URL of this page: https://medlineplus.gov/druginfo/natural/790.html


What is it?

Lactobacillus is a type of bacteria. There are lots of different species of lactobacillus. These are "friendly" bacteria that normally live in our digestive, urinary, and genital systems without causing disease. Lactobacillus is also in some fermented foods like yogurt and in dietary supplements.

Lactobacillus is taken by mouth to treat and prevent diarrhea, including infectious types such as rotaviral diarrhea in children and traveler's diarrhea. It is also taken by mouth to prevent and treat diarrhea associated with using antibiotics.

Some people take lactobacillus by mouth for general digestion problems, irritable bowel syndrome (IBS), colic in babies, inflammatory bowel disease (IBD), inflammation of the colon, too much bacterial growth in the intestines, constipation, to improve outcomes after bowel surgery, and to prevent a serious gut problem called necrotizing enterocolitis (NEC) in babies born prematurely. Lactobacillus is also taken by mouth for infection with Helicobacter pylori, the type of bacteria that causes ulcers, and also for other types of infections including urinary tract infections (UTIs), vaginal yeast infections, to prevent the common cold and flu, to prevent ear infections in children, and to prevent respiratory infections in children attending daycare centers and in children with cystic fibrosis. It is also taken by mouth for weight loss, rheumatoid arthritis, dental cavities, dental plaque, gum disease, and mouth sores. It is also being tested to prevent serious infections in people on ventilators.

Lactobacillus is taken by mouth for skin disorders such as fever blisters, canker sores, and acne. It is also used to treat or prevent eczema (allergic dermatitis), sensitivity to sun exposure (polymorphous light eruption), sensitivity to environmental allergens, and hay fever in infants and children.

It is also taken by mouth for high cholesterol, swine flu, HIV/AIDS, lactose intolerance, Lyme disease, hives, to prevent cancer, and to boost the immune system.

Women sometimes use lactobacillus suppositories to treat vaginal infections and urinary tract infections (UTIs).

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for LACTOBACILLUS are as follows:

Likely effective for...

  • Diarrhea in children caused by a certain virus (rotavirus). Children with rotaviral diarrhea who are being treated with lactobacillus seem to get over their diarrhea up to 3 days earlier than they would without this treatment. Larger doses of lactobacillus are more effective than smaller ones. At least 10 billion colony-forming units during the first 48 hours should be used.

Possibly effective for...

