Antibiotics can disturb the balance of your "inner rain forest" by killing friendly bacteria. When this happens, harmful bacteria and yeasts can move in and flourish. This can lead to vaginal yeast infections. Conversely, it appears that the regular use of probiotics can help prevent vaginal infections and generally improve the health of the gastrointestinal system. Whenever you take antibiotics, you should probably take probiotics as well and continue them for some time after you are done with the course of treatment.
Evidence from many but not all
trials suggests that probiotics may be helpful for many types of
, as well as
irritable bowel syndrome
Additionally, probiotics have shown some promise for preventing or treating
29,30,51,52, 125, 126,139,203,205
Probiotics may be helpful for controlling symptoms and maintaining remission in
However, probiotics may be less useful for
remission; when probiotics were added to standard medications used for induction of remission, no additional benefits were seen in a study of people with mild-to-moderate ulcerative colitis.
Probiotics might help prevent
On a related note, one small, double-blind study found evidence that use of the probiotic bacteria
improved the effectiveness of the influenza vaccine.
(The probiotic supplement was taken in two doses. One was taken two weeks before the vaccine, and the other was taken two weeks after.)
Although probiotics are widely used to prevent or treat
vaginal yeast infections
), evidence regarding potential benefit remains incomplete and inconsistent.
A small trial of 55 women with vulvovaginal candidiasis did demonstrate that daily
supplementation for 4 weeks combined with single dose fluconazole (an anti-fungal medication) decreased symptoms compared to fluconazole alone.
Another large, well-designed trial, however, failed to find a
preparation helpful for preventing yeast infections caused by antibiotics.
One study did find that probiotics might reduce levels of
in the mouth.
can cause a different type of
; as with vaginal yeast infections, probiotics have shown some promise for this condition, but evidence remains inconclusive.
A trial of 64 women taking a single dose of tinidazole for bacterial vaginosis suggests that women who also took daily probiotics capsules had better cure rates at 4 weeks.
A larger trial involving 120 women with a history of bacterial vagninosis found that taking one capsule daily of the probiotics
, acidophilus, and
is the main cause of
in the stomach and duodenum. Antibiotics can kill
, but more than one must be used at the same time, and, even then, the bacteria is not necessarily eradicated. Probiotics may be helpful.
Evidence suggests that various probiotics can inhibit the growth of
While this effect does not appear to be strong enough for probiotic treatment to eradicate
on its own, preliminary evidence, including several small double-blind trials, suggest that various probiotics may help standard antibiotic therapy work better, reducing side effects and possibly increasing rate of eradication.
For example, over a 2-week period, 82 adults with dyspepsia and
infection were randomized to receive lansoprazole (30 mg), amoxicillin (1,000 mg), clarithromycin (500 mg), plus kefir (a cultured dairy product rich in probiotics) or the medications plus placebo. Those in the kefir group experienced a better rate of
eradication and an improvement in their symptoms (eg, diarrhea, nausea, abdominal pain) compared to the placebo group.
Some, but not, all preliminary double-blind trials suggest that probiotics might improve
In addition, milk fermented by probiotics may slightly improve blood pressure levels.
Various probiotics might be helpful for
While there is some evidence that probiotics can help reduce symptoms of milk allergies,
one study found that adding probiotics to infant cow’s milk formula was not helpful.
One interesting study found that the use of probiotics during pregnancy and breastfeeding may decrease the likelihood that a highly allergic mother will pass her allergic tendencies to her breastfed infant.
One double-blind, placebo-controlled study of 70 people with
found some evidence of benefit with
Lactobacillus casei Shirota
Another study found that
was helpful for chronic constipation in children.
A small trial also found benefits in children, this time with a mixture of
In another study, a combination of
showed promise for improving bowel regularity in nursing home residents.
Finally, in a 6-week double-blind, placebo-controlled trial of 274 people with constipation-predominant irritable bowel syndrome, use of a probiotic formula containing
significantly improved stool frequency.
A preliminary double-blind, placebo-controlled study found evidence that
might potentially be helpful for treating antibiotic-resistant bacteria.
