Streptococcus Faecalis
Also known as: Streptococcus faecalis, Enterococcal probiotic, E. faecalis, Enterococcus faecalis
Overview
Enterococcus faecalis, formerly known as Streptococcus faecalis, is a gram-positive bacterium naturally found in the human gut microbiota and fermented foods. It is utilized as a probiotic supplement to support various aspects of health, primarily focusing on gastrointestinal and immune functions. Research indicates its efficacy in managing conditions such as acute gastroenteritis, antibiotic-associated diarrhea (AAD), and inflammatory bowel diseases (IBD). Beyond gut health, E. faecalis has shown promise in respiratory conditions like recurrent bronchitis and allergic rhinitis, and may even play a role in enhancing cancer immunotherapy outcomes. While its use is not as widespread as some other probiotics, a growing body of evidence, including randomized controlled trials and meta-analyses, supports its therapeutic applications. The evidence quality ranges from moderate to high, suggesting a robust, though still developing, understanding of its benefits.
Benefits
Enterococcus faecalis offers several evidence-based benefits across different physiological systems. For gastrointestinal health, a multistrain probiotic containing E. faecalis (30 million CFU) has been shown to significantly reduce the duration of acute gastroenteritis and antibiotic-associated diarrhea (AAD) in outpatient settings, with improvements observed within 7 days. Meta-analyses further support its role in reducing diarrhea duration by approximately 24 hours and lowering AAD risk. In respiratory health, a double-blind placebo-controlled trial involving patients with chronic recurrent bronchitis demonstrated that an E. faecalis strain (Symbioflor 1) significantly prolonged the time to relapse (699 vs. 334 days, p=0.01) and reduced relapse severity (p=0.001). Probiotic mixtures containing E. faecalis have also been found to reduce symptoms and medication use in children with allergic rhinitis (p<0.01). Furthermore, a meta-analysis suggests that probiotics, including potentially E. faecalis, may improve cancer immunotherapy outcomes, particularly in patients exposed to antibiotics, by enhancing response rates and survival, indicating systemic immunomodulatory effects. Benefits typically manifest within days to weeks, depending on the condition.
How it works
Enterococcus faecalis primarily exerts its beneficial effects through several key mechanisms. It modulates the gut microbiota, helping to restore a healthy balance by competing with pathogenic bacteria and potentially producing bacteriocins. This action contributes to the enhancement of the mucosal barrier function in the gut, which is crucial for preventing the translocation of harmful substances. E. faecalis also possesses immunomodulatory properties, influencing the production of cytokines and reducing inflammation. This anti-inflammatory effect is believed to underpin its benefits in allergic and inflammatory conditions. Upon oral administration, the strain colonizes the gut, with its viability and efficacy dependent on the specific formulation and its ability to survive the gastric environment.
Side effects
Enterococcus faecalis probiotics are generally considered safe, with clinical trials reporting no significant adverse effects. Mild gastrointestinal discomfort, such as bloating or gas, is rare but can occur. There are no documented significant drug interactions or contraindications in the reviewed literature. However, caution is advised for immunocompromised individuals due to the theoretical risk of opportunistic infections, although such occurrences are exceedingly rare. The reclassification from Streptococcus faecalis to Enterococcus faecalis reflects its distinct characteristics, and while enterococci are known for their resilience, the probiotic strains are selected for their safety profile. Overall, the safety data supports its use in healthy populations, but specific medical conditions or concurrent medications should always be discussed with a healthcare professional.
Dosage
Effective dosages of Enterococcus faecalis in clinical studies typically range around 30 million CFU (colony-forming units) per day, often as part of multistrain probiotic formulations. The optimal dosage can vary depending on the specific condition being treated and the formulation (single-strain vs. combination). For acute conditions like diarrhea, treatment durations in clinical trials are often around 7 days. For chronic conditions, such as recurrent bronchitis or inflammatory bowel diseases, supplementation may extend for several months. It is generally recommended to administer E. faecalis orally with meals. This timing helps to enhance the survival of the bacteria as they pass through the acidic environment of the stomach, thereby improving their chances of reaching and colonizing the gut effectively. Specific product instructions should always be followed.
FAQs
Is E. faecalis safe for long-term use?
Generally, E. faecalis is well-tolerated for short- to medium-term use. While long-term safety data is limited, no significant adverse effects have been reported in studies up to several months.
Can it be used alone or only in combination?
E. faecalis is used both as a single-strain probiotic and, more commonly, as part of multistrain formulations. Both approaches have demonstrated efficacy in clinical studies.
How quickly do benefits appear?
For acute conditions like diarrhea, benefits may appear within 1 week. For chronic conditions such as respiratory issues, it may take several weeks to months to observe significant improvements.
Does it help with antibiotic-associated diarrhea?
Yes, evidence supports that E. faecalis, particularly as part of multistrain probiotics, can reduce the duration and incidence of antibiotic-associated diarrhea.
Research Sources
- https://pmc.ncbi.nlm.nih.gov/articles/PMC12291354/ – This study evaluated a multistrain probiotic, including S. faecalis, in outpatients with acute gastroenteritis and antibiotic-associated diarrhea. It found a significant reduction in diarrhea duration and symptom improvement within 7 days, suggesting its effectiveness in these conditions, though it was an observational study with a multistrain product.
- https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2025.1538969/full – This meta-analysis explored the impact of probiotics on cancer immunotherapy outcomes. It suggests that probiotics can improve response rates and survival in cancer patients undergoing immunotherapy, especially those exposed to antibiotics, highlighting a potential immunomodulatory role for probiotics in cancer treatment.
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10451534/ – This double-blind, placebo-controlled RCT investigated E. faecalis (Symbioflor 1) in patients with chronic recurrent bronchitis. It demonstrated a significantly longer relapse-free period and reduced relapse severity, indicating its efficacy in managing chronic respiratory conditions.
- https://onlinelibrary.wiley.com/doi/full/10.1002/ueg2.12636 – This systematic review and meta-analysis examined the role of probiotics, including S. faecalis, in inflammatory bowel disease (IBD). It concluded that probiotics are effective in maintaining remission in IBD, despite heterogeneity in strains and protocols across studies, supporting their use in chronic inflammatory gut conditions.