  • Hayfever. Taking 2 billion colony-forming units of lactobacillus daily for 5 weeks can improve quality of life by almost 18% in people with grass pollen allergy that doesn't respond to the anti-allergy drug loratadine. In children with allergies that persist throughout the year, taking 10 billion colony-forming units of lactobacillus for 12 weeks seems to improve itchy eye symptoms.
  • Preventing diarrhea caused by antibiotics. Taking probiotics products containing lactobacillus strains helps prevent diarrhea caused by antibiotics in adults and children. The most well-studied strain of lactobacillus seems to reduce the chance of diarrhea by about 60% to 70% when started within 2 days of beginning antibiotic treatment and continued for at least 3 days after finishing the antibiotics.
  • Eczema (atopic dermatitis). Most research shows that taking lactobacillus products can reduce eczema symptoms in infants and children. Research also shows that lactobacillus can help PREVENT eczema from developing. When taken by a mother during the last month of pregnancy and then given to the child for the first 1-2 years of life, lactobacillus probiotics can reduce the chance of the child developing eczema by about 11%.
  • A condition associated with an increased risk for developing allergic reactions (atopic disease). Research shows that taking certain lactobacillus strains can prevent atopic disease, such as asthma, allergic rhinitis, and eczema, in infants with a family history of this condition. However, not all strains seem to work.
  • Treating vaginal infections caused by bacteria (bacterial vaginosis). Researchers have found that lactobacillus suppositories and vaginal tablets may be effective in treating bacterial vaginosis. Researchers have also found that eating yogurt or using vaginal capsules containing lactobacillus can help prevent these infections from occurring again.
  • Preventing diarrhea due to cancer treatment (chemotherapy). A chemotherapy drug called 5-fluorouracil can cause severe diarrhea and other gastrointestinal (GI) side effects. There is some evidence that patients with cancer of the colon or rectum have less severe diarrhea, less stomach discomfort, shorter hospital care, and require fewer chemotherapy dose reductions due to GI side effects when they take lactobacillus.
  • Constipation. Taking lactobacillus probiotics for 4-8 weeks can reduce symptoms of constipation including stomach pain and discomfort, bloating, and incomplete bowel movements. It might also increase the number of bowel movements in some people.
  • Diarrhea. Giving lactobacillus to infants and children 1-36 months old when they are admitted to the hospital seems to reduce the risk developing diarrhea. Also, lactobacillus can reduce the risk of diarrhea from all causes in undernourished children. There is conflicting evidence about whether lactobacillus can shorten the duration of diarrhea in children.
  • Helicobacter pylori (H pylori) infection. Research shows that taking lactobacillus probiotics along with "triple therapy" that consists of the prescription drugs clarithromycin, amoxicillin, and a proton-pump inhibitor helps treat stomach ulcers caused by H. pylori. About 7-11 patients with H. pylori infections need to be treated with lactobacillus plus "triple therapy" for one additional patient to achieve remission compared to what would be achieved with "triple therapy" alone. But taking lactobacillus probiotics does not help treat the infection when taken alone, with only an antibiotic, with other "triple therapies," or with "quadruple therapy" that includes bismuth.
  • High cholesterol. Taking lactobacillus probiotics can lower total cholesterol by about 10 mg/dL and low-density lipoprotein (LDL or "bad") cholesterol by about 9 mg/dL in people with or without high cholesterol. The most well-studied strains of lactobacillus for this use are Lactobacillus plantarum, Lactobacillus reuteri, and Lactobacillus acidophilus. However, lactobacillus probiotics do not seem to improve high-density lipoprotein (HDL or "good") cholesterol or triglycerides.
  • Colic in babies. Some research shows that giving lactobacillus to nursing infants reduces daily crying time. Some research suggests that lactobacillus is more effective at reducing crying time than using the drug simethicone. But one large study shows that lactobacillus does not reduce crying. It's possible that infants in the large study had more severe colic than those in the earlier research.
  • Inflamed mouth sores from cancer treatment (oral mucositis). Research shows that taking lozenges containing lactobacillus from the first day of radiation/chemotherapy treatment until one week after reduces the number of patients who develop severe mouth sores.
  • Inflammation of an artificial rectum surgically created in people with inflammatory bowel disease (pouchitis). Taking lactobacillus by mouth seems to help treat pouchitis, a complication of surgery for ulcerative colitis. Taking a multi-species probiotic containing lactobacillus, bifidobacterium, and streptococcus for one year seems to maintain remission in 85% of people with this condition. Taking a different formulation containing two lactobacillus species and bifidobacterium for 9 months seems to reduce pouchitis severity.
  • Airway infections. Some research shows that lactobacillus probiotics can help prevent airway infections in infants and children. Giving one strains of lactobacillus to infants and children seems to reduce the chance of upper airway infections by about 38%. Also, children ages 1-6 years who attend daycare centers seem to get fewer and less severe airway infections when given milk containing this lactobacillus strain or when given a specific combination of lactobacillus and bifidobacterium.
  • Rheumatoid arthritis (RA). Research shows that taking lactobacillus for 8 weeks reduces tender and swollen joints in women with rheumatoid arthritis.
  • Preventing diarrhea due to traveling. Traveler's diarrhea is caused by bacteria, viruses, or parasites that the traveler has not been exposed to before. Taking lactobacillus seems to help prevent diarrhea in travelers. The effectiveness can vary a lot depending on the travel destination because of differences in bacteria in different locations.
  • Treating a bowel condition called ulcerative colitis. Lactobacillus probiotics seem to increase remission in people with ulcerative colitis. The best evidence of benefit is for a multi-species probiotic containing lactobacillus, bifidobacterium, and streptococcus. Research shows that taking this product can increase remission rates by almost 2-fold when used with standard ulcerative colitis treatment. Taking a single strain of lactobacillus also seems to improve symptoms. But lactobacillus doesn't seem to prevent ulcerative colitis relapse.

Possibly ineffective for...

