Probiotics (preparations of living organisms such as bifidobacteria and lactobacilli that colonise the gut and are thought to be beneficial) promote maturation of intestinal function, improve immune function, and stimulate production of secretory IgA and anti-inflammatory cytokines. They may protect very preterm infants from necrotising enterocolitis. A systematic review and meta-analysis (Lancet 2007; 369: 1614-20; see also Comment ibid: 1578-80) has given support to this contention. Analysis of seven randomised controlled trials (1393 very low birthweight neonates) showed probiotic administration to be associated with a 64% reduction in risk of necrotising enterocolitis and a 53% reduction in overall (but not necrotising enterocolitis specific) mortality. The time to full feeds was reduced by almost 3 days with probiotics. The risk of sepsis was not affected. Both the authors of this paper and the Lancet commentators call for caution in the use of probiotics until issues of dosage, optimum microbial content, and safety are clarified.

A patient with mild persistent asthma is well controlled on twice daily, low-dose inhaled corticosteroid; should this treatment be continued or a step-down be attempted? In a North American multicentre trial (New England Journal of Medicine 2007; 356: 2027-39; see also Clinical Decisions ibid: 2096-100) a total of 500 patients aged 6 years and older (79 aged 6-14 years) were randomised to continue fluticasone (100 μg twice daily) or …