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From the National Institutes of HealthNational Institutes of Health

Lactobacillus


What is it?

Lactobacillus is a type of bacteria. There are lots of different species of lactobacillus. These are "friendly" bacteria that normally live in our digestive, urinary, and genital systems without causing disease. Lactobacillus is also in some fermented foods like yogurt and in dietary supplements.

Lactobacillus is used for treating and preventing diarrhea, including infectious types such as rotaviral diarrhea in children and traveler's diarrhea. It is also used to prevent and treat diarrhea associated with using antibiotics.

Some people use lactobacillus for general digestion problems; irritable bowel syndrome (IBS); colic in babies; Crohn's disease; inflammation of the colon; and a serious gut problem called necrotizing enterocolitis (NEC) in babies born prematurely. Lactobacillus is also used for infection with Helicobacter pylori, the type of bacteria that causes ulcers, and also for other types of infections including urinary tract infections (UTIs), vaginal yeast infections, to prevent the common cold in adults, and to prevent respiratory infections in children attending daycare centers. It is also being tested to prevent serious infections in people on ventilators.

Lactobacillus is used for skin disorders such as fever blisters, canker sores, eczema (allergic dermatitis); and acne.

It is also used for high cholesterol, lactose intolerance, Lyme disease, hives, and to boost the immune system.

Women sometimes use lactobacillus suppositories to treat vaginal infections and urinary tract infections (UTIs).

There are concerns about the quality of some lactobacillus products. Some products labeled to contain Lactobacillus acidophilus actually contain no lactobacillus acidophilus, or they contain a different strain of lactobacillus such as Lactobacillus bulgaricus. Some products are contaminated with “unfriendly” bacteria.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for LACTOBACILLUS are as follows:

Likely effective for...

  • Diarrhea in children caused by a certain virus (rotavirus). Children with rotaviral diarrhea who are being treated with lactobacillus seem to get over their diarrhea about a half day earlier than they would without this treatment. Larger doses of lactobacillus are more effective than smaller ones. At least 10 billion colony-forming units during the first 48 hours should be used.

Possibly effective for...

  • Preventing diarrhea in children caused by antibiotics. Giving children Lactobacillus GG (Culturelle) along with antibiotics seems to reduce the diarrhea that children sometimes experience when taking antibiotics alone.
  • Preventing diarrhea in hospitalized adults. Drinking a specific beverage containing Lactobacillus casei, Lactobacillus bulgaricus, and Streptococcus thermophilus (Actimel, Danone) twice daily during antibiotic treatment and for a week afterwards significantly decreases the risk of developing diarrhea.
  • Preventing diarrhea due to traveling. Traveler’s diarrhea is caused by bacteria, viruses, or parasites that the traveler has not been exposed to before. Taking a specific strain of Lactobacillus rhamnosus, Lactobacillus GG (Culturelle) seems to help prevent diarrhea in travelers. The effectiveness of Lactobacillus GG can vary a lot depending on the travel destination because of differences in bacteria in different locations.
  • Preventing diarrhea due to cancer treatment (chemotherapy). A chemotherapy drug called 5-fluorouracil can cause severe diarrhea and other gastrointestinal (GI) side effects. There is some evidence that patients with cancer of the colon or rectum have less severe diarrhea, less stomach discomfort, shorter hospital care, and require fewer chemotherapy dose reductions due to GI side effects when they take a particular strain of Lactobacillus rhamnosus, Lactobacillus GG (Culturelle).
  • Colic in babies. Taking a specific Lactobacillus reuteri product (Probiotic Drops, BioGaia AB) 100 million CFUs once daily for 21-28 days reduces daily crying time in nursing infants. Taking this Lactobacillus reuteri product seems to be more effective than using the drug simethicone.
  • Lung infections. Children ages 1 to 6 years who attend daycare centers seem to get fewer and less severe lung infections when given milk containing lactobacillus GG or a specific combination product containing both Lactobacillus acidophilus and Bifidobacterium (HOWARU Protect).
  • Treating a bowel condition called ulcerative colitis. Some research suggests that taking a specific combination product containing lactobacillus, bifidobacteria, and streptococcus might improve symptoms. Taking lactobacillus also seems to help treat chronic pouchitis, a complication of surgery for ulcerative colitis. Continuous treatment for one year with a specific concentrated formulation of lactobacillus, bifidobacterium, and streptococcus (VSL#3) seems to help most patients.
  • Treating irritable bowel syndrome (IBS). There is some research showing that certain strains of lactobacillus, but not others, can improve symptoms of IBS such as bloating, and stomach pain.
  • Treating vaginal infections caused by bacteria (bacterial vaginosis). Clinical research shows certain strains of Lactobacillus might help treat bacterial vaginosis when applied inside the vagina. Researchers have found Lactobacillus acidophilus suppositories (Vivag, Pharma Vinci A/S, Denmark) and vaginal tablets (Gynoflor, Medinova, Switzerland) may be effective. Researchers also found that vaginal capsules Lactobacillus gasseri and Lactobacillus rhamnosus, seem to lengthen the time between infections.
  • Treating and preventing eczema (atopic dermatitis) in infants and children who are allergic to cow’s milk. A combination of freeze-dried Lactobacillus rhamnosus and Lactobacillus reuteri seems to reduce eczema symptoms in children ages 1 to 13 years.
  • Helping prescription medications treat Helicobacter pylori (H pylori) infection, which causes stomach ulcers.
  • Treating diarrhea caused by the bacterium Clostridium difficile.

