Saccharomyces boulardii (Traveler)

INTRODUCTION: Approximately 10-40 million travelers get Traveler's Diarrhea (TD) yearly. A significant decrease in TD incidence has not been achieved by depending solely on antibiotic prophylaxis and educational initiatives. Using prebiotics to prevent TD has also not been examined in previous evaluations of probiotics for TD, which failed to consider the strain-specificity of probiotic efficacy. This review investigates the overall effects of probiotics on preventing TD, including the impact of dosage, duration, and age. METHODS: Standard literature databases were searched without restriction on publication year or language. The following criteria are included: randomized controlled trials (RCTs) in English or non-English unrestricted to publication year, excluding animal and observational studies. This systematic review applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS: Of the 166 screened papers, 10 RCTs were included. Lactobacillus acidophilus showed no efficacy in preventing TD except when mixed with other strains. Other genera of lactobacilli showed a protection rate of up to 39% against TD. Similarly, Saccharomyces cerevisiae and Saccharomyces boulardii have been effective in preventing TD. CONCLUSION: Studies investigating probiotics as a preventive measure for TD remain limited. Only a few probiotics that reduce TD risk exist. Based on this systematic review and meta-analysis, specific probiotic strains, including L. acidophilus, L. rhamnosus, L. fermentum, S. cerevisiae, and S. boulardii, may prevent TD. The effect of additional probiotic strains on TD prevention must be further investigated.

BACKGROUND: Probiotics may be effective in reducing the duration of acute infectious diarrhoea. OBJECTIVES: To assess the effects of probiotics in proven or presumed acute infectious diarrhoea. SEARCH METHODS: We searched the trials register of the Cochrane Infectious Diseases Group, MEDLINE, and Embase from inception to 17 December 2019, as well as the Cochrane Controlled Trials Register (Issue 12, 2019), in the Cochrane Library, and reference lists from studies and reviews. We included additional studies identified during external review. SELECTION CRITERIA: Randomized controlled trials comparing a specified probiotic agent with a placebo or no probiotic in people with acute diarrhoea that is proven or presumed to be caused by an infectious agent. DATA COLLECTION AND ANALYSIS: Two review authors independently applied inclusion criteria, assessed risk of bias, and extracted data. Primary outcomes were measures of diarrhoea duration (diarrhoea lasting ≥ 48 hours; duration of diarrhoea). Secondary outcomes were number of people hospitalized in community studies, duration of hospitalization in inpatient studies, diarrhoea lasting ≥ 14 days, and adverse events. MAIN RESULTS: We included 82 studies with a total of 12,127 participants. These studies included 11,526 children (age < 18 years) and 412 adults (three studies recruited 189 adults and children but did not specify numbers in each age group). No cluster-randomized trials were included. Studies varied in the definitions used for "acute diarrhoea" and "end of the diarrhoeal illness" and in the probiotic(s) tested. A total of 53 trials were undertaken in countries where both child and adult mortality was low or very low, and 26 where either child or adult mortality was high. Risk of bias was high or unclear in many studies, and there was marked statistical heterogeneity when findings for the primary outcomes were pooled in meta-analysis. Effect size was similar in the sensitivity analysis and marked heterogeneity persisted. Publication bias was demonstrated from funnel plots for the main outcomes. In our main analysis of the primary outcomes in studies at low risk for all indices of risk of bias, no difference w

BACKGROUND: Travellers' diarrhea (TD) impacts annually over 20 million tourists, business travellers and military troops on a worldwide basis. Reliance on antibiotic prophylaxis and educational programs has not lead to a significant reduction in TD rates. Previous reviews of probiotics for TD have not accounted for the strain-specificity of probiotic efficacy nor have investigated prebiotics for the prevention of TD. METHODS: Standard literature databases were searched from 1977 to June 2018 unrestricted by language. Inclusion criteria included: Probiotic, probiotic or symbiotic interventions, randomized, controlled clinical trials (RCTs) and ≥2 RCTs with the same probiotic strain or mixture. RESULTS: Of 158 screened articles, 12 RCT were included in the systematic review and 6 RCTs (with nine treatment different arms) were included in the meta-analysis. Saccharomyces boulardii CNCM I-745 showed a significant reduction in TD incidence (RR = 0.79, 95% C.I. 0.72-0.87, p < 0.001), while L. rhamnosus GG showed a trend (p = 0.08) and L. acidophilus showed no significant (p = 0.16) reduction of TD. CONCLUSIONS: The number of trials using probiotics or prebiotics for the prevention of TD continues to be limited in number. Only one of three probiotics showed significant efficacy for the prevention of TD. More research is needed for other probiotics strains and prebiotics to determine if they could also prevent TD.

