Probiotic use in an infectious disease setting.

INTRODUCTION: The lethality of infectious diseases and deep concern over growing antimicrobial resistance make it essential that alternative or adjunct therapies be developed. Areas covered: Using papers published in PubMed, a case is presented to consider beneficial microbes as a means to improve management of infectious diseases. Clinical evidence is mounting that certain probiotic microbes can contribute to this armamentarium. These could have an immediate effect against necrotizing enterocolitis, pre- and post-surgical procedures, antibiotic-associated infections, urogenital infections in women and for reducing the severity and duration of respiratory infections. While further studies will always be warranted irrespective of the intervention, and quality assurance and patient safety must remain a priority, the main barrier to implementation may well be unwarranted hesitation amongst physicians, healthcare administrators and regulators. Meanwhile, patients are already taking things into their own hands at a time when their knowledge of product selection is poor and clinical guidance is invariably missing. Expert commentary: Until vaccines and other alternatives emerge, it would be foolhardy to not use best practices to bring probiotics into mainstream infectious disease management. Our ability to manipulate microbial-host interactions offers hope before the last antibiotic stops being effective.