Basic aspects and pharmacology of probiotics: an overview of pharmacokinetics, mechanisms of action and side-effects.

Probiotics have been defined as non-pathogenic micro-organisms that, when ingested, exert a positive influence on host health or physiology. Their pharmacology is more complex than that of inert drugs but is now being studied in detail. Some strains have a high survival capacity until they reach the faeces, whereas others are rapidly killed by acid and bile (a characteristic that can be used for the delivery of active intracellular components). Potential translocation and permanent colonization are rare but possible events; and should come under closer scrutiny. Mechanisms of action can be direct or indirect through modifications of the endogenous flora or through immunomodulation. The active components are poorly known but include bacterial formylated peptides, peptidoglycan cell wall constituents and nucleotides. Although the safety of commercial probiotics is excellent, this aspect should be studied in more detail, especially in immunocompromised hosts.