12. World J Gastroenterol. 2010 May 14;16(18):2202-22. doi: 10.3748/wjg.v16.i18.2202. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. McFarland LV. This article reviews the evidence for efficacy and safety of Saccharomyces boulardii (S. boulardii) for various disease indications in adults based on the peer-reviewed, randomized clinical trials and pre-clinical studies from the published medical literature (Medline, Clinical Trial websites and meeting abstracts) between 1976 and 2009. For meta-analysis, only randomized, blinded controlled trials unrestricted by language were included. Pre-clinical studies, volunteer studies and uncontrolled studies were excluded from the review of efficacy and meta-analysis, but included in the systematic review. Of 31 randomized, placebo-controlled treatment arms in 27 trials (encompassing 5029 study patients), S. boulardii was found to be significantly efficacious and safe in 84% of those treatment arms. A meta-analysis found a significant therapeutic efficacy for S. boulardii in the prevention of antibiotic-associated diarrhea (AAD) (RR = 0.47, 95% CI: 0.35-0.63, P < 0.001). In adults, S. boulardii can be strongly recommended for the prevention of AAD and the traveler's diarrhea. Randomized trials also support the use of this yeast probiotic for prevention of enteral nutrition-related diarrhea and reduction of Helicobacter pylori treatment-related symptoms. S. boulardii shows promise for the prevention of C. difficile disease recurrences; treatment of irritable bowel syndrome, acute adult diarrhea, Crohn's disease, giardiasis, human immunodeficiency virus-related diarrhea; but more supporting evidence is recommended for these indications. The use of S. boulardii as a therapeutic probiotic is evidence-based for both efficacy and safety for several types of diarrhea.

BACKGROUND: Traveler's diarrhea (TD) is a common health complaint among travelers. Rates of TD can range from 5% to 50%, depending on the destination. The use of probiotics for this disease remains controversial. The objective of this study was to compare the efficacy of probiotics for the prevention of TD based on published randomized, controlled clinical trials. METHODS: PubMed, Google Scholar, metaRegister, NIH registry of clinical trials and Cochrane Central Register of Controlled Trials were searched from 1977 to 2005, unrestricted by language. Secondary searches of reference lists, authors, reviews, commentaries, associated diseases, books and meeting abstracts. Inclusion criteria included: randomization, controlled, blinded, efficacy trials, in humans, peer-reviewed journals. Exclusion criteria were: pre-clinical, safety, phase 1 studies in volunteers, reviews, duplicate reports, trials of unspecified probiotics, trials of prebiotics, and inconsistent outcome measures. RESULTS: Twelve of 940 screened studies met the inclusion and exclusion criteria. The pooled relative risk indicates that probiotics significantly prevent TD (RR=0.85, 95% CI 0.79,0.91, p<0.001). CONCLUSION: Several probiotics (Saccharomyces boulardii and a mixture of Lactobacillus acidophilus and Bifidobacterium bifidum) had significant efficacy. No serious adverse reactions were reported in the 12 trials. Probiotics may offer a safe and effective method to prevent TD.

To evaluate the evidence for the use of probiotics in the prevention of acute diarrhoea, we did a meta-analysis of the available data from 34 masked, randomised, placebo-controlled trials. Only one trial was community based and carried out in a developing country. Most of the remaining 33 studies were carried out in a developed country in a health-care setting. Evaluating the evidence by types of acute diarrhoea suggests that probiotics significantly reduced antibiotic-associated diarrhoea by 52% (95% CI 35-65%), reduced the risk of travellers' diarrhoea by 8% (-6 to 21%), and that of acute diarrhoea of diverse causes by 34% (8-53%). Probiotics reduced the associated risk of acute diarrhoea among children by 57% (35-71%), and by 26% (7-49%) among adults. The protective effect did not vary significantly among the probiotic strains Saccharomyces boulardii, Lactobacillus rhamnosus GG, Lactobacillus acidophilus, Lactobacillus bulgaricus, and other strains used alone or in combinations of two or more strains. Although there is some suggestion that probiotics may be efficacious in preventing acute diarrhoea, there is a lack of data from community-based trials and from developing countries evaluating the effect on acute diarrhoea unrelated to antibiotic usage. The effect on acute diarrhoea is dependent on the age of the host and genera of strain used.