This small study followed 23 people with severe kidney disease who tested positive for vancomycin-resistant bacteria in the stool. (Vancomycin is one of the main “last-ditch” antibiotics for treatment of resistant bacteria.) Use of a yogurt product containing
appeared to be more effective at ridding the gastrointestinal tract of these bacteria than placebo. However, the study suffered from a number of flaws, especially its small size. Note also that participants in this study did not have active infection with antibiotic-resistant bacteria; they were carriers for it. Do
attempt to use probiotics as sole treatment for active infection with resistant bacteria.
On a related note, preventive use of probiotics does not appear to help prevent the development of resistant bacterial strains that may arise during antibiotic treatment.
Probiotic treatment has also been proposed as a treatment for
and as a preventative measure against colon
, but there is no solid evidence that it is effective.
Probiotics have shown some promise for helping to prevent
by antagonizing cavity-causing bacteria.
One study found that giving probiotics to certain critically ill people could help prevent multiple organ failure.
One small, placebo-controlled study found that use of
might improve sleep quality in seniors, for reasons that are not at all clear.
An open study found hints that probiotics might be helpful for mouth sores caused by Behcet’s syndrome.
As noted above, probiotics have shown some promise in the treatment of infections with the yeast
. Probiotics are also proposed for the treatment of a theoretically related, but markedly controversial condition, known as
yeast hypersensitivity syndrome
(also known as chronic candidiasis, chronic candida, systemic candidiasis, or just
). As described by some alternative medicine practitioners, yeast hypersensitivity syndrome is a common problem that consists of a population explosion of the normally benign
yeast that live in the vagina and elsewhere in the body, coupled with a type of allergic sensitivity to it. Probiotic supplements are widely recommended for this proposed condition because they establish large, healthy populations of friendly bacteria that compete with the
that is trying to take up residence. However, there is no evidence that yeast hypersensitivity is a common problem, and virtually none that it exists at all.
In one small, 12-week study,
failed to prove more effective than placebo for the treatment of
A study failed to find
(stomach discomfort of unknown origin) in children.
Evidence for the effectiveness of probiotics in preventing
urinary tract infections
has been mixed. A year-long open trial of 150 women, for example, failed to find
probiotics effective for preventing
urinary tract infections
as compared to
juice or no treatment.
And a randomized trial involving 252 postmenopausal women found that
did not reduce the number of urinary tract infections compared to antibiotics.
Other studies, however, including a large (453-participant), 3-month, double-blind, placebo-controlled study of a special healthy
probiotic, did find benefits.
A substantial study failed to find a mixture of
in yogurt and milk helpful for
But, another study found that the combination of a probiotic (
) and a prebiotic (galacto/fructo-oligosaccharide) may help reduce wheezing in infants with eczema.
Probiotics have also been studied as possible treatment for
. In one such study, 84 adults (aged 18-65) with liver disease (
) were randomized to receive yogurt (1 cup, 3 times daily) with or without the probiotics
After 2 weeks, the people in the probiotics group experienced an improvement in their symptoms (eg, improved food intake and appetite).
Chronic liver disease with cirrhosis can lead to a potentially life-threatening brain abnormality, called hepatic encephalopathy. A 2011 review of 7 randomized trials involving 550 people found inconclusive evidence to support the use of probiotics as a treatment for this condition.
What Is the Scientific Evidence for Acidophilus and Other Probiotics?
According to several studies, it appears that regular use of acidophilus and other probiotics can help prevent "traveler's diarrhea" (an illness caused by eating contaminated food, usually in developing countries).
One double-blind, placebo-controlled study followed 820 people traveling to southern Turkey, and found that use of
significantly protected against intestinal infection.
Other studies using
have found similar benefits,
including a double-blind, placebo-controlled trial enrolling 3,000 Austrian travelers.
The greatest benefits were seen in travelers who visited North Africa and Turkey. The researchers noted that the benefit depended on consistent use of the product, and that a dosage of 1,000 mg daily was more effective than 250 mg daily.
Probiotics may also help prevent or treat acute infectious diarrhea in children and adults.
A 2001 review found 13 double-blind, placebo-controlled trials on the use of probiotics for acute infectious diarrhea in infants and children; 10 of these trials involved treatment and 3 involved prevention.
Overall, the evidence suggests that probiotics can significantly reduce the duration of diarrhea and perhaps help prevent it. The evidence is strongest for the probiotic
and for infection with a particular virus called rotavirus, which causes severe diarrhea in children.
Another more recent review of 63 trials involving over 8,000 people (mainly infants and children) found that probiotics reduced how long the episode of diarrhea lasted.
