклеточных взаимодействий микро-организмов при антагонистическом характере взаимоотношений. Микробиология 2006; 75: 4: 550–555. (Rybalchenko O.V. Electron microscopic study of intercellular interactions of microorganisms with antagonistic nature of the relationship. Mikrobiologiya 2006; 75: 4: 550–555.)Рыбальченко О.В. Электронно-микроскопическое исследование межклеточных взаимодействий микро-организмов при антагонистическом характере взаимоотношений. Микробиология 2006; 75: 4: 550–555. (Rybalchenko O.V. Electron microscopic study of intercellular interactions of microorganisms with antagonistic nature of the relationship. Mikrobiologiya 2006; 75: 4: 550–555.)Лиходед В.Г., Бондаренко В.М., Гинцбург А.Л. Экзогенные и эндогенные факторы в патогенезе атеросклероза. Рецепторная теория атерогенеза. Рос кардиол журн 2010; 2: 92–96. (Likhoded V.G., Bondarenko V.M., Gintsburg A.L. Exogenous and endogenous factors in the pathogenesis of atherosclerosis. Receptor theory of atherogenesis. Ros kardiol zhurn 2010; 2: 92–96.)Лиходед В.Г., Бондаренко В.М., Гинцбург А.Л. Экзогенные и эндогенные факторы в патогенезе атеросклероза. Рецепторная теория атерогенеза. Рос кардиол журн 2010; 2: 92–96. (Likhoded V.G., Bondarenko V.M., Gintsburg A.L. Exogenous and endogenous factors in the pathogenesis of atherosclerosis. Receptor theory of atherogenesis. Ros kardiol zhurn 2010; 2: 92–96.)Дисбиоз кишечника. Руководство по диагностике и лечению. Под ред. Е.И. Ткаченко, А.Н. Суворова. СПб.: СпецЛит 2007; 238. (Intestinal dysbiosis. Guidance on diagnostics and treatment. E.I. Tkachenko, A.N. Suvorov (eds). SPb.: Spetslit, 2007; 238.)Дисбиоз кишечника. Руководство по диагностике и лечению. Под ред. Е.И. Ткаченко, А.Н. Суворова. СПб.: СпецЛит 2007; 238. (Intestinal dysbiosis. Guidance on diagnostics and treatment. E.I. Tkachenko, A.N. Suvorov (eds). SPb.: Spetslit, 2007; 238.)Шендеров Б.А. Роль персонального функционального питания в современных программах медицины антистарения. Вестн восстанов мед 2009; 3: 9–17. (Shenderov B.A. functional Role of personal power in the contemporary medicine the anti-aging. Vestn vosstanov med 2009; 3: 9–17.)Шендеров Б.А. Роль персонального функционального питания в современных программах медицины антистарения. Вестн восстанов мед 2009; 3: 9–17. (Shenderov B.A. functional Role of personal power in the contemporary medicine the anti-aging. Vestn vosstanov med 2009; 3: 9–17.)Рыбальченко О.В., Бондаренко В.М., Добрица В.П. Атлас ультраструктуры микробиоты кишечника человека. Изд-во СПб. ИИЦ ВМА 2008; 102. (Rybalchenko O.V., Bondarenko V.M., Dobrica V.P. Atlas of the ultrastructure of the microbiota of the human intestine. Publishing house of SPb. IRC. VMA, 2008; 102.)Рыбальченко О.В., Бондаренко В.М., Добрица В.П. Атлас ультраструктуры микробиоты кишечника человека. Изд-во СПб. ИИЦ ВМА 2008; 102. (Rybalchenko O.V., Bondarenko V.M., Dobrica V.P. Atlas of the ultrastructure of the microbiota of the human intestine. Publishing house of SPb. IRC. VMA, 2008; 102.)Чернин В.В., Бондаренко В.М., Червинец В.М., Базлов С.Н. Дисбактериоз мукозной микрофлоры эзофагогастродуоденальной зоны. М: МИА 2011; 144. (Chernin V.V., Bondarenko V.M., Chervinec V.M., Bazlov S.N. Dysbacteriosis of mucosal microflora esophago-gastroduodenal zone. M: MIA 2011; 144.)Чернин В.В., Бондаренко В.М., Червинец В.М., Базлов С.Н. Дисбактериоз мукозной микрофлоры эзофагогастродуоденальной зоны. М: МИА 2011; 144. (Chernin V.V., Bondarenko V.M., Chervinec V.M., Bazlov S.N. Dysbacteriosis of mucosal microflora esophago-gastroduodenal zone. M: MIA 2011; 144.)