INTRODUCTION: Clinicians and patients face a daunting task when choosing the most appropriate probiotic for their specific needs. Available preparations encompass a diverse and continuously expanding product base, with most available products lacking evidence-based trials that support their use. Even when evidence exists, not all probiotic products are equally effective for all disease prevention or treatment indications. At this point in time, drug regulatory agencies offer limited assistance with regard to guidance and oversight in most countries, including the U.S. METHODS: We reviewed the current medical literature and sources on the internet to survey the types of available probiotic products and to determine which probiotics had evidence-based efficacy data. Standard medical databases from inception to June 2018 were searched and discussions with experts in the field were conducted. We graded the strength of the evidence for probiotics having multiple, randomized controlled trials and developed a guide for the practical selection of current probiotic products for specific uses. RESULTS: We found the efficacy of probiotic products is both strain-specific and disease-specific. Important factors involved in choosing the appropriate probiotic include matching the strain(s) with the targeted disease or condition, type of formulation, dose used and the source (manufacturing quality control and shelf-life). While we found many probiotic products lacked confirmatory trials, we found sufficient evidence for 22 different types of probiotics from 249 trials to be included. For example, several types of probiotics had strong evidence for the prevention of antibiotic-associated diarrhea [Saccharomyces boulardii I-745, a three-strain mixture (Lactobacillus acidophilus CL1285, L. casei Lbc80r, L. rhamnosus CLR2) and L. casei DN114001]. Strong evidence was also found for four types of probiotics for the prevention of a variety of other diseases/conditions (enteral-feed associated diarrhea, travellers' diarrhea, necrotizing enterocolits and side-effects associated with H. pylori treatments. The evidence was most robust for the treatment of pediatric acute diarrhea based on

OBJECTIVE: Here, we evaluated the efficacy of probiotic interventions in prevention of antibiotic-associated diarrhoea (AAD) and Clostridium difficile diarrhoea (CDD) in older patients. METHODS: PubMed, Embase, CENTRAL, CINAHL, and Web of Science were comprehensively searched from their dates of inception to May 2014. Only randomised controlled trials reporting data on probiotics including Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and Bacillus-alone or in combination-versus placebo or absence of treatment in older patients (age ≥65 years) were included. Risk ratios (RRs) for AAD and CDD relative to placebo or absence of treatment were estimated. RESULTS: Six trials with a total of 3562 patients were included. Only one trial showed that Bacillus licheniformis was effective for preventing AAD in older patients. However, there was no preventive effect for AAD and CDD with Lactobacillus acidophilus (Florajen), Lactobacillus casei Shirota, Saccharomyces cerevisiae (boulardii) lyo, mixture of Lactobacillus acidophilus and Bifidobacterium bifidum (Cultech strains), and mixture of Lactobacillus acidophilus CUL60, CUL21, Bifidobacterium bifidum CUL20 and B. lactis CUL34. CONCLUSIONS: Our findings indicate that probiotics may not reduce the risk of AAD and CDD in older patients. However, with current published data, it is difficult to draw concrete conclusions. To confirm these findings, sample sizes, multi-centre, double-blind studies that consider factors such as probiotic strains and types of antibiotics are required.

BACKGROUND: Whether the incorporation of Saccharomyces boulardii (S. boulardii) into vonoprazan-amoxicillin dual therapy contributes to improved eradication rate and a lower frequency of adverse events in rescue regimens for Helicobacter pylori (H. pylori) infection has yet to be established. METHODS: In a single-center, randomized controlled trial, 190 adults with previous H. pylori treatment failure were assigned to receive either vonoprazan (20 mg twice daily) plus amoxicillin (750 mg three times daily) (VA group) or the same regimen with S. boulardii (250 mg twice daily) (VAS group) for 14 days. Eradication rates, compliance, adverse events, and safety were assessed. Risk factors influencing the eradication rate were explored. RESULTS: Based on intention-to-treat analysis, H. pylori eradication rates were 80.0% in the VA group and 92.6% in the VAS group (P = 0.011), and per-protocol analysis yielded eradication rates of 85.4% and 94.6%, respectively (P = 0.037). There were no significant differences in eradication rates for either the VA regimen (P = 0.736) or the VAS regimen (P = 0.431) based on the number of previous treatment failures. However, a history of prior furazolidone use reduced the eradication rate of VAS therapy. The incidence of adverse events was significantly lower in the VAS group (11.6%) than it was in the VA group (32.6%; P < 0.001). Both groups showed similar good compliance and safety. CONCLUSION: Supplementing vonoprazan-amoxicillin dual therapy with S. boulardii significantly increases H. pylori eradication rates and reduces adverse events, offering an effective and simple rescue treatment unaffected by previous treatment failures. TRIAL REGISTRATION: Chinese Clinical Trial Registry No. ChiCTR2300075382, September 4, 2023. © 2026 Qu et al.