However, the authors concluded that more research needs to be done to determine which probiotics work best for infectious diarrhea.
And, in a subsequent smaller review focusing on persistent diarrhea (lasting for 2 weeks or longer), researchers concluded that probiotics are capable of reducing both the duration of the diarrhea episode as well as the stool frequency.
Another study that was part of this same review suggested that probiotics may help to reduce how long a child is hospitalized due to diarrhea.
One double-blind, placebo-controlled trial of 269 children (ages 1 month to 3 years) with acute diarrhea found that those treated with
recovered more quickly than those given placebo.
The best results were seen among children with rotavirus infection. Similar results with
were seen in a double-blind study of 71 children.
However, 224 young Chinese children with severe, acute diarrhea found no benefit from lactose-free formula supplemented with
, suggesting that probiotics may not be as useful for cases of severe, dehydrating diarrhea.
GG is not always associated with improvement. When given for 10 days to 229 infants from rural India hospitalized with acute diarrhea it did not reduce the severity of the diarrhea during that time period.
In addition, a double-blind study evaluated the possible benefits of the probiotic
in 66 children with rotavirus diarrhea.
The study found that treatment shortened the duration of symptoms, and the higher the dose, the better the effect.
Similar benefits were seen in a placebo-controlled trial of 151 infants and children given the probiotic
Nissle 1917 (a safe strain of
) for 21 days for nonspecific (presumably viral) cases of mild to moderate diarrhea.
In another randomized trial of 74 children receiving oral rehydration solution for mild to moderate dehydration,
reduced the frequency, duration, and relapse rate of acute diarrhea compared to placebo.
A double-blind, placebo-controlled study of 81 hospitalized children found that treatment with
reduced the risk of developing diarrhea, particularly rotavirus infection.
A double-blind, placebo-controlled study found that
helped prevent diarrhea in 204 undernourished children.
Other studies, though not entirely consistent, generally indicate that the probiotics
S. thermophilus, L. casei
—both individually and combined with
—may also help prevent or treat diarrhea in infants and children.
One study found that bacteria in the
family can kill numerous bacteria that cause diarrhea.
Researchers also studied whether adding
could have preventive benefits.
Two hundred and fifteen healthy infants were randomized to receive formula with prebiotics plus
or the formula and prebiotics only. The infants in the
group had fewer cases of gastrointestinal and upper respiratory infection.
Prophylactic use of probiotics was found to be effective at preventing
-induced diarrhea in a review of 20 randomized trials with 3,421 patients (including three trials with 605 children) when compared to placebo or no treatment. The most effective probiotics were
Keep in mind that diarrhea in young children can be serious. If it persists for more than a day, consult a physician.
A large (211-participant), double-blind, placebo-controlled study found that adults with diarrhea can benefit from probiotic treatment as well.
Another study found that regular use of probiotics could help prevent gastrointestinal infections in adults.
The results of many, but not all, double-blind and open trials suggest that probiotics, especially
may help prevent or treat antibiotic-related diarrhea.
10,11,16 18,25 28,75,76,94-95, 97-98,143,183,215
For example, one study evaluated 180 people, who received either placebo or 1,000 mg of saccharomyces daily along with their antibiotic treatment, and found that the treated group developed diarrhea significantly less often.
A similar study of 193 people also found benefit.
Three additional studies involving adults found that various species of
, taken either alone in combination, to be beneficial,
even in cases of
the most serious cause of antibiotic-induced diarrhea.
A review of 16 randomized trials further adds to this evidence.
This review included many different strains of probiotics (eg,
), which were used alone or in combination. Bacteria that appeared to lack evidence of benefit included
. Like the earlier review, the pooled results of 34 randomized trials also found evidence to support the use of probiotics for the prevention of antibiotic-associated diarrhea in both children and adults.
On the other hand, a study of 302 people found no benefit with
And, a review of four probiotic studies found insufficient evidence for their effectiveness in the treatment of
, the most serious cause of antibiotic-induced diarrhea.
Prophylactic use of
BB-12 (in combination with antibiotic treatment) was not associated with reduced incidence of diarrhea when compared to placebo. However, the probiotic reduced the duration time with diarrhea.