Possibly ineffective for...

  • Vaginal yeast infections after taking antibiotics. There is evidence that taking lactobacillus by mouth or eating yogurt enriched with lactobacillus doesn’t prevent vaginal yeast infections after antibiotics. However, women with yeast infections who use vaginal suppositories containing 1 billion live Lactobacillus GG bacteria twice daily for 7 days in combination with conventional treatment often report their symptoms improve.
  • Crohn's disease.
  • Lactose intolerance.
  • Reducing symptoms of too much bacteria in the intestines.

Insufficient evidence to rate effectiveness for...

  • Urinary tract infections (UTIs). There is some preliminary evidence that vaginal use of some Lactobacillus species might be helpful for preventing UTIs, but not all studies have agreed.
  • General digestion problems.
  • Necrotizing enterocolitis (NEC) in babies born prematurely.
  • High cholesterol.
  • Sensitivity to milk (lactose-intolerance).
  • Lyme disease.
  • Hives.
  • Fever blisters.
  • Canker sores.
  • Acne.
  • Cancer.
  • Boosting the immune system.
  • Common cold.
  • Preventing infections in people on ventilators.
  • Other conditions.
More evidence is needed to rate lactobacillus for these uses.

How does it work?

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Many bacteria and other organisms live in our bodies normally. "Friendly" bacteria such as lactobacillus can help us break down food, absorb nutrients, and fight off "unfriendly" organisms that might cause diseases such as diarrhea.

Are there safety concerns?

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Lactobacillus is LIKELY SAFE for most people, including babies and children. Side effects are usually mild and most often include intestinal gas or bloating.

Lactobacillus is also LIKELY SAFE for women to use inside the vagina.

Special precautions & warnings:

Pregnancy and breast-feeding: Using lactobacillus during pregnancy and breast-feeding is POSSIBLY SAFE. Lactobacillus GG has been used safely in pregnant and breast-feeding women. But other types of lactobacillus have not been studied during pregnancy and breast-feeding, so their safety is unknown.

Weakened immune system: There is some concern that lactobacillus from supplements that contain live bacteria might grow too well in people whose immune systems are weakened. This includes people with HIV/AIDS or people who have taken medicines to prevent rejection of a transplanted organ. Lactobacillus has caused disease (rarely) in people with weakened immune systems. To be on the safe side, if you have a weakened immune system, talk with your healthcare provider before taking lactobacillus.

Short bowel syndrome: People with short bowel syndrome might be more likely than other people to develop lactobacillus infections. If you have this condition, talk with your healthcare provider before taking lactobacillus.

