S. boulardii

Related Terms

Brewer's yeast, Florastor?, Florastor? Kids, Hansen CBS 5926, Lactobacillus, Lactobacillus acidophilus, Lactobacillus bulgaricus, Lactobacillus gasseri, Lactobacillus GG, Lactobacillus plantarum, Perenterol?, probiotic, S. boulardii, Saccharomyces cerevisiae, Saccharomyces salivarius, Saccharomyces thermophilus, Saccharomycetaceae (family), Ultra-Levure?, yeast.
Note: There is debate as to whether Saccharomyces boulardii is a subspecies of Saccharomyces cerevisiae or a separate entity. Traditional techniques cannot distinguish the two, but manufacturers of Saccharomyces boulardii claim that the two yeasts are separate species.

Background

Saccharomyces boulardii is a non-pathogenic yeast strain that has been used for treatment and prevention of diarrhea. Saccharomyces boulardii is classified as a "probiotic," or a microorganism that when ingested may have a positive influence on the host's health. Probiotics may exert their effects on the gastrointestinal system directly, or may modulate the immune system in a larger scope.
Human studies indicate Saccharomyces boulardii may prevent antibiotic-associated diarrhea, Clostridium difficile diarrhea in combination with antibiotic therapy, diarrhea associated with tube feeds, and acute childhood diarrhea. Promising initial studies have shown that Saccharomyces boulardii may be beneficial in treating diarrhea associated with HIV.
The German Commission E has approved the use of Saccharomyces boulardii for symptomatic treatment of acute diarrhea, prophylactic and symptomatic treatment of diarrhea during travel, treatment of diarrhea occurring while tube feeding, use as an adjuvant for chronic acne, for a dietary supplementation, and for a source of B vitamins and protein.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


There is good evidence that concurrent use of Saccharomyces boulardii with antibiotic therapy reduces the incidence of developing antibiotic-associated diarrhea (AAD) (Clostridium difficile and other). In general, positive results occur only when Saccharomyces boulardii is continued for several days to several weeks after the course of antibiotics is stopped. Duplication of these results should still be attempted to confirm these findings.

A


There is good evidence that concurrent use of Saccharomyces boulardii with antibiotic therapy reduces the incidence of developing antibiotic-associated diarrhea (AAD) (Clostridium difficile and other). In general, positive results occur only when Saccharomyces boulardii is continued for several days to several weeks after the course of antibiotics is stopped. Duplication of these results should still be attempted to confirm these findings.

A


Several trials suggest efficacy of Saccharomyces boulardii in the treatment of diarrhea in childhood. Further studies are still required. Use of Saccharomyces boulardii may be advantageous in both the reduction of stool frequency per day and the duration of diarrhea in this age group.

 B


Several trials suggest efficacy of Saccharomyces boulardii in the treatment of diarrhea in childhood. Further studies are still required. Use of Saccharomyces boulardii may be advantageous in both the reduction of stool frequency per day and the duration of diarrhea in this age group.

 B


Evidence from one clinical trial supports improvement of symptoms and in patients with amebiasis treated with Saccharomyces boulardii, in addition to standard therapy. Further clinical trials are required before a firm recommendation can be made.

 C


Evidence from one clinical trial supports improvement of symptoms and in patients with amebiasis treated with Saccharomyces boulardii, in addition to standard therapy. Further clinical trials are required before a firm recommendation can be made.

 C


Evidence supports mild improvement of symptoms and quality of life in patients with Crohn's disease who use Saccharomyces boulardii. More clinical trials are required before a firm recommendation can be made in this area.

 C


Evidence supports mild improvement of symptoms and quality of life in patients with Crohn's disease who use Saccharomyces boulardii. More clinical trials are required before a firm recommendation can be made in this area.

 C


With the introduction of broad-spectrum antibiotics into clinical practice, Clostridium difficile infection has become a common cause of infectious diarrhea in hospitalized patients. For treatment of recurrent Clostridium difficile-associated diarrhea, Saccharomyces boulardii may decrease recurrences by about 50%, especially when combined with high-dose vancomycin. Further studies are still required.