  • Diarrhea caused by the bacterium Clostridium difficile. People who are treated for Clostridium difficile infections often experience recurrence. Although some conflicting results exist, most research shows that taking lactobacillus does not prevent recurrent episodes of Clostridium difficile diarrhea. Most research also shows that lactobacillus probiotics do not prevent first episodes of Clostridium difficile diarrhea.
  • Crohn's disease. Taking lactobacillus probiotics does not prevent Crohn's disease from becoming active again in people who are in remission or in those who have just had surgery for Crohn's disease.
  • Dental plaque. Giving lactobacillus to pregnant women starting 4 weeks before delivery until birth, and then continuing in the infants until 12 months of age, does not seem to reduce dental plaque in the baby teeth of the child by the age of 9 years.
  • Vaginal yeast infections after taking antibiotics. Taking lactobacillus by mouth or eating yogurt enriched with lactobacillus doesn't prevent vaginal yeast infections after antibiotics. However, women with yeast infections who use vaginal suppositories containing 1 billion colony-forming units of lactobacillus twice daily for 7 days in combination with conventional treatment often report their symptoms improve.

Insufficient evidence to rate effectiveness for...

  • Acne. Early research shows that taking a multi-species probiotic containing lactobacillus and bifidobacterium twice daily along with minocycline once daily for 12 weeks improves acne.
  • Common cold. Early research shows that taking lactobacillus daily for 12 weeks reduces the risk of common cold by about 12% and reduces the number of days with symptoms from 8.6 to 6.2 in adults. Also, taking lactobacillus plus bifidobacterium for 3 months seems to reduce school absences due to cold symptoms. However, research is inconsistent. Taking some lactobacillus strains does not seem to reduce the risk of catching a cold or the number of cold/flu days.
  • Cystic fibrosis. Research suggests that taking lactobacillus daily for 6 months reduces the percentage of cystic fibrosis patients with lung complications from 37% to 3% and the percentage with upper respiratory tract infections from 20% to 3%.
  • Dental cavities. Research on the effects of lactobacillus on dental cavities is mixed. Giving lactobacillus to pregnant women starting 4 weeks before delivery until birth, and then continuing in the infants until 12 months of age, seems to reduce cavities in the child's baby teeth. But giving lactobacillus to only infants from 4 months until 13 months of age does not reduce cavities in baby or permanent teeth.
  • Stomach pain. Early research suggests that taking lactobacillus twice daily for 4 weeks can reduce the severity but not frequency of stomach pain in children 6 to 16 years-old. Other early research shows that taking lactobacillus and bifidobacterium twice daily for 30 days improves stomach pain.
  • Flu. Taking a drink containing one strain of lactobacillus 5 days weekly for 8 weeks reduces the incidence of the flu in schoolchildren during flu season. Taking a different lactobacillus strain daily for 6 weeks does not reduce the number of cold/flu days in otherwise healthy adults.
  • Treating irritable bowel syndrome (IBS). Many studies have evaluated lactobacillus species for treating IBS. Some strains might reduce IBS symptoms including abdominal pain, bloating, and flatulence in some people. But other lactobacillus strains don't seem to work in most people with IBS.
  • Lactose intolerance. Research on the effects of lactobacillus on lactose intolerance is conflicting. Some research shows that drinking lactobacillus milk produces the same symptoms of intolerance as regular cow's milk in people with lactose intolerance. But other research shows that drinking a milk product containing lactobacillus reduces symptoms of lactose intolerance.
  • Necrotizing enterocolitis (NEC) in babies born prematurely. When results from multiple clinical studies are evaluated, giving lactobacillus to preterm infants seems to reduce the risk of severe NEC by 30% to 55%. But when results from individual clinical studies are considered, lactobacillus does not seem to prevent NEC. It's possible that the individual clinical studies are too small to show benefit. Giving lactobacillus to preterm infants does not reduce the risk of death.
  • Skin rash caused by sun exposure (polymorphous light eruption). Early research shows that taking a supplement containing lactobacillus and other ingredients daily for 12 weeks reduces the severity of skin reactions after sun exposure in people with polymorphous light eruption.
  • Growth of bacteria in the intestines. Some clinical research has evaluated lactobacillus for treating and preventing growth of potentially harmful bacteria in the intestines. Some of this research shows modest improvements in symptoms of stomach pain, bloating, and diarrhea; however, other research has found no benefit in people with bacterial overgrowth. Lactobacillus does not seem to be helpful for preventing growth of harmful bacteria in the intestines.
  • Urinary tract infections (UTIs). There is some early evidence that vaginal use of some lactobacillus species might be helpful for preventing UTIs, but not all studies have agreed. There is also conflicting evidence about the effects of taking lactobacillus by mouth.
  • Pneumonia in people on breathing machines in the hospital. Early research shows that taking lactobacillus twice daily might reduce the incidence of pneumonia in people in the intensive care unit.
  • Weight loss. Research shows that taking lactobacillus twice daily for 24 weeks does not reduce body weight or fat mass in obese adults. However, it might reduce body weight in just women.
  • Boosting the immune system.
  • Cancer.
  • Canker sores.
  • Fever blisters.
  • Hives.
  • Lyme disease.
  • Other conditions.
More evidence is needed to rate lactobacillus for these uses.

