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1 x 10^9 CFU (1 billion) daily taken WITH the iron-containing meal is sufficient for the iron effect — in the dual-isotope crossover trial 10^9 was significant (28.6% vs 18.5%, p<0.028) while 10^10 was NOT (29.1% vs 20.1%, p=0.080). The freeze-dried capsule and IBS trials used 1 x 10^10 CFU daily, and the pregnancy trial used 1 x 10^10 CFU twice daily (2 x 10^10 CFU/day)

With meals · with food

Freeze-dried capsule standardized to 299v (DSM 9843)

Prevention and maintenance are DIFFERENT doses and are often conflated. Preventing the first onset of acute pouchitis used 900 billion CFU/day (1 sachet). Maintaining remission in established chronic or refractory pouchitis — where the effect size is largest — used 6 g/day, which at 5 x 10^11 viable bacteria per gram is about 3 trillion CFU/day, in both maintenance trials. As a ulcerative colitis add-on, 3.6 trillion CFU daily; the active-UC induction trial went highest at 3.6 trillion CFU TWICE daily (7.2 trillion/day), and the paediatric trial lowest at 450 billion/day weight-based

Any time

Refrigerated sachet of the De Simone Formulation

• Immunocompromise or immunosuppression (class-level precaution for live probiotics)
• Critical illness or indwelling central venous catheter
• Short-bowel syndrome or compromised gut barrier

• Oral iron supplements
• Systemic antibiotics

• Severe immunocompromise or immunosuppression (class-level precaution for live probiotics)
• Critical illness or indwelling central venous catheter

• Systemic antibiotics