Бондаренко В.М., Лиходед В.Г. Распознавание комменсальной микрофлоры образраспознающими рецепторами в физиологии и патологии человека. Журн микробиол 2012; 3: 82 89. (Bondarenko V.M., Likhoded V.G. Recognition of commensal microflora by pattern recognition receptors in human physiology and pathology. Zhurn mikrobiol 2012; 3: 82–89.)Бондаренко В.М., Лиходед В.Г. Распознавание комменсальной микрофлоры образраспознающими рецепторами в физиологии и патологии человека. Журн микробиол 2012; 3: 82 89. (Bondarenko V.M., Likhoded V.G. Recognition of commensal microflora by pattern recognition receptors in human physiology and pathology. Zhurn mikrobiol 2012; 3: 82–89.)Ардатская М.Д., Минушкин О.Н. Современные принципы диагностики и фармакологической коррекции. Consilium Medicum Гастроэнтерология 2006; 8: 2. (Ardatskaya M.D., Minushkin O.N. Modern principles of diagnosis and pharmacological correction. Consilium Medicum Gastroehnterologiya 2006; 8: 2.)Ардатская М.Д., Минушкин О.Н. Современные принципы диагностики и фармакологической коррекции. Consilium Medicum Гастроэнтерология 2006; 8: 2. (Ardatskaya M.D., Minushkin O.N. Modern principles of diagnosis and pharmacological correction. Consilium Medicum Gastroehnterologiya 2006; 8: 2.)Бондаренко В.М., Мацулевич Т.В. Дисбактериоз кишечника как клинико-лабораторный синдром: современное состояние проблемы. Руководство для врачей М.: ГЭОТАР–Медиа 2007; 304. (Bondarenko V.M., Matsulevitch T.V. Dysbacteriosis of the intestine as clinical and laboratory syndrome: the state of the art. The guide for physicians. M.: GEOTAR–Media, 2007: 304.)Бондаренко В.М., Мацулевич Т.В. Дисбактериоз кишечника как клинико-лабораторный синдром: современное состояние проблемы. Руководство для врачей М.: ГЭОТАР–Медиа 2007; 304. (Bondarenko V.M., Matsulevitch T.V. Dysbacteriosis of the intestine as clinical and laboratory syndrome: the state of the art. The guide for physicians. M.: GEOTAR–Media, 2007: 304.)FAO/WHO. Working group on drafting guidelines for the evaluation of probiotics in food. Guidelines for the evaluation of probiotics in food. 2002; http://ftp. fao. org/es/esn/food/ wgreport2.pdfFAO/WHO. Working group on drafting guidelines for the evaluation of probiotics in food. Guidelines for the evaluation of probiotics in food. 2002; http://ftp. fao. org/es/esn/food/ wgreport2.pdfProbiotic bacteria in dietetic products for infants: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2004; 38: 365–374.Probiotic bacteria in dietetic products for infants: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2004; 38: 365–374.Borchers A.T. Probiotics and immunity. J Gastroenterol 2009; 4: 26–46.Borchers A.T. Probiotics and immunity. J Gastroenterol 2009; 4: 26–46.Ng S.C., Hart A.L., Kamm M.A. et al. Mechanisms of action of probiotics: recent advances. Inflamm Bowel Dis 2009; 15: 2: 301–312.Ng S.C., Hart A.L., Kamm M.A. et al. Mechanisms of action of probiotics: recent advances. Inflamm Bowel Dis 2009; 15: 2: 301–312.Resta-Lenert S., Barrett K.E. Live probiotics protect intestinal epithelial cells from the effects of infection. Gut 2003: 52: 7: 988–997.Resta-Lenert S., Barrett K.E. Live probiotics protect intestinal epithelial cells from the effects of infection. Gut 2003: 52: 7: 988–997.Ouwehand A., Isolauri E., Salminen S. The role of intestinal microflora for development of the immune system in early childhood. Eur J Nutr 2002; 41: 1: 132–137.Ouwehand A., Isolauri E., Salminen S. The role of intestinal microflora for development of the immune system in early childhood. Eur J Nutr 2002; 