How does it work?

Many bacteria and other organisms live in our bodies normally. "Friendly" bacteria such as Lactobacillus can help us break down food, absorb nutrients, and fight off "unfriendly" organisms that might cause diseases such as diarrhea.

Are there safety concerns?

Lactobacillus is LIKELY SAFE when taken by mouth appropriately. Side effects are usually mild and most often include intestinal gas or bloating.

Lactobacillus is also LIKELY SAFE for women to use inside the vagina.

Special precautions & warnings:

Children: Lactobacillus is LIKELY SAFE when taken by mouth appropriately in children. Lactobacillus GG, a specific strain of Lactobacillus rhamnosus, has been used safely from five days to 15 months.

Pregnancy and breast-feeding: Lactobacillus is POSSIBLY SAFE when taken by mouth appropriately while pregnant and breastfeeding. Lactobacillus GG has been used safely in pregnant and breast-feeding women. The combinations of Lactobacillus rhamnosus or Lactobacillus paracasei with Bifidobacterium longum from 2 months before delivery until the breastfed infant was 2 months has been used safely. But other types of lactobacillus have not been studied during pregnancy and breast-feeding, so their safety is unknown.

Weakened immune system: There is some concern that lactobacillus from supplements that contain live bacteria might grow too well in people whose immune systems are weakened. This includes people with HIV/AIDS or people who have taken medicines to prevent rejection of a transplanted organ. Lactobacillus has caused disease (rarely) in people with weakened immune systems. To be on the safe side, if you have a weakened immune system, talk with your healthcare provider before taking lactobacillus.

Short bowel syndrome: People with short bowel syndrome might be more likely than other people to develop lactobacillus infections. If you have this condition, talk with your healthcare provider before taking lactobacillus.

Ulcerative colitis: People with ulcerative colitis that is severe enough to require hospitalization might be more likely than other people to develop lactobacillus infections. If you have this condition, talk with your healthcare provider before taking lactobacillus.

Damaged heart valves: Lactobacillus can cause an infection in the inner lining of the heart chambers and heart valve, but this is extremely rare. However, people with damaged heart valves might be more likely than other people to develop this type of infection, especially if they take lactobacillus before dental or invasive stomach and intestinal procedures. People with damaged heart valves should stop taking probiotics before dental procedures or invasive stomach and intestinal procedures such as an endoscopy.

Are there interactions with medications?

Be cautious with this combination.
Antibiotic drugs
Antibiotics are used to reduce harmful bacteria in the body. Antibiotics can also reduce friendly bacteria in the body. Lactobacillus is a type of friendly bacteria. Taking antibiotics along with Lactobacillus can reduce the effectiveness of Lactobacillus. To avoid this interaction, take Lactobacillus products at least 2 hours before or after antibiotics.
Be watchful with this combination.
Medications that decrease the immune system (Immunosuppressants)
Lactobacillus contains live bacteria and yeast. The immune system usually controls bacteria and yeast in the body to prevent infections. Medications that decrease the immune system can increase your chances of getting sick from bacteria and yeast. Taking Lactobacillus along with medications that decrease the immune system might increase the chances of getting sick.

