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Efficacy of multispecies versus monostrain probiotics:

what is the (recent) scientific evidence?

Nowadays, there are many different types of probiotics available, varying in amount of cfu’s and number of different strains and species present. From past literature it is well known that multispecies probiotics are more effective for most conditions than monostrain probiotics. What does current research suggest?

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Monostrain - Multispecies

Probiotic products can be divided in 2 categories: products containing only a single bacterial strain are called monostrain probiotics, whereas multispecies products contain multiple strains. For multispecies products it is important that the product is well designed and that the different strains are compatible. When this is the case,  these products can benefit from more mechanisms of action and synergies. 




Multispecies versus monostrain probiotics_1380

The question remains whether multispecies probiotics are more effective than singly species. Older literature suggest, this is the case [1]. There are only limited in vivo studies directly comparing head to head a multispecies product and the respective single strains separately. Probably, the outcome of such a study is dependent on the indication and the specific strains investigated, and no conclusions can be drawn for all indications and bacterial strains. However, although more research is needed for a conclusive scientific prove, there are good indications that multispecies products are more effective than monostrain products. 



Evidence from meta-analyses

Meta-analyses comparing results of different probiotic studies for a single indication give the suggestion that multispecies probiotics are more effective than single strain products. These meta-analyses usually compare studies which have used different doses, different durations and different probiotic products, but due to the high number of studies included still comparisons can be made. For multiple indications, like gastrointestinal diseases [2], Clostridium difficile associated diarrhea [3], prevention [4] and treatment [5] of atopic dermatitis and type 2 diabetes [6] it has been concluded that multispecies probiotics were better compared to single strain probiotics. 



Meta-analyses show higher effectivity of multispecies formulations for GI-diseases, C. difficile  associated diarrhea, prevention and treatment of atopic dermatitis and type 2 diabetes.



Evidence from in vivo studies

Another body of evidence comes from in vitro studies. A review from 2011 mentioned 16 studies with a direct comparison between monostrain and multispecies products, and of these, 12 out of 16 studies showed the multispecies product to be more effective than the single strains [7]. For pathogen invasion inhibition, mixtures of 2 or 3 strains were more effective compared to the single strains [8]. Another example is the growth of a Lactobacillus salivarius on sc-inulin.  Whereas this strain grew poorly on this substrate, the addition of a Lactobacillus paracasei strain improved the growth remarkably. It turned out that this latter strain can produce an extracellular enzyme, from which both lactobacilli strains can benefit (Böger et al., manuscript in preparation).


Altogether, although not proven by a direct comparison, both meta-analyses of in vivo probiotic studies as well as results from in vitro studies suggest that multispecies products can be more effective than monostrain products.






1.            Timmerman HM, Koning CJ, Mulder L, Rombouts FM, Beynen AC. Monostrain, multistrain and multispecies probiotics--A comparison of functionality and efficacy. Int J Food Microbiol 2004;96:219-33.

2.            Ritchie ML, Romanuk TN. A meta-analysis of probiotic efficacy for gastrointestinal diseases. PLoS One 2012;7:e34938.

3.            Johnston BC, Ma SS, Goldenberg JZ, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta-analysis. Ann Intern Med 2012;157:878-88.

4.            Panduru M, Panduru NM, Salavastru CM, Tiplica GS. Probiotics and primary prevention of atopic dermatitis: a meta-analysis of randomized controlled studies. J Eur Acad Dermatol Venereol 2014.

5.            Huang R, Ning H, Shen M, Li J, Zhang J, Chen X. Probiotics for the Treatment of Atopic Dermatitis in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in cellular and infection microbiology 2017;7:392.

6.            Hu YM, Zhou F, Yuan Y, Xu YC. Effects of probiotics supplement in patients with type 2 diabetes mellitus: A meta-analysis of randomized trials. Medicina clinica 2017;148:362-70.

7.            Chapman CM, Gibson GR, Rowland I. Health benefits of probiotics: are mixtures more effective than single strains? European journal of nutrition 2011;50:1-17.

8.            Campana R, van Hemert S, Baffone W. Strain-specific probiotic properties of lactic acid bacteria and their interference with human intestinal pathogens invasion. Gut Pathog 2017;9:12.






Multispecies versus monostrain probiotics

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