Prescribing Perspectives of Malaysian Gastroenterologist on Probiotic Use: A Qualitative Interview Study

Introduction: Despite widespread use of probiotics in clinical practice, uncertainty persists regarding their clinical authority, evidence base, and safety, particularly in the absence of consistent guideline endorsement and regulatory clarity. This qualitative study explored how Malaysian clinicians perceive, interpret, and operationalize probiotic use in real-world practice. Methods Using in-depth, semi-structured interviews with 14 experienced clinicians across multiple specialties, and analysed through reflexive thematic analysis, the study examined decision-making processes, perceptions of effectiveness, safety considerations, and future expectations. Results Clinicians consistently framed probiotics as useful but not authoritative, positioning them as adjunctive rather than primary therapies. Prescribing was driven predominantly by mechanistic plausibility especially gut-barrier and gut–brain axis concepts and patient-reported symptom improvement, rather than high-certainty clinical trial evidence. Trial-and-error use and selective trust in a limited number of familiar strains were normalized practices, shaped by regulatory ambiguity, product variability, and pragmatic constraints. While probiotics were generally assumed to be safe, clinicians expressed cautious exclusion of immunocompromised or critically ill patients, highlighting gaps in systematic safety monitoring. Enthusiasm for precision probiotics and emerging applications in mental health and cancer prevention was evident but tempered by concerns regarding feasibility and evidence readiness. Conclusion These findings underscore a critical need for strain-specific evidence, clearer regulatory standards, and clinician-focused decision-support tools to bridge the gap between evolving microbiome science and routine clinical practice.