 C


With the introduction of broad-spectrum antibiotics into clinical practice, Clostridium difficile infection has become a common cause of infectious diarrhea in hospitalized patients. For treatment of recurrent Clostridium difficile-associated diarrhea, Saccharomyces boulardii may decrease recurrences by about 50%, especially when combined with high-dose vancomycin. Further studies are still required.

 C


While only small studies have been performed, treatment with Saccharomyces boulardii may improve quality of life for AIDS patients with chronic diarrhea. As fungemia has been associated with Saccharomyces boulardii administration in patients with central lines, care should be exercised in treating these patients.

 C


While only small studies have been performed, treatment with Saccharomyces boulardii may improve quality of life for AIDS patients with chronic diarrhea. As fungemia has been associated with Saccharomyces boulardii administration in patients with central lines, care should be exercised in treating these patients.

 C


Preliminary evidence supports the use of Saccharomyces boulardii for this indication. However, the role of antibiotics in the results is unclear. More studies should be performed before a strong recommendation can be made.

 C


Preliminary evidence supports the use of Saccharomyces boulardii for this indication. However, the role of antibiotics in the results is unclear. More studies should be performed before a strong recommendation can be made.

 C


Although evidence supports the use of Saccharomyces boulardii for other forms of diarrhea, little evidence exists to support standard treatment with Saccharomyces boulardii for traveler's diarrhea. More studies need to be performed.

 C


Although evidence supports the use of Saccharomyces boulardii for other forms of diarrhea, little evidence exists to support standard treatment with Saccharomyces boulardii for traveler's diarrhea. More studies need to be performed.

 C


One clinical trial exists to support treatment with Saccharomyces boulardii for irritable bowel syndrome. Additional study is required before a firm recommendation can be made.

 C


One clinical trial exists to support treatment with Saccharomyces boulardii for irritable bowel syndrome. Additional study is required before a firm recommendation can be made.

 C


One clinical trial exists investigating the addition of Saccharomyces boulardii to nutritional support for premature infants. No evidence was found for lipid gut absorption or increased weight gain. A benefit was noted on gut flora. Additional study is needed.

 C


One clinical trial exists investigating the addition of Saccharomyces boulardii to nutritional support for premature infants. No evidence was found for lipid gut absorption or increased weight gain. A benefit was noted on gut flora. Additional study is needed.

 C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Dosing

Adults (18 years and older):
In large multicenter trials, few (if any) side effects have been noted in patients taking Saccharomyces boulardii for up to 15 months. Regardless of diarrhea type, Saccharomyces boulardii is often taken in doses of 500-2,000 milligrams in divided daily doses (three or four times daily). The brand name product, Ultra-Levure?, has been studied in doses of 2-4 capsules daily for up to eight months. For antibiotic-associated diarrhea, 1 gram daily for three days following completion of antibiotics has been used. Two sachets per day containing 5x109 colony forming units (CFU) per sachet has also been used for four weeks. One capsule twice daily has been used; duration was not noted. 250-500mg twice daily for up to two weeks following antibiotics has been used. Four capsules Ultra-Levure? daily for eight months has been used.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Interactions

Interactions with Drugs
Concomitant antibiotic treatment may change gastrointestinal flora, subsequently increasing steady state levels of Saccharomyces boulardii in humans. According to various clinical trials, use of Saccharomyces boulardii in combination with antibiotics decreases the frequency and duration of diarrhea. Caution is also advised when taking Saccharomyces boulardii with other antidiarrheal agents due to additive effects.
Use of antifungal agents may result in decreased efficacy of Saccharomyces boulardii.
Use of metronidazole plus iodoquinol plus Saccharomyces boulardii was more effective than metronidazole plus iodoquinol alone for reducing diarrhea associated with amebiasis (intestinal infection). Similarly, use of mesalamine plus Saccharomyces boulardii may be more effective than mesalamine alone for reducing diarrhea associated with Crohn's disease. These may be examples of positive interactions.
Saccharomyces boulardii taken in combination with monoamine oxidase inhibitors (MAOIs) may lower blood pressure.

Attribution

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

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