Some medications that decrease the immune system include azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone, Orasone), corticosteroids (glucocorticoids), and others.

Are there interactions with herbs and supplements?

There are no known interactions with herbs and supplements.

Are there interactions with foods?

There are no known interactions with foods.

What dose is used?

The strength of Lactobacillus products is usually indicated by the number of living organisms per capsule. Typical doses range from 1 to 10 billion living organisms taken daily in 3-4 divided doses.

The following doses have been studied in scientific research:


  • For hayfever: At least 2 billion colony-forming units of lactobacillus daily for 7 weeks has been used along with 10 mg of loratadine once daily for 5 weeks.
  • For preventing diarrhea caused by antibiotics: Many different lactobacillus species have been studied. In most cases, lactobacillus is given in daily doses that provide 10-100 billion colony-forming units daily. Lower doses of 100 million colony-forming units have also been used. Usually treatment is started within 2 days of beginning antibiotic treatment and continued for at least 3 days after antibiotic treatment is complete.
  • For eczema (atopic dermatitis): For preventing eczema in children, lactobacillus has been given to pregnant women during the last month of pregnancy. Typically, lactobacillus is given alone or along with other probiotic species in doses of 100 million to 10 billion colony-forming units. Doses vary depending on the lactobacillus strain and if the product is a multi-species probiotic.
  • For a condition associated with an increased risk for developing allergic reactions (atopic disease): 10-20 billion colony-forming units of lactobacillus have been used daily for 2-4 weeks before delivery.
  • For treating vaginal infections caused by bacteria (bacterial vaginosis): 150 mL of yogurt containing lactobacillus has been used daily for 2 months.
  • For preventing diarrhea due to cancer treatment (chemotherapy): 5-10 billion colony-forming units of lactobacillus has been used twice daily during 24 weeks of chemotherapy.
  • For constipation: 200-400 million colony-forming units of lactobacillus has been taken daily for 4-8 weeks. Also, a multi-species probiotic product containing 5 billion colony-forming units of lactobacillus and other probiotic species has been used twice daily for 7 days.
  • For Helicobacter pylori (H pylori) infection: Probiotic products containing 200 million to 15 billion colony-forming units of lactobacillus daily have been used along with triple therapy. Also, a multi-strain probiotic containing 30 million colony-forming units of lactobacillus and other probiotic species has been used for 2 weeks before until 2 weeks after triple therapy. In all cases, triple therapy consisted of the prescription drugs clarithromycin, amoxicillin, and a proton-pump inhibitor.
  • For high cholesterol: Probiotic products containing 39 million to 50 billion colony-forming units of lactobacillus have been used for 6-12 weeks.
  • For inflamed mouth sores from cancer treatment (oral mucositis): Lozenges containing 2 billion colony-forming units of lactobacillus have been dissolved in the mouth every 2-3 hours up to 6 times daily during chemotherapy and continuing until one week after.
  • Inflammation of an artificial rectum surgically created in people with inflammatory bowel disease (pouchitis): A combination probiotic containing 900-1500 billion colony-forming units of lactobacillus, bifidobacterium, and streptococcus has been taken twice daily for up to one year. Another multi-species probiotic containing about 10 billion colony-forming units of lactobacillus and bifidobacterium has been taken daily for 9 months.
  • For rheumatoid arthritis: 100 million colony-forming units of lactobacillus have been used daily for 8 weeks.
  • For traveler's diarrhea: 2 billion colony-forming units of lactobacillus has been used daily, starting 2 days before traveling and continuing until the end of the trip.
  • For a bowel condition called ulcerative colitis: A product containing 25 billion colony-forming units of lactobacillus has been taken twice daily for 8 weeks. Also, a combination probiotic containing 900-1500 billion colony-forming units of lactobacillus, bifidobacterium, and streptococcus has been taken once or twice daily.
  • For treating vaginal infections caused by bacteria: One to two vaginal tablets containing 10 million colon-forming units of lactobacillus per tablet have been taken daily along with 0.3 mg estriol for 6 days. Intravaginal suppositories containing 100 million to 1 billion colony-forming units of lactobacillus, given twice daily for 6 days, has also been used.