41: 1: 132–137.Duary R.K., Rajput Y.S., Batish V.K., Grover S. Assessing the adhesion of putative indigenous probiotic lactobacilli to human colonic epithelial cells. Indian J Med Res 2011; 134: 5: 664–671.Duary R.K., Rajput Y.S., Batish V.K., Grover S. Assessing the adhesion of putative indigenous probiotic lactobacilli to human colonic epithelial cells. Indian J Med Res 2011; 134: 5: 664–671.Yan F., Polk D.B. Probiotic bacterium prevents cytokineinduced apoptosis in intestinal epithelial cells. J Biol Chem 2002; 277: 50959–50965.Yan F., Polk D.B. Probiotic bacterium prevents cytokineinduced apoptosis in intestinal epithelial cells. J Biol Chem 2002; 277: 50959–50965.Braat H., Van Den B.J., Van Tol E. et al. Lactobacillus rhamnosus induces peripheral hyporesponsiveness in stimulated CD4+ T cells via modulation of dendritic cell function. Am J Clin Nutr 2004; 80: 1618–1625.Braat H., Van Den B.J., Van Tol E. et al. Lactobacillus rhamnosus induces peripheral hyporesponsiveness in stimulated CD4+ T cells via modulation of dendritic cell function. Am J Clin Nutr 2004; 80: 1618–1625.Fang H., Elina T., Heikki A. et al. Modulation of humoral immune response through probiotic intake. Immunol Med Microbiol 2000: 29: 47–52.Fang H., Elina T., Heikki A. et al. Modulation of humoral immune response through probiotic intake. Immunol Med Microbiol 2000: 29: 47–52.Szajewska H., Setty M., Mrukowicz J., Guandalini S. Probiotics in gastrointestinal diseases in children: hard and not-so-hard evidence of efficacy. J Pediatr Gastroenterol Nutr 2006; 42: 454–475.Szajewska H., Setty M., Mrukowicz J., Guandalini S. Probiotics in gastrointestinal diseases in children: hard and not-so-hard evidence of efficacy. J Pediatr Gastroenterol Nutr 2006; 42: 454–475.Szajewska H., Karas J. Acute gastroenteritis. The COMMENT working group on acute diarrhea: Where are we now and where are we going? J Clin Gastroenterol 2014; 48: Suppl 1: S32–33.Szajewska H., Karas J. Acute gastroenteritis. The COMMENT working group on acute diarrhea: Where are we now and where are we going? J Clin Gastroenterol 2014; 48: Suppl 1: S32–33.Shamir R., Makhoul I.R., Etzioni A. et al. Evaluation of a diet containing probiotics and zinc for the treatment of mild diarrheal illness in children younger than one year of age. J Am Coll Nutr 2005; 24: 370–375.Shamir R., Makhoul I.R., Etzioni A. et al. Evaluation of a diet containing probiotics and zinc for the treatment of mild diarrheal illness in children younger than one year of age. J Am Coll Nutr 2005; 24: 370–375.Isolauri E., Juntunen M., Rautanen T. et al. A human Lactobacillus strain (Lactobacillus casei sp strain GG) promotes recovery from acute diarrhea in children. Pediatrics 1991; 88: 90–97.Isolauri E., Juntunen M., Rautanen T. et al. A human Lactobacillus strain (Lactobacillus casei sp strain GG) promotes recovery from acute diarrhea in children. Pediatrics 1991; 88: 90–97.Shornikova A.V., Isolauri E., Burkanova L. et al. A trial in the Karelian Republic of oral rehydration and Lactobacillus GG for treatment of acute diarrhea. Acta Paediatr 1997; 86: 460–465.Shornikova A.V., Isolauri E., Burkanova L. et al. A trial in the Karelian Republic of oral rehydration and Lactobacillus GG for treatment of acute diarrhea. Acta Paediatr 1997; 86: 460–465.Guarino A., Canani R.B., Spagnuolo M.I. et al. Oral bacterial therapy reduces the duration of symptoms and of viral excretion in children with mild diarrhea. J Pediatr Gastroenterol Nutr 1997; 25: 516–519.Guarino A., Canani R.B., Spagnuolo M.I. et al. Oral bacterial therapy reduces the duration of symptoms and of viral excretion in children with mild diarrhea. J Pediatr Gastroenterol Nutr 1997; 25: 516–519.Guandalini S., Pensabene L., Zikri M.A. et al. Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. J Pediatr Gastroenterol Nutr 2000; 30: 54–60.Guandalini S., Pensabene L., Zikri M.A. et al. Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. J Pediatr Gastroenterol Nutr 2000; 30: 54–60.Guarino A., Ashkenazi S., Gendrel D. et al. ESPGHAN/European Pediatric Infectious Disease evidence-based guidelines for the management of acute gastroenteritis in children in Europe, update 2014. J Pediatr Gastroenterol Nutr 2014; 59: 1: 132–152.Guarino A., Ashkenazi S., Gendrel D. et al. ESPGHAN/European Pediatric Infectious Disease evidence-based guidelines for the management of acute gastroenteritis in children in Europe, update 2014. J Pediatr Gastroenterol Nutr 2014; 59: 1: 132–152.Johnston B.C., Goldenberg J.Z., Vandvik P.O. et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev 2011; 11: CD004827.Johnston B.C., Goldenberg J.Z., Vandvik P.O. et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev 2011; 11: CD004827.Applegate J.A., Christa L.F.W., Ramya A., Robert E.B. Systematic review of probiotics for the treatment of community- acquired acute diarrhea in children. BMC Public Health 2013; 13: Suppl 3: S16.Applegate J.A., Christa L.F.W., Ramya A., Robert E.B. Systematic review of probiotics for the treatment of community- acquired acute diarrhea in children. BMC Public Health 2013; 13: Suppl 3: S16.Применение пробиотиков при острых гастроэнтеритах. Consilium medicum Педиатрия 2014; 4: 53-58. (The use of probiotics in acute gastroenteritis. Consilium medicum Pediatriya 2014; 4: 53–58.)Применение пробиотиков при острых гастроэнтеритах. Consilium medicum Педиатрия 2014; 4: 53-58. (The use of probiotics in acute gastroenteritis. Consilium medicum Pediatriya 2014; 4: 53–58.)Мазанкова Л. Н., Яковлева Г.Ю., Ардатская М.Д. Ротавирусная инфекция у детей раннего возраста: обоснование пробиотической терапии. Дет инф 2011; 2: 52–56. (Mazankova L.N., Yakovleva G.Y., Ardatskaya M.D. Rotavirus infection in infants: rationale of probiotic therapy. Det inf 2011; 2: 52–56.)Мазанкова Л. Н., Яковлева Г.Ю., Ардатская М.Д. Ротавирусная инфекция у детей раннего возраста: обоснование пробиотической терапии. Дет инф 2011; 2: 52–56. (Mazankova L.N., Yakovleva G.Y., Ardatskaya M.D. Rotavirus infection in infants: rationale of probiotic therapy. Det inf 2011; 2: 52–56.)WGO. Probiotics and Prebiotics. World Gastroenterology Organization, 2011; http://www. worldgastroenterology. org/assets/export/userfiles/2012%20 Probiotics_ NEW%20 FINAL_sp. pdf.WGO. Probiotics and Prebiotics. World Gastroenterology Organization, 2011; http://www. worldgastroenterology. org/assets/export/userfiles/2012%20 Probiotics_ NEW%20 FINAL_sp. pdf.Szajewska H., Ruszczyński M, Radzikowski A. Probiotics in the prevention of antibioticassociated diarrhea in children: a me ta-analysis of randomized controlled trials. J Pediatr 2006; 149: 367–372.Szajewska H., Ruszczyński M, Radzikowski A. Probiotics in the prevention of antibioticassociated diarrhea in children: a me ta-analysis of randomized controlled trials. J Pediatr 2006; 149: 367–372.Johnston B.C., Supina A.L., Ospina M. et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev 2007; 2: CD004827.Johnston B.C., Supina A.L., Ospina M. et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev 2007; 2: CD004827.Lynne V. McFarland. Probiotics for the Primary and Secondary Prevention of