What is the recommended dosing of Florastor (Saccharomyces boulardii lyo) in elderly patients?

Florastor (Saccharomyces boulardii lyo) Dosing in the Elderly

The recommended dosing of Florastor (Saccharomyces boulardii lyo) in elderly patients is 500 mg twice daily (1000 mg total daily dose), which is equivalent to 2×10^10 CFU per day. 1

Dosing Recommendations

• Standard adult dose of Saccharomyces boulardii for prevention or treatment of antibiotic-associated diarrhea is 500 mg twice daily 1
• This dosing should be maintained for the duration of antibiotic therapy and continued for 1-4 weeks after antibiotic discontinuation 1
• For Clostridium difficile-associated diarrhea, the same dosing (500 mg twice daily) has been shown to be effective when combined with standard antibiotic therapy 1

Efficacy in Elderly Patients

• In elderly inpatients, Saccharomyces boulardii at 500 mg twice daily for 21 days significantly reduced the incidence of antibiotic-associated diarrhea (14.8% vs 28.0% in control group) 2
• The frequency and duration of diarrhea were also significantly reduced in elderly patients receiving this dosage 2
• However, some studies have shown no benefit in elderly hospitalized patients, suggesting variable efficacy in this population 3, 4

Special Considerations for Elderly Patients

• No specific dose adjustment based on age alone is required for Saccharomyces boulardii in elderly patients 1
• Nutritional needs in elderly patients are generally higher, with protein requirements of at least 1 g/kg body weight per day and energy requirements around 30 kcal/kg body weight per day 1
• These increased nutritional requirements should be considered when evaluating overall treatment plans that include probiotics 1

Safety Concerns in Elderly Patients

• Caution is warranted when administering Saccharomyces boulardii to elderly patients with:

  • Immunocompromised status 5
  • Central venous catheters 5, 6
  • Recent major surgeries 5
  • Prolonged hospitalization 5
  • Use of broad-spectrum antibiotics 5

• Cases of Saccharomyces cerevisiae fungemia have been reported in elderly patients following probiotic treatment, even when capsules were used unopened 5, 6

Administration Guidelines

• Florastor capsules should be swallowed whole and not opened, crushed, or mixed with hot foods or liquids 5
• If the patient has difficulty swallowing capsules, contents can be mixed with cool foods or liquids, but this increases risk of fungemia in vulnerable patients 5
• Administration should continue for at least one month, with efficacy assessment performed monthly 1

Monitoring

• Regular assessment of compliance with Florastor consumption is recommended 1
• Type, flavor, and time of consumption should be adapted to the patient's preferences and eating capabilities 1
• Monitor for signs of fungemia in high-risk elderly patients (fever, increased CRP without obvious source) 5

By following these dosing guidelines and monitoring recommendations, Florastor can be safely and effectively administered to elderly patients while minimizing potential risks.