Although taking probiotic organisms in the proper concentration may be beneficial for antibiotic-induced diarrhea, at least one study found that consuming fresh yogurt during antibiotic treatments had no significant effect on the incidence of diarrhea.
Diarrhea that occurs in the context of antibiotics may be dangerous; for this reason, physician consultation is essential.
Other Forms of Diarrhea
Two double-blind, placebo-controlled studies enrolling a total of almost 700 people undergoing
therapy for cancer found that use of probiotics significantly improved radiation-induced diarrhea.
Similar evidence supports the use of
as well as a special, nonpathogenic form of
However, of 85 women receiving pelvic radiation for cervical or uterine cancer, those who consumed a liquid yogurt preparation enriched with
had no less diarrhea than those who took a placebo drink.
Small double-blind studies suggest
might be helpful for treating chronic diarrhea in people with HIV, hospitalized patients being tube-fed, and people with Crohn's disease.
Premature infants weighing less than 2,500 grams (5.5 pounds) are at risk for a life-threatening intestinal condition called necrotizing enterocolitis (NEC). In a study that pooled the results of 9 randomized, placebo-controlled trials involving 1,425 infants, probiotic supplementation significantly reduced the occurrence of NEC and death associated with it.
A subsequent study found similar benefits in very low birth weight infants weighing less than 1,500 grams (3.3 pounds).
For one probiotic strain,
, there may be other benefits, as well. In another study involving 249 premature infants, those treated with
experienced fewer gastrointestinal symptoms, received fewer antibiotics, and were hospitalized less frequently than those treated with
or no probiotic.
Benefits of probiotics for NEC was further supported in three reviews that evaluated 24 randomized trials involving infants at risk of developing NEC. Prophylactic enteral probiotic supplementation was compared to placebo or no treatment in infants who were preterm (less than 37 weeks gestation), had low birth weight (2,500 grams or 5.5 pounds), or both. Probiotics were associated with reduced incidence of severe NEC in 20 trials with 5,529 infants, fewer infant deaths for any cause in 17 trials with 5,112 infants, and fewer infant deaths related to NEC in 7 trials with 2,755 infants.
Inflammatory Bowel Disease (Ulcerative Colitis and Crohn’s Disease)
fall into the family of conditions known as inflammatory bowel disease. Chronic diarrhea is a common feature of these conditions.
A double-blind trial of 116 people with ulcerative colitis compared probiotic treatment against a relatively low dose of the standard drug mesalazine.
The results suggest that probiotic treatment might be equally effective as low-dose mesalazine for controlling symptoms and maintaining remission. Evidence of benefit was seen in other trials, as well.
For example, a 2011 review of 4 randomized trials with a total of 587 patients seemed to support the use of probiotics to reduce the relapse rates in people with ulcerative colitis.
The authors, though, pointed out the need for better designed trials.
One preliminary study found
helpful for mild diarrhea in stable Crohn’s disease.
However, two studies failed to find benefit with
and in an analysis of 8 randomized, placebo-controlled studies, probiotics were ineffective at maintaining remission in Crohn’s disease patients.
Probiotics might be useful for people with ulcerative colitis who have had part or all of the colon removed. Such people frequently develop a complication called pouchitis, inflammation of part of the remaining intestine. A 9-month, double-blind trial of 40 people found that a combination of three probiotic bacteria could significantly reduce the risk of a pouchitis flare-up in people with chronic pouchitis.
Participants were given either placebo or a mixture of various probiotics, including four strains of
three strains of
and one strain of
The results showed that treated people were far less likely to have relapses of pouchitis. Another study found that probiotics used right after surgery can help prevent pouchitis from developing at all.
One study, however, failed to find benefit with
in people with Crohn’s disease who have undergone a similar operation.
Finally, some evidence hints that probiotics might reduce the joint pain that commonly occurs in people with either kind of inflammatory bowel disease.
Irritable Bowel Syndrome
irritable bowel syndrome
(IBS) experience crampy digestive pain as well as alternating diarrhea and constipation and other symptoms. Although the cause of irritable bowel syndrome is not known, one possibility is a disturbance in healthy intestinal bacteria. Based on this theory, probiotics have been tried as a treatment for IBS, with some success.
For example, in a 6-week double-blind, placebo-controlled trial of 274 people with constipation-predominant irritable bowel syndrome, use of a probiotic formula containing
significantly reduced discomfort and increased stool frequency.
