Lactobacillus (Culturelle) is a gram-positive bacteria that produce lactic acid and makes the gastrointestinal environment acidic. It has many species and is a gut-friendly bacteria that inhibit the growth of other pathogenic bacteria in the gut.

Lactobacillus Uses:

• Dietary supplement:

  • It is a probiotic that is used to promote the growth of normal intestinal bacterial flora.
  • It is also used as a supplement for breastfed infants who have frequent episodes of colicky abdominal pain, fuzziness, and excessive crying.

• Medical food:

  • Visbiome: It is used as dietary management of ulcerative colitis, pouchitis, and irritable bowel syndrome.
  • VSL#3: It is used as dietary management of an ileal pouch or ulcerative colitis.

Lactobacillus dose in Adults:

Lactobacillus dose as a dietary supplement or a medical food: Oral:

The dosing varies by manufacturer; consult product labeling.

• Acidophilus products:

  • Two capsules 2 to 4 times a day or 1 to 2 wafers 2 to 4 times a day.

• Culturelle Digestive Health capsule and chewable tablet:

  • One capsule or one chewable tablet once a day.
  • The dose of chewable tablets may be increased to twice a day to minimize gastrointestinal distress or during travel.

• Floranex:

  • 4 tablets 3 to 4 times a day.

• Flora-Q:

  • 1 capsule once a day.

• Lactinex:

  • 1 packet or 4 tablets 3 to 4 times a day.

• Visbiome:

  • Irritable bowel syndrome:
    • 2 to 4 capsules or ½ to 1 packet per day
  • Pouchitis:
    • 2 to 4 packets/day
  • Ulcerative colitis (active):
    • 4 to 8 packets/day
  • Ulcerative colitis (maintenance):
    • 4 to 8 capsules or 1 to 2 packets per day
  • VSL #3:
    • 1 to 8 packets or 2 to 8 capsules/day
  • VSL #3-DS:
    • 1 to 4 packets/day

Lactobacillus dose in Childrens:

Lactobacillus dose as a dietary supplement:

Note:

• Pediatric dosing formulation and product labeling may vary. Consult product labeling.

• Culturelle (Lactobacillus rhamnosus GG): Oral:

  • Kids Packets: Lactobacillus rhamnosus GG 5 billion CFU/packet:

    • Children <3 years: 1 packet once or twice a day.

  • Kids Chewables: Lactobacillus rhamnosus GG 5 billion CFU/tablet:

    • Children ≥3 years and Adolescents: 1 tablet once or twice a day.

  • Digestive Health Capsule: Lactobacillus rhamnosus GG 10 billion CFU/capsule:

    • Children and Adolescents: 1 capsule once a day.

  • Digestive Health Chewable: Lactobacillus rhamnosus GG 10 billion CFU/tablet:

    • Children ≥3 years and Adolescents: 1 tablet once or two times a day.

  • Gerber Soothe Probiotic Colic Drops: Lactobacillus reuteri 20 million CFU/drop:

    • Infants: 5 drops once a day.

Pregnancy Risk Category: N

• The drug does not enter the maternal systemic circulation and can therefore be safely used during pregnancy or lactation.
• However, the drug has not been tested in pregnant women. 
• Pregnancies have been able to test probiotics in vaginal suppositories. 
• One study concluded that probiotics in pregnancy could prevent miscarriage for individuals at high risk.

Use during breastfeeding:

• Human breastmilk usually contains lactobacillus.
• While breastfeeding, lactating mothers can safely use it.

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

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Side effects of Lactobacillus (Culturelle):

• Gastrointestinal:

  • Bloating (intestinal)
  • Flatulence

Contraindications to Lactobacillus (Culturelle):

OTC labeling: People who are sensitive to milk proteins should not use it.

Warnings and precautions

• Patients with immunocompromised conditions:

  • Patients with immunocompromised should be cautious when taking dietary supplements that contain yeast or live bacteria.
  • After the administration of 3 pieces of live bacteria to dietary supplements, one case of neonatal gastro intestinal mucormycosis was reported in a premature baby.

Monitoring parameters:

None mentioned.

How to administer Lactobacillus (Culturelle)?

It is administered orally.

• Acidophilus products:
  • Administer with water or milk during a meal.
• Culturelle:
  • It should not be added to warm water or hot foods or beverages.
  • The capsules may be opened and mixed in a cool beverage or sprinkled onto baby food or applesauce.
  • The entire contents of the packet should be mixed into cool food or drink until dissolved.
• Floranex:
  • It may be administered with milk, fruit juice, or water.
• Flora-Q:
  • It may be administered with or without food.
• Lactinex:
  • The tablets may be chewed or swallowed.
  • It may be administered with milk, fruit juice, or water. The granules may be added to cereal, food, or milk.
• Visbiome:
  • The unflavored powder packet or contents of the capsule may be sprinkled on cold food or into cold noncarbonated beverages.
  • The flavored packet may be mixed with a cold noncarbonated beverage.
• VSL #3, VSL #3-DS:
  • The powder may be mixed in any noncarbonated beverage or mixed with any food such as yogurt, ice cream, or apple sauce.

Mechanism of action of Lactobacillus:

• It is a probiotic which helps establish normal intestinal flora.
• In addition, it suppresses the growth of pathogenic bacteria by producing lactic acids. 
• Lactic acid promotes aciduric gut flora.

Absorption when administered orally:

• None

Distribution:

• Local, primarily in the colon

Excretion:

• Feces

International Brand Names of Lactobacillus:

• Advanced Probiotic
• Culturelle
• Dialyvite Probiotic
• Dofus
• Flora-Q
• Floranex
• Kala
• Lactinex
• Lacto-Bifidus
• Lacto-Key
• LactoPectin
• Lacto-TriBlend
• Megadophilus
• MoreDophilus
• Pedia-Lax Probiotic Yums
• Prodigen
• ReZyst IM
• Risa-Bid
• RisaQuad
• RisaQuad-2
• Superdophilus
• Visbiome
• VSL #3
• VSL #3-DS
• Bacid
• Bio-K+
• Fermalac
• Lacteol Fort

Lactobacillus Brand Names in Pakistan: