Evaluation of Probiotic-Loaded Pharmaceutical Formulations for Prevention and Treatment of Gastrointestinal Infections

Abstract

Gastrointestinal (GI) infections are a continuing worldwide public health problem and are responsible for creating a significant portion of the illnesses and deaths attributed to children, elderly, and immunocompromised individuals. The increasing rates of antibiotic resistance and changing intestinal flora after taking antibiotics have led to a renewed interest in using probiotics as an alternative or additional method of treating infections. Probiotics are defined as live microorganisms that confer health benefits when consumed in sufficient quantities by restoring the healthy balance of microorganisms in the intestine, enhancing the integrity of the intestinal barrier function, preventing the growth of harmful microorganisms in the intestines, and regulating immune responses. The effectiveness of probiotics as therapeutic agents is also dependent upon their ability to survive the manufacturing and storage process and also survive the harsh environment of the GI tract. Various pharmaceutical formulations have been created to improve the physical stability and viability of probiotics (e.g., capsules, tablets, sachets, microencapsulation and nanoencapsulation, hydrogels, and lipid-based delivery systems) and facilitate a targeted release of the probiotics in the intestine. This review provides an overview of the latest developments in the area of probiotic delivery systems as they are being used to help manage GI infections, including commonly used probiotic strains, formulation technologies, evaluation methods, and the clinical applications of probiotics in the prevention and treatment of GI infections caused by Helicobacter pylori, Clostridioides difficile, pathogenic Escherichia coli, Salmonella, and rotavirus. In addition, we will discuss current challenges to probiotic viability, formulation stability, regulatory considerations and quality control before discussing emerging technologies such as nanotechnology, synbiotics, precision probiotics, and microbiome-based therapies that will help improve the development of new probiotic delivery systems to improve GI health and minimize the burden of infectious diseases.