Helicobacter pylori is a class I carcinogen, strongly associated with gastric cancer, gastric ulcers, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Helicobacter pylori (H. pylori) infection necessitates effective eradication strategies. This study evaluated Saccharomyces boulardii (S. boulardii) as an adjunctive therapy to standard bismuth-containing quadruple therapy for H. pylori eradication. Comprehensive searches across PubMed, Embase, Cochrane Library, CNKI, WanFang Data, CBM, and Web of Science identified relevant randomised controlled trials (RCTs). Analysis of 11 RCTs (n = 2,295 patients) demonstrated significantly higher eradication rates (78.6% to 89.2%) with adjunctive S. boulardii (n = 2,295; ITT analysis: RR = 1.12; 95% CI: 1.06-1.18; Z = 4.27, p <0.01) versus standard therapy alone. Crucially, the probiotic combination also substantially reduced treatment-related adverse events (n = 2,183; RR = 0.46; 95% CI: 0.28-0.74; Z = 3.16; p = 0.002), with pronounced reductions in diarrhoea (n = 2,091; RR = 0.46; 95% CI: 0.22-0.93; Z = 2.15; p = 0.03) and rash occurrence (n = 1,271; RR = 0.33; 95% CI: 0.14-0.77; Z = 2.55; p = 0.01). These findings support S. boulardii supplementation as an effective strategy that enhances standard bismuth quadruple therapy efficacy while mitigating gastrointestinal and dermatological complications in H. pylori management. Therefore, the combination of S. boulardii and bismuth-containing quadruple therapy was effective in the treatment of H. pylori infection and has shown significant efficacy and safety as an effective and safe treatment. Key Words: Saccharomyces boulardii, Helicobacter pylori, Bismuth, Quadruple therapy.

BACKGROUND: Ventilator-associated pneumonia (VAP) remains a significant complication among critically ill patients, with associated mortality approaching 50%. Despite the implementation of established preventive strategies, additional interventions are urgently needed to further reduce the incidence of VAP. Probiotic therapy has emerged as a promising adjunctive approach; the benefits of probiotic therapy may be more pronounced in critically ill patients without pre-existing infections. The PROACT study will evaluate the prophylactic role of probiotics in a critically ill population with acute brain injury to reduce the VAP incidence, while also exploring microbiological endpoints and mortality to refine patient selection criteria. METHODS: The PROACT study is a prospective, randomized, double-blind, placebo-controlled, multicenter trial designed to evaluate the efficacy of probiotic prophylaxis in adult critically ill patients requiring invasive mechanical ventilation following acute brain injury (e.g., head trauma, ischemic or hemorrhagic stroke). Patients with suspected pulmonary aspiration or pre-existing pulmonary infections at enrollment are excluded to reduce confounding. Participants are randomized in a 1:1 ratio to receive either a placebo (glucose polymer) or a probiotic formulation containing Lactobacillus acidophilus LA-5, Lactobacillus plantarum, Bifidobacterium lactis BB12, and Saccharomyces boulardii. The assigned intervention is administered twice daily via nasogastric tube and oropharyngeal application for up to 30 days or until intensive care unit (ICU) discharge. The primary endpoint is the incidence of VAP, as defined by current international guidelines, in the intention-to-treat (ITT) population. Secondary endpoints include the incidence of VAP in the modified intention-to-treat (mITT) population, catheter-related bloodstream infections, occurrence of sepsis and septic shock, 30-day all-cause mortality, ICU length of stay, and duration of mechanical ventilation. The study is powered at 80% (α = 0.