Florastor (Saccharomyces boulardii) Dosing Recommendations
The standard dosing for Florastor (Saccharomyces boulardii) is 250-500 mg twice daily, with specific dosing regimens depending on the clinical indication. 1
General Dosing Guidelines
- For adults and children 12 years and over: 250 mg (1 capsule) twice daily 2
- For prevention of antibiotic-associated diarrhea: 250-500 mg twice daily for the duration of antibiotic therapy and 1 week after completion 1
- For treatment of recurrent Clostridioides difficile infection: 500 mg twice daily (1 g/day) for 4 weeks as an adjunct to standard antibiotic therapy 1
- For acute diarrhea in children: 250 mg twice daily (5 billion CFU twice daily) for 5 days 3
Specific Clinical Scenarios
Prevention of Antibiotic-Associated Diarrhea
- Start Saccharomyces boulardii within 48 hours of beginning antibiotic therapy 4
- Continue treatment throughout antibiotic course and for 7 days after antibiotic withdrawal 4
- Dosage: 250-500 mg twice daily 1
Recurrent C. difficile Infection
- Most effective when combined with high-dose vancomycin (2 g/day) 1
- Dosage: 500 mg twice daily (1 g/day total) for 4 weeks 1
- Less effective when combined with lower-dose vancomycin (500 mg/day) or metronidazole 1
Inflammatory Bowel Disease
- Dosage: 250 mg three times daily for 4 weeks 5
- May be used as adjunctive therapy with standard treatments 5
Special Populations
- Children under 12 years: Consult a physician before use 2
- Infants (3-36 months) with acute diarrhea: 5 billion CFU twice daily for 5 days 3
- Immunocompromised patients: Saccharomyces boulardii is contraindicated due to risk of fungemia 1
- Critically ill patients: Avoid use due to reported cases of fungemia 1
Safety Considerations
- Saccharomyces boulardii has been associated with fungemia in critically ill and immunocompromised patients 1
- Do not administer to patients at risk of bacteremia or fungemia 1
- Generally considered safe for the general population by regulatory authorities 1
- Careful evaluation is required before use in patients with damaged intestinal mucosa or immune dysregulation 1
Administration Tips
- Can be taken with or without food 2
- Capsules can be opened and mixed with cool foods or liquids for patients who cannot swallow pills 2
- Do not mix with hot beverages or foods as heat may inactivate the yeast 2
- Store at room temperature in a dry place 2
Remember that Saccharomyces boulardii is a living organism and its efficacy depends on maintaining viability until it reaches the intestines. The risk-benefit ratio should be carefully considered, particularly in vulnerable populations.