Paper incompletely describes evidence-based usage of probiotics.

We were concerned by the conclusions made in the publication by Rondanelli et al. titled, Using probiotics in clinical practice: Where are we now? A review of existing meta-analyses. This paper reviewed data supporting clinical uses of probiotics. However, the narrow scope of the review excludes some of the most compelling findings in the field and as such several important meta-analyses were not included.

The authors correctly note that recommendations can be made for clinical use of probiotics for prevention of antibiotic-associated diarrhea, prevention of C. difficile diarrhea, and reduction of risk for respiratory tract infections. However, they do not consider the following data for prevention of necrotizing enterocolitis, managing symptoms of colic, primary prevention of atopic dermatitis, treatment of acute pediatric diarrhea, maintenance of remission for pouchitis and ulcerative colitis, reducing risk of symptoms of lactose maldigestion, and prevention and treatment of bacterial vaginosis. For all of these conditions there are existing recommendations by different clinical organizations (including the European Society for Paediatric Gastroenterology Hepatology and Nutrition, World Gastroenterology Organisation and World Allergy Organization), by Cochrane, or in the case of lactose maldigestion, there is an approved claim in the European Union.

Finally, we would like to call attention to a degree of imprecision in descriptions of some clinical endpoints, which could leave incorrect impressions about the target of some studies. For example, the paper refers to ‘probiotics for pancreatitis’ but is not clear that probiotics were tested for reducing infectious complications of pancreatitis, not for treating the condition.

We appreciate the opportunity to comment, which we hope will facilitate evidence-based usage of probiotics.