  • For rotaviral diarrhea: Doses of at least 10 billion colony-forming units of lactobacillus daily during the first 48 hours seem to work best.
  • For hayfever: 10 billion colony-forming units of lactobacillus has been taken once daily for 12 weeks along with 5 mg of levocetirizine in children 7-12 years-old.
  • For preventing diarrhea caused by antibiotics: 10-20 billion colony-forming units of lactobacillus has been taken once daily; 20 billion colony-forming units twice daily has also been used.
  • For eczema (atopic dermatitis): For treating eczema in children, 10-100 billion colony-forming units of lactobacillus has been taken daily for 6-12 weeks. For preventing eczema, 100 million to 6 billion colony-forming units of lactobacillus daily from birth until 1-2 years has been used. Also a multi-species probiotic containing 10 billion colony-forming units of lactobacillus and Bifidobacterium has been used daily from birth until 6 months.
  • For a condition associated with an increased risk for developing allergic reactions (atopic disease): 10-20 billion colony-forming units of lactobacillus have been used daily for the first 3-6 months of life.
  • For constipation: 100 million colony-forming units of lactobacillus have been used daily for 8 weeks.
  • For diarrhea: Six billion colony-forming units of lactobacillus has been used twice daily in infants while hospitalized. Also, 37 billion colony-forming units of lactobacillus has been used daily, 6 days weekly, for 15 months in children 6-24 months-old.
  • For Helicobacter pylori (H pylori) infection: A multi-species probiotic containing about 100 billion colony-forming units of lactobacillus and bifidobacterium has been used for 2 weeks along with triple therapy and for 4 weeks after triple therapy was complete. Triple therapy consisted of the prescription drugs clarithromycin, amoxicillin, and a proton-pump inhibitor.
  • For colic in babies: 100 million colony-forming units of lactobacillus have been used daily for up to 90 days in breast-fed and formula-fed infants. Also, a specific multi-ingredient product containing 65 mg of lemon balm, 9 mg of German chamomile, and 1 billion colony-forming units of lactobacillus (ColiMil Plus by Milte Italia SPA ) has been used twice daily for 4 weeks.
  • For airway infections: Milk products containing 130 million to 10 billion colony-forming units of lactobacillus have been used daily.
  • For traveler's diarrhea: 2 billion colony-forming units of lactobacillus has been used daily, starting 2 days before traveling and continuing until the end of the trip.
  • For a bowel condition called ulcerative colitis: A combination probiotic containing 450-1800 billion colony-forming units of lactobacillus, bifidobacterium, and streptococcus has been used daily in children with moderate-to-severe ulcerative colitis.

Other names

Acidophilus, Acidophilus Bifidus, Acidophilus Lactobacillus, L. Acidophilus, L. Amylovorus, L. Brevis, L. Bulgaricus, L. Casei, L. Casei Immunitas, L. Crispatus, L. Delbrueckii, L. Fermentum, L. Gallinarum, L. Helveticus, L. Johnsonii, L. Johnsonii LC-1, L. Lactis, L. Plantarum, L. Reuteri, L. Rhamnosus, L. Salivarius, Lacto Bacillus, Lactobacille, Lactobacilli, Lactobacilli Acidophilus, Lactobacilli Bulgaricus, Lactobacilli Plantarum, Lactobacilli Rhamnosus, Lactobacilli Salivarium, Lactobacillus acidophilus, Lactobacillus amylovorus, Lactobacillus brevis, Lactobacillus bulgaricus, Lactobacillus casei, Lactobacillus casei sp. rhamnosus, Lactobacillus crispatus, Lactobacillus delbrueckii, Lactobacillus delbrueckii ssp. bulgaricus, Lactobacillus fermentum, Lactobacillus gallinarum, Lactobacillus Gasseri, Lactobacillus GG, Lactobacillus Helveticus, Lactobacillus johnsonii, Lactobacillus Lactis, Lactobacillus Paracasei, Lactobacillus plantarum, Lactobacillus reuteri, Lactobacillus Rhamnosus GG, Lactobacillus rhamnosus, Lactobacillus sakei, Lactobacillus Salivarium, Lactobacillus salivarius, Lactobacilo, Lactospores, LC-1, Probiotic.


To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.


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Last reviewed - 02/22/2018