C. difficile Infections: A Meta-analysis and Systematic Review. Antibiotics 2015; 4: 160–178.Lynne V. McFarland. Probiotics for the Primary and Secondary Prevention of C. difficile Infections: A Meta-analysis and Systematic Review. Antibiotics 2015; 4: 160–178.Saavedra J. Probiotics and infectious diarrhea. Am J Gastroenterol 2000; 95: Suppl 1: 16–18.Saavedra J. Probiotics and infectious diarrhea. Am J Gastroenterol 2000; 95: Suppl 1: 16–18.Surawicz C.M. Probiotics, antibiotic-associated diarrhea and Clostridium difficile diarrhea in humans. Best Pract Res Clin Gastroenterol 2003; 17: 775–783.Surawicz C.M. Probiotics, antibiotic-associated diarrhea and Clostridium difficile diarrhea in humans. Best Pract Res Clin Gastroenterol 2003; 17: 775–783.Malfertheiner P., Megraud F., O’Morain C.A. et al. Management of Helicobacter pylori infection – the Maastricht IV/ Florence Consensus report. Gut 2012; 61: 646–664.Malfertheiner P., Megraud F., O’Morain C.A. et al. Management of Helicobacter pylori infection – the Maastricht IV/ Florence Consensus report. Gut 2012; 61: 646–664.Moayyedi P., Ford A.C., Talley N.J. et al. The efficacy of probiotics in the therapy of irritable bowel syndrome: a systemic review. Gut 2008; 64: 654–667.Moayyedi P., Ford A.C., Talley N.J. et al. The efficacy of probiotics in the therapy of irritable bowel syndrome: a systemic review. Gut 2008; 64: 654–667.Bin-Nun A., Bromiker R., Wilschanski M. et al. Oral probiotics prevent necrotizing enterocolitis in very low birth weight neonates. J Pediatr 2005; 147: 192–196.Bin-Nun A., Bromiker R., Wilschanski M. et al. Oral probiotics prevent necrotizing enterocolitis in very low birth weight neonates. J Pediatr 2005; 147: 192–196.Lin H.C., Su B.H., Chen A.C. et al. Oral probiotics reduce the incidence and severity of necrotizing enterocolitis in very low birth weight infants. Pediatrics 2005; 115: 1–4.Lin H.C., Su B.H., Chen A.C. et al. Oral probiotics reduce the incidence and severity of necrotizing enterocolitis in very low birth weight infants. Pediatrics 2005; 115: 1–4.Wolvers D., Antoine J., Myllyluoma E. et al. Guidance for substantiating the evidence for beneficial effects of probiotics: prevention and management of infections by probiotics. J Nutr 2010; 140: 698–712.Wolvers D., Antoine J., Myllyluoma E. et al. Guidance for substantiating the evidence for beneficial effects of probiotics: prevention and management of infections by probiotics. J Nutr 2010; 140: 698–712.Alfaleh K., Anabrees J., Bassler D. et al. Probiotics reduce the risk of necrotizing enterocolitis in preterm infants: a metaanalysis. Neonatology 2010; 97: 93–99.Alfaleh K., Anabrees J., Bassler D. et al. Probiotics reduce the risk of necrotizing enterocolitis in preterm infants: a metaanalysis. Neonatology 2010; 97: 93–99.Hunter C., Mary A., Peter G. et al. Effect of routine probiotic, Lactobacillus reuteri DSM 17938, use on rates of necrotizing enterocolitis in neonates with birthweight 1000 grams: a sequential analysis. BMC Pediatr 2012; 12: 142.Hunter C., Mary A., Peter G. et al. Effect of routine probiotic, Lactobacillus reuteri DSM 17938, use on rates of necrotizing enterocolitis in neonates with birthweight 1000 grams: a sequential analysis. BMC Pediatr 2012; 12: 142.Mercenier A., Pavan S., Pot B. Probiotics as biotherapeutic agents: present knowledge and future prospects. Curr Pharm Des 2003; 9: 2: 175–191.Mercenier A., Pavan S., Pot B. Probiotics as biotherapeutic agents: present knowledge and future prospects. Curr Pharm Des 2003; 9: 2: 175–191.Borriello S.P., Hammes