Use of probiotics in the fight against Helicobacter pylori

Table 1 Summary of trials using probiotics with Helicobacer pylori eradication treatment (2012 to date)

Treatment(oral administration)	Probiotic(s)(oral administration)	Region	Eradication rates		% side effects	Probiotic(s) efficacy	Ref.
			Intention to treat	Per protocol
Esomeprazole 20 mg, levofloxacin 500 mg, amoxicillin 1 g, all bid, 7 d	108 CFU Lactobacillus reuteri, during therapy + further 7 d	Italy	80% (36/45)	80% (36/45)	66.7	Significant increase of eradication rates and reduction of side effects (nausea and diarrhea)	[44]
	Control		62.2% (28/45)	62.2% (28/45)	100.0
Esomeprazole 20 mg and amoxicillin 1 g, both bid, 5 d; then esomeoprazole 20 mg, clarithromycin 500 mg, tinidazole 500 mg, all bid, 5 d (sequential therapy)	109 CFU L. Acidophilus, 109 CFU L. bulgaricus, 5 × 108 CFU Bifidobacterium bifidum, 109 CFU Streptococcus thermophilus, bid, during therapy	Italy	89% (65/73)	92.9% (65/70)	39.7	Eradication rates unaffected; significant decrease of side effects (metallic taste, abdominal/epigastric pain, diarrhea). Addition of lactoferrin did not influence the results achieved with probiotics	[45]
	Probiotics as above + 200 mg lactoferrin		88.5% (69/78)	93.2% (69/74)	38.5
	Control		88.2% (67/76)	94.4% (67/71)	65.8
Omeprazole 1 mg/kg sid, amoxicillin 50 mg/kg bid, clarithromycin 15 mg/kg bid, 7 d	5 × 109 CFU L. plantarum, 2 × 109 CFU L. reuterii, 2 × 109 CFU L. casei subsp. rhamnosus, 2 × 109 CFU B. infantis and B. longum, 109 CFU L. salivarius, 109 CFU L. acidophilus, 5 × 109 CFU S. thermophilus, 109 CFU L. sporogenes, sid., during therapy	Italy	88.2% (30/34)	88.2% (30/34)	14.5	Non-significant increase of eradication rates; significant reduction of side effects (epigastric pain, nausea, vomiting, diarrhea)	[46]
	Control		76.4% (26/34)	76.4% (26/34)	61.5
Omeprazole 20 mg, clarithromycin 500 mg, amoxicillin 1 g, all bid, 7 d	L. acidophilus 14 d after therapy	China	79.2% (61/77)	82.4% (61/74)	89.2	Significant increase of eradication rates; no influence on side effects	[47]
	3 × 107L. acidophilus 14 d before therapy		79.5% (62/78)	81.6% (62/76)	85.5
	Control		60.8% (48/79)	61.5% (48/78)	87.2
Omeprazole 20 mg, bismuth subcitrate 240 mg, amoxicillin 1 g, clarithromycin 500 mg, all bid, 14 d (quadruple therapy)	L. casei, L. rhamnosus, L. acidophilus, L. bulgaricus, B. breve, B. longum, S. thermophilus, total viable count 108 CFU, bid, during therapy	Iran	76.6% (69/90)	82.1% (69/84)	18.8	No significant differences in efficacy and overall side effects (decrease of diarrhea but increase of abdominal pain)	[48]
	Control		81.1% (73/90)	84.8% (73/86)	16.6
Standard triple therapy (details not disclosed)	3 × 109 CFU B. infantis, bid, during therapy	United Arab Emirates	83% (83/100)		3.0	Significant increase of eradication rates, and reduction of incidence of antibiotic-induced side effects (diarrhea, loose bowel motion)	[49]
	3 × 109 CFU B. infantis, bid, 14 d before therapy, then during therapy		90.5% (86/95)		2.1
	Control		68.9% (73/106)		14.2
Sequential therapy (details not disclosed), 10 d	3 × 109 CFU B. infantis, bid, during therapy		90.8% (69/76)		1.3
Amoxicillin 50 mg/kg, furazolidone 6 mg/kg, both bid, 7 d, plus omeprazole 1 mg/kg sid 28 d	L. casei, L. rhamnosus, L. acidophilus, L. bulgaricus, B. infantis, B. breve, S. thermophilus, total viable count 109 CFU, sid, during therapy	Iran	90.1% (30/33)		21.2	Significant increase of eradication rates, and reduction of side effects (nausea, vomiting, diarrhea)	[50]
	Control		69.7% (23/33)		63.6
Furazolidone 200 mg, tetracycline 500 mg, lansoprazole 30 mg, bid, 7 d	L. acidophilus, L. rhamnosus, B. bifidum, S. faecium, 1.25 × 109 CFU each, sid,during therapy and further 23 d	Brazil	81.8% (45/55)	89.8% (44/49)	59.3/44.9	Non-significant increase of eradication rates and non-significant reduction of side effects (at 7 and 30 d)	[51]
	control		76.9% (40/52)	85.1% (41/48)	71.2/60.4
Standard triple therapy	L. acidophilus, B. bifidum during and after therapy	China	83.7% (36/43)			Increase of eradication rates	[52]
	Control		64.4% (29/45)
Omeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg, all bid, 14 d	2 × 108 CFU L. reuteri, sid, during therapy and further 14 d	Egypt	74.3% (26/35)	74.3% (26/35)	28.6%	Non-significant increase of eradication rates; significant decrease of side effects (taste disorders, diarrhea)	[53]
	Control		65.7% (23/35)	65.7% (23/35)	68.6%

CFU: Colony forming unit; Control: Group that received the eradication treatment without probiotics or with placebo; the term “significant” was used when P < 0.05 was reported in the corresponding paper.