In another trial of 298 IBS patients, 8 weeks of treatment with beneficial
reduced typical symptoms compared to placebo.
In a review of 3 randomized trials,
Lactobacillus rhamnosus GG
was associated with improvement in symptom, especially a reduction in abdominal pain, among 393 children with IBS.
And finally, a 4-week randomized trial involving 122 people with IBS found evidence that
improved symptoms and quality of life compared to placebo.
Benefits have also been seen in small, double-blind trials using
in addition to
proprietary probiotic combinations including various strains.
One such combination, called VSL#3, contains
. In a double-blind,
, 59 children aged 5-18 years old were randomized to receive VSL#3 or placebo for 6 weeks.
After a 2-week "wash-out" period, the children were switched to the other treatment. VSL#3 was associated with a reduction in symptoms, including abdominal pain, bloating, and gas.
Benefits have also been seen with combination
118, 182, 199
and prebiotics alone.
Of course, other studies have failed to find probiotics more effective than placebo.
One randomized trial involving 90 people with diarrhea-predominant IBS found
to be more effective than placebo at improving quality of life.
But, the probiotic did not seem to improve the actual symptoms of IBS.
Two studies that pooled previous randomized trials on the use of probiotics for IBS came to similar conclusions: probiotics appear to offer some benefit, most notably for global symptoms and abdominal discomfort. However, these two studies were unable to determine which probiotic species were most effective.
Lactobacillus plantarum 299v failed to provide significant improvements in abdominal pain, bloating, or quality of life when compared to placebo in a randomized trial with 81 adults over an 8 week period. 239
Probiotics Lactobacillus, Bifidobacterium, Escherichia, and Streptococcus (alone or in combination) were evaluated in a review of 37 randomized trials. Priobiotics were associated with fewer global symptoms, abdominal pain, bloating, and flatulence when compared to placebo. There were no differences found in urgency-related symptoms. Although probiotic therapy appears effective, the right combination of strains remains unknown.238
Use of probiotics during pregnancy and after childbirth may reduce risk of childhood
. In a very large, long-term, double-blind study, 1,223 pregnant women were given either placebo or a probiotic mixture (containing
) beginning 2-4 weeks before delivery.
Their newborn children then received either probiotics or placebo for six months. The results showed that the probiotics mixture markedly reduced the incidence of eczema (though not of other allergic diseases).
However, in a follow-up to this study, researchers found that the probiotic supplementation was not associated with reduced eczema in children followed through age 5. The probiotics also had no effect on allergic rhinitis or asthma.
Another study also yielded marginal results,
and a third study involving only lactobacillus found no benefit at all for the prevention of eczema. This latter study actually demonstrated a modestly increased the risk of wheezing bronchitis in infants who took the probiotic.
But, some probiotics combined with prebiotics may help to reduce wheezing in infants with eczema. For example,
and a galacto-/fructo-oligosaccharide mixture (Immunofortis) showed benefit in one randomized study involving 90 infants.
supplementation did not reduce incidence of eczema atopic dermatitis or allergic sensitization at 12 months among Asian infants at risk of allergic diseases.
Researchers in another study concluded that not all probiotics are created equal. In this placebo-controlled study involving pregnant women and their infants,
reduced the incidence of eczema in the children, but a strain of
was effective in reducing the severity of eczema symptoms. The randomized trial included 118 children aged 1-13 years with eczema comparing
to placebo for 12 weeks.
According to some but not all studies, infants who already have eczema may benefit from probiotics.
However, a careful review of 12 studies involving a total of 781 children found no convincing evidence that probiotics can effectively treat eczema in this age group.
If probiotics are beneficial for childhood eczema, they are probably more effective at preventing the condition rather than treating it. A carefully conducted review of numerous studies cautiously concluded that probiotics may help reduce the risk of eczema in infants and children, particularly those at high risk.
And two subsequent reviews found that probiotics were more effective at preventing childhood eczema, particularly when given both to mother (before birth) and infant.
A number of studies suggest that various probiotics can enhance
. One 12-week, double-blind, placebo-controlled trial evaluated 25 healthy elderly people, half of whom were given milk containing a particular strain of
the others milk alone.
The results showed various changes in immune parameters which the researchers took as possibly indicating improved immune function. Another double-blind, placebo-controlled study of 50 people using
had similar results.
