From the Guidelines
Saccharomyces boulardii may reduce the duration of diarrhea by 28.77 hours and the frequency of prolonged diarrhea in children with acute gastroenteritis, although the quality of evidence is very low.
Key Points
- The most frequently studied probiotic for treating gastroenteritis is S. boulardii, which has been evaluated in 22 trials enrolling children with acute gastroenteritis 1.
- Analysis of 10 studies revealed that S. boulardii may reduce the number of hours with diarrhea (mean 28.77 fewer hours; 95% CI, 40.35 fewer hours to 17.18 fewer hours), but the quality of evidence is very low 1.
- Eight studies reported on the number of children with diarrhea lasting >4 days; S. boulardii may reduce the frequency of prolonged diarrhea (RR, 0.45; 95% CI, 0.32–0.64, Very Low CoE) 1.
- The ESPGHAN working group recommends S. boulardii CNCM I-745, LGG, and L. reuteri DSM 17938 for adjunct treatment in acute gastroenteritis, and S. boulardii and LGG for prevention of antibiotic-associated diarrhea 1.
Mechanism of Action
S. boulardii works by competing with pathogenic organisms for nutrients and attachment sites in the intestine, strengthening the intestinal barrier, producing antimicrobial substances, and modulating the immune response.
Dosage and Administration
The typical recommended dose of S. boulardii is 250-500 mg taken 1-2 times daily for adults and 250 mg daily for children during acute gastroenteritis episodes, usually continuing for 5-7 days or until symptoms resolve.
Safety and Precautions
S. boulardii is generally well-tolerated with minimal side effects, though individuals with compromised immune systems, central venous catheters, or yeast allergies should avoid it 1.
From the Research
Effectiveness of Saccharomyces (S.) boulardii for Treating Gastroenteritis
- The effectiveness of S. boulardii for treating gastroenteritis has been studied in several clinical trials and meta-analyses 2, 3, 4, 5.
- A systematic review and meta-analysis found that S. boulardii significantly reduced the duration of diarrhea by approximately 24 hours and the duration of hospitalization by approximately 20 hours 2.
- Another systematic review and meta-analysis found that S. boulardii reduced the duration of diarrhea by 1.06 days and the duration of hospitalization by 0.85 days in children with acute gastroenteritis 3.
- A review of randomized controlled trials, meta-analyses, and guidelines found that S. boulardii had compelling evidence of efficacy in reducing the duration of acute gastroenteritis by 1 day 4.
- A review of published clinical trials found that S. boulardii was one of the most effective strains in preventing antibiotic-associated diarrhea and treating acute infectious diarrhea, with a moderate clinical benefit of reducing diarrhea duration by approximately 1 day 5.
Safety Considerations
- While S. boulardii is generally considered safe, there have been reports of fungemia due to S. boulardii, particularly in immunosuppressed patients, people with underlying diseases, and low-birth-weight babies 6.
- Clinicians should be cautious when using probiotics, including S. boulardii, in these patient populations, and consider the potential risks and benefits 6.
Clinical Applications
- S. boulardii may be a useful adjunctive treatment for acute gastroenteritis, particularly in children, and may help reduce the duration of diarrhea and hospitalization 2, 3, 4, 5.
- S. boulardii may also be effective in preventing antibiotic-associated diarrhea and treating acute infectious diarrhea 4, 5.