# Probiotics for chemotherapy and radiotherapy diarrhoea

Source: https://onco.cc/technologies/probiotics-treatment-diarrhoea/  
OnCo record `probiotics-treatment-diarrhoea` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Probiotic supplements (Lactobacillus, Bifidobacterium) may reduce diarrhoea during pelvic radiotherapy for cervical, rectal and prostate cancer and some chemotherapy, but a 2018 Cochrane review rated the evidence low certainty and strains differ between trials. Patients in profound neutropenia or with a central line should not take them without advice, because bloodstream infections have occurred.

## Summary

A 2018 Cochrane review of randomised trials found that probiotics may reduce the incidence and severity of diarrhoea caused by chemotherapy or radiotherapy, with low-certainty evidence and marked variation in strains (Lactobacillus, Bifidobacterium, VSL#3), doses and endpoints. Trials in pelvic radiotherapy for cervical, rectal and prostate cancer are the most consistent. Cases of bacteraemia and fungaemia in immunocompromised patients mean probiotics are avoided during profound neutropenia and in patients with central venous catheters unless specifically advised. Separately, antibiotics and probiotics around checkpoint immunotherapy may reduce response by disturbing the microbiome, a distinct question covered in the immunotherapy record.

## Fields

- Kind: Technology
- Status: phase-2
- Last checked: 2026-09-10
- Tags: complementary; supportive-care; evidence:moderate
- Principle: Colonising bacteria compete with pathogens, reinforce the mucosal barrier and modulate local inflammation in irradiated or chemotherapy-damaged gut.
- Strengths: Cochrane signal of benefit for treatment-related diarrhoea; Cheap and generally safe in immunocompetent patients
- Limitations: Low-certainty evidence; strains not standardised; Infection risk in neutropenia and with central lines; Possible interference with checkpoint immunotherapy

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Probiotic
- Cochrane: probiotics for the prevention or treatment of chemotherapy- or radiotherapy-related diarrhoea (2018): https://doi.org/10.1002/14651858.CD008831.pub3

## Connected records

- cancers: [Cervical cancer](https://onco.cc/cancers/cervical/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Chemotherapy](https://onco.cc/fronts/chemotherapy/), [Radiation Therapy](https://onco.cc/fronts/radiation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Evidence-based integrative oncology](https://onco.cc/technologies/integrative-oncology/), [Probiotics, antibiotics and stewardship around immunotherapy](https://onco.cc/technologies/probiotics-antibiotic-stewardship-io/)
- bottlenecks: [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [Probiotics for the prevention or treatment of chemotherapy- or radiotherapy-related diarrhoea in people with cancer](https://onco.cc/key-papers/paper-wei-cochrane-database-syst-rev/)

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