Are there interactions with medications?

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Moderate

Be cautious with this combination.

Antibiotic drugs
Antibiotics are used to reduce harmful bacteria in the body. Antibiotics can also reduce friendly bacteria in the body. Lactobacillus is a type of friendly bacteria. Taking antibiotics along with lactobacillus can reduce the effectiveness of lactobacillus. To avoid this interaction, take lactobacillus products at least 2 hours before or after antibiotics.

Medications that decrease the immune system (Immunosuppressants)
Lactobacillus contains live bacteria and yeast. The immune system usually controls bacteria and yeast in the body to prevent infections. Medications that decrease the immune system can increase your chances of getting sick from bacteria and yeast. Taking lactobacillus along with medications that decrease the immune system might increase the chances of getting sick.

Some medications that decrease the immune system include azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone, Orasone), corticosteroids (glucocorticoids), and others.

Are there interactions with herbs and supplements?

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There are no known interactions with herbs and supplements.

Are there interactions with foods?

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There are no known interactions with foods.

What dose is used?

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The strength of lactobacillus products is usually indicated by the number of living organisms per capsule. Typical doses range from 1 to 10 billion living organisms taken daily in 3-4 divided doses.

The following doses have been studied in scientific research:

BY MOUTH:
  • For children with rotaviral diarrhea: 5 to 10 billion live Lactobacillus GG in a solution that replaces lost water.
  • For treating babies and children with diarrhea:
    • 10 to 100 billion live Lactobacillus reuteri daily for up to 5 days. Lower doses may not be effective.
    • Also, combination of Lactobacillus rhamnosus and Lactobacillus reuteri, 10 billion live cells of each strain, twice daily for 5 days.
  • For preventing antibiotic-associated diarrhea in children: A specific strain of Lactobacillus rhamnosus, Lactobacillus GG (Culturelle) containing 20 billion live organisms daily has been used during treatment with antibiotics. A specific beverage containing Lactobacillus casei, Lactobacillus bulgaricus, and Streptococcus thermophilus (Actimel, Danone) 97 mL twice daily also has been used.
  • For preventing diarrhea in infants and children ages 1 to 36 months:
    • 6 billion live Lactobacillus GG twice daily.
    • A fermented milk product containing a specific Lactobacillus casei strain DN-114 001 (DanActive, Dannon) in doses of 100 grams, 125 grams, or 250 grams daily has also been used.
  • For preventing and shortening the duration of diarrhea in newborns within the first year of life in rural areas of developing countries: 100 million live Lactobacillus sporogenes have been given daily for one year.
  • For preventing respiratory infections in children attending day-care centers: 260 mL milk with 500,000 to 1 million colony-forming units of Lactobacillus GG per mL. A milk product containing 5 billion colony forming units each of Lactobacillus acidophilus and Bifidobacterium (HOWARU Protect, Danisco) in 120 mL of milk twice a day has also been used. A milk product containing Lactobacillus 5 billion colony forming units in 120 mL of milk twice a day has also been used.
  • For treating recurrent diarrhea caused by Clostridium difficile: 1.25 billion live Lactobacillus GG in two divided doses for 2 weeks.
  • For ulcerative colitis: a combination product containing living freeze-dried bacteria species including lactobacillus, bifidobacteria, and streptococcus (VSL#3) 3 grams twice daily has been used for maintenance therapy.
  • For patients with active mild-to-moderate ulcerative colitis: VSL#3 three grams once or twice daily in combination with conventional treatment.
  • For children with moderate-to-severe ulcerative colitis: VSL#3 450-1800 billion bacteria once a day in combination with mesalamine.
  • For preventing traveler's diarrhea: Lactobacillus GG, 2 billion organisms daily.
  • For diarrhea due to chemotherapy: a specific strain of Lactobacillus rhamnosus, Lactobacillus GG (Culturelle) containing 10-20 billion live organisms daily.
  • For atopic dermatitis: a specific strain of Lactobacillus rhamnosus, Lactobacillus GG (Culturelle). Lactobacillus reuteri 100 million live bacteria daily, or Lactobacillus sakei 5 billion live bacteria twice daily have also been used.
  • For irritable bowel syndrome (IBS): 10 billion heat-killed Lactobacillus acidophilus (Lacteol Fort) twice daily for 6 weeks. A specific lactobacillus combination probiotic containing viable lyophilized bacteria species including lactobacillus, bifidobacteria, and streptococcus (VSL#3) containing 450 billion viable lyophilized bacteria twice daily. A specific beverage containing Lactobacillus plantarum 299v (ProViva, Skanemejerier, Sweden) taken twice daily.
  • For preventing the common cold in adults: a mixture of Lactobacillus plantarum and Lactobacillus paracasei, 1 billion live bacteria daily.
  • For colic in babies: A specific Lactobacillus reuteri product (Probiotic Drops, BioGaia AB) 100 million CFUs once daily 30 minutes after a feeding.
  • For preventing the serious gut condition called necrotizing enterocolitis (NEC) in babies born prematurely: Lactobacillus rhamnosus GG 6 billion live bacteria daily.
  • For preventing serious lung infections in adults on ventilators: Lactobacillus rhamnosus GG (Amerifit Brands Nutrition), 2 billion live bacteria twice daily.
APPLIED INSIDE THE VAGINA:
  • For treating vaginal infections caused by bacteria:
    • 1-2 vaginal tablets (Gynoflor, Medinova, Switzerland) daily containing living Lactobacillus acidophilus (10 million colon-forming units/tablet) and 0.3 mg estriol for 6 days.
    • Intravaginal suppositories containing 100 million to 1 billion colony forming units of Lactobacillus acidophilus (Vivag, Pharma Vinci A/S, Denmark) given twice daily for 6 days has also been used.
    • Vaginal capsules containing Lactobacillus gasseri and Lactobacillus rhamnosus, 100 million to 1 billion colony-forming units of each strain per capsule (EcoVag Vaginal Capsules, Bifodan A/S, Denmark), following usual treatment, for 10 days in three menstrual cycles following the infection has also been used.

Other names

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Acidophilus, Acidophilus Bifidus, Acidophilus Lactobacillus, L. Acidophilus, L. Amylovorus, L. Brevis, L. Bulgaricus, L. Casei Immunitas, L. Casei, L. Crispatus, L. Delbrueckii, L. Fermentum, L. Gallinarum, L. Helveticus, L. Johnsonii, L. Johnsonii LC-1, L. Lactis, L. Plantarum, L. Reuteri, L. Rhamnosus, L. Salivarius, L. Sporogenes, Lacto Bacillus, Lactobacille, Lactobacilli, Lactobacilli Acidophilus, Lactobacilli Bulgaricus, Lactobacilli Plantarum, Lactobacilli Rhamnosus, Lactobacilli Salivarium, Lactobacillus acidophilus, Lactobacillus amylovorus, Lactobacillus brevis, Lactobacillus bulgaricus, Lactobacillus casei, Lactobacillus casei sp. rhamnosus, Lactobacillus crispatus, Lactobacillus delbrueckii, Lactobacillus delbrueckii ssp. bulgaricus, Lactobacillus fermentum, Lactobacillus gallinarum, Lactobacillus Gasseri, Lactobacillus GG, Lactobacillus Helveticus, Lactobacillus johnsonii, Lactobacillus Lactis, Lactobacillus Paracasei, Lactobacillus plantarum, Lactobacillus reuteri, Lactobacillus Rhamnosus GG, Lactobacillus rhamnosus, Lactobacillus sakei, Lactobacillus Salivarium, Lactobacillus salivarius, Lactobacillus sporogenes, Lactobacilo, Lactospores, LC-1, Probiotics, Probiotiques.

Methodology

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To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.methodology (http://www.nlm.nih.gov/medlineplus/druginfo/natural/methodology.html).

References

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To see all references for the Lactobacillus page, please go to http://www.nlm.nih.gov/medlineplus/druginfo/natural/790.html.

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