W.P., Holzapfel W. et al. Safety of probiotics that contain lactobacilli or bifidobacteria. Clin Infect Dis 2003; 36: 775–780.Borriello S.P., Hammes W.P., Holzapfel W. et al. Safety of probiotics that contain lactobacilli or bifidobacteria. Clin Infect Dis 2003; 36: 775–780.Karpa K.D. Probiotics for Clostridium difficile diarrhea: putting it into perspective. Ann Pharmacother 2007; 41: 1284–1287.Karpa K.D. Probiotics for Clostridium difficile diarrhea: putting it into perspective. Ann Pharmacother 2007; 41: 1284–1287.Snydman D.R. The safety of probiotics. Clin Infect Dis 2008; 46: Suppl 2: 104–111.Snydman D.R. The safety of probiotics. Clin Infect Dis 2008; 46: Suppl 2: 104–111.Probiotics Pros and Cons. BERKELEY WELLNESS, 2014; http: www. berkeleywellness. com›…article/probiotics…andcons.Probiotics Pros and Cons. BERKELEY WELLNESS, 2014; http: www. berkeleywellness. com›…article/probiotics…andcons.Kunz A.N., Noel J.M., Fairchok M.P. Two cases of Lactobacillus bacteremia during probiotic treatment of short gut syndrome. Pediatr Gastroenterol Nutr 2004; 38: 4: 457– 458.Kunz A.N., Noel J.M., Fairchok M.P. Two cases of Lactobacillus bacteremia during probiotic treatment of short gut syndrome. Pediatr Gastroenterol Nutr 2004; 38: 4: 457– 458.Soleman N., Laferl H., Kneifel W. et al. How safe is safe? A case of Lactobacillus paracasei ssp. paracasei endocarditis and discussion of the safety of lactic acid bacteria. Scand J Infect Dis 2003; 35: 10: 759–762.Soleman N., Laferl H., Kneifel W. et al. How safe is safe? A case of Lactobacillus paracasei ssp. paracasei endocarditis and discussion of the safety of lactic acid bacteria. Scand J Infect Dis 2003; 35: 10: 759–762.Salminen M.K., Tynkkynen S., Rautelin H. et al. Lactobacillus bacteremia during a rapid increase in probiotic use of Lactobacillus rhamnosus GG in Finland. Clin Infect Dis 2002; 35: 10: 1155–1160.Salminen M.K., Tynkkynen S., Rautelin H. et al. Lactobacillus bacteremia during a rapid increase in probiotic use of Lactobacillus rhamnosus GG in Finland. Clin Infect Dis 2002; 35: 10: 1155–1160.Liong M.T. Safety of probiotics: translocation and infection. Nutr Rev 2008; 66: 4: 192–202.Liong M.T. Safety of probiotics: translocation and infection. Nutr Rev 2008; 66: 4: 192–202.Besselink M.G., van Santvoort H.C., Buskens E. et al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet 2008; 371: 651–659.Besselink M.G., van Santvoort H.C., Buskens E. et al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet 2008; 371: 651–659.Gou S., Yang Z., Liu T., Wu H., Wang C. Use of probiotics in the treatment of severe acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Crit Care 2014; 18: 2: R57.Gou S., Yang Z., Liu T., Wu H., Wang C. Use of probiotics in the treatment of severe acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Crit Care 2014; 18: 2: R57.Boyle R.J., Robins-Browne R.M., Tang M.L. Probiotic use in clinical practice: what are the risks? Am J Clin Nutr 2006; 83: 1256–1264.Boyle R.J., Robins-Browne R.M., Tang M.L. Probiotic use in clinical practice: what are the risks? Am J Clin Nutr 2006; 83: 1256–1264.Marteau P., Shanahan F. Basic aspects and pharmacology of probiotics an overview on pharmacokinetics, mechanisms of action and side effects. Best Pract Res Clin Gastroenterol 2003; 17: 5: 725–740.Marteau P., Shanahan F. Basic aspects and pharmacology of probiotics an overview on pharmacokinetics, mechanisms of action and side effects. Best Pract Res Clin Gastroenterol 2003; 17: 5: 725–740.

The authors declare that there are no conflicts of interest present.