Background: Probiotics can be found in many food products and supplements. None, however, is FDA-approved for any clinical indication and professional guidelines for probiotic use are few. Using information from a large, national database of physician practices, we sought to characterise trends in physician probiotic recommendations from 2009 to 2015.
Methods: The IMS Health National Disease and Therapeutic Index (NDTI) is a survey of outpatient visits to 4800 nationally representative U.S. physicians; it includes information on patient diagnoses and the new or continuing therapies provided for them. We examined information on patients for whom probiotics were recommended between 1/2009 and 4/2015.
Results: Probiotic prescriptions increased 2.7-fold from 2009 to 2015, with this rise attributable almost entirely to a linear increase in prescriptions of Lactobacillus of all types. Children comprised 34% of the probiotic prescriptions with boys and girls equally likely to receive probiotic recommendations from their physicians. Women, however, were 2.5 times more likely than men to receive probiotics with substantial variation by age (from RR=1.2 [age 65-74 yrs] to RR= 8.9 [age 85+ yrs]). Of the 5.37 million probiotic recommendations reported, 37% were for diarrhea or Clostridium difficile infection and 59% were for less substantiated indications (non-infectious GI: 31%; upper respiratory infection: 7%, urinary tract infection: 1%; other: 21%). Stark differences in indications for probiotics were observed by sex and age (see Figure).
Conclusion: Over the last 5 years, physicians are increasingly recommending probiotics--particularly Lactobacillus formulations-- for their patients. Indications for these recommendations, however, are often not evidence-based.
Figure: Percent of probiotic use by age and sex for top five indications.
J. Parsonnet, None