Probiotics in dietary guidelines and clinical recommendations outside the European Union

Table 2 Recommendations on probiotics from scientific associations

Scientific society	Area of application	Recommendations
National Institute for Health and Care	Diarrhoea and vomiting in children under 5: NICE guideline[44]	Probiotic specificity for each target should be considered available studies report benefits in reduced duration of diarrhea or stool frequency BUT: published studies have methodological limitations - in specific evaluated probiotics and treatment regimes Many of the studies were conducted in developing countries - response to probiotic therapy may differ Good quality randomized controlled trials should be conducted in the United Kingdom
Excellence (NICE) European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and European Society for Paediatric Infectious Diseases (ESPID)	Evidence-based Guidelines for the Management of Acute Gastroenteritis in Children in Europe[39]	Selected probiotics may reduce the duration and intensity of symptoms Oral rehydration solution with Lactobacillus GG may be beneficial in children with acute gastroenteritis; however, because of insufficient evidence, routine use is not recommended Lactobacillus GG and Saccharomyces boulardii showed benefits in the management of diarrhea but evidence of a lack of risk of antibiotic resistance transfer is required
European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)	Supplementation of infant formula with probiotics and/or prebiotics[45]	Probiotic-supplemented formula: no safety concerns with regard to growth and adverse effects for healthy infants Administration of probiotic-supplemented infant formula during early life does not result in any consistent clinical effects Administration of a few probiotics supplemented to infant or follow-on formulae and given beyond early infancy may have clinical benefits; however there is too much uncertainty to draw reliable conclusions No extrapolation of safety and clinical effects of one probiotic microbe to another ones Generally there is a lack of data on the long-term effects of the administration of formula supplemented with probiotics; would be of particular importance Routine use of probiotic-supplemented formula in infants is not recommended by the Committee