A 7-month, double-blind, placebo-controlled study of 571 children in daycare centers in Finland found that use of milk fortified with
reduced the number and severity of respiratory infections.
In another controlled trial, probiotics (
Lactobacillus rhamnosus GG
Bb-12) given daily to infants in their formula significantly reduced the risk of acute
and recurrent respiratory infections during the first year of life compared to placebo.
Benefits were seen in three other large studies, in which probiotics combined with multivitamins and minerals helped prevent colds (or reduce their duration and severity) in adults.
However, a smaller and shorter study failed to find any effect on respiratory infections.
given to 20 healthy elite distance runners over a 4-month period during winter training was significantly more effective at reducing the number and severity of respiratory symptoms compared with a placebo.
One study found that
may improve the immune response to vaccinations.
A review of 13 randomized trials with 3,780 children, adults, and older adults compared different probiotics to either placebo or no treatment for prevention of colds. Probiotic use was associated with lower risk of number of colds and shorter duration of cold. Several types of probiotics were used in the trials, including:240
- Actimel with L. paracasei (L. casei), Streptococcus thermophilus, and Lactobacillus bulgaricus
L. plantarum HEAL 9 plus L. paracasei 8700:2
Lactobacillus rhamnosus strain GG
L. rhamnosus plus Bifidobacterium lactis Bb-12
Lactobacillus acidophilus plus Bifidobacterium bifidum
L. acidophilus plus L. casei
An 8-week, double-blind, placebo-controlled trial of 70 overweight people found that a probiotic treatment containing
could reduce LDL ("bad") cholesterol by about 8%.
Similarly positive results were seen in other short-term trials of various probiotics.
However, a 6-month, double-blind, placebo-controlled trial found no long-term benefit.
Researchers speculate that participants stopped using the product regularly toward the later parts of the study.
The addition of the probiotic
to regular was no better than than placebo in 77 patients with chronic rhinosinusitis.
Critical illnesses can result in changes to gut bacteria, leading to a loss of healthy bacteria and overgrowth of harmful bacteria. This change in bacteria may affect the immune system, affecting overall health. Certain strains of probiotics may restore balance to the to the intestinal tract, which can help with overall immunity. Probiotics were analyzed in 2 reviews of 31 randomized trial with 3,236 critically ill patients. When compared to placebo or no treatment, probiotics were associated with fewer cases of ventilator-associated pneumonia (VAP), less risk of VAP, and other serious complications resulting from infection. Some data suggested probiotics may also be connected to fewer intensive care deaths. Although the results of these reviews are promising, more research needs to be done to make firm conclusions.237
Supplementation for Infant Growth and Development
A review of 25 randomized trials with 2,971 infants did not find sufficient evidence to support supplementation of infant formula with synbiotics, probiotics, or prebiotics. There were no significant effects on growth, crying, colic, regurgitation, or restlessness compared to conventional infant formula. Synbiotics and prebiotics were associated with increased stool frequency.
Probiotics may play a role in balancing bacteria in the gut, but not all probiotics may be helpful.
A randomized trial of 82 breastfed infants with colic compared supplementation with oral
Lactobacillus reuteri (L. reuteri)
to placebo for 21 days. A reduction in more that 50% in mean crying time was seen in all infants who received
compared to 63% of infants in placebo group.
supplement and was also associated with a larger decrease in the amount of daily crying and better family quality of life scores.
In another randomized trial of 50 exclusively breastfed infants with colic, supplementation with
for 21 days was associated with a 50% reduction in daily crying time when compared with placebo.
A second randomized trial with 90 infants found a similar decrease in crying time with
, but there were no significant differences in crying time found in a small trial of 18 infants when
were compared to placebo.
was also found to have significantly better reduction in crying time compared to simethicone in randomized trial of 82 infants with colic. After 28 days, median crying time was reduced from 197 minutes a day to 51 minutes a day with
supplemention compared to 145 minutes a day with simethicone. Crying time decreased by 50% or more in 95% of infants taking
compared to 7% of infants taking simethicone.
However, L. reuteri in formula-fed infants 6 weeks old or less had the opposite effect. The probiotic was associated with an increase in fussing time (not crying, but awake and not content) compared to placebo. Probiotics were used for one month and the infants were followed for six months. L. reuteri showed no benefit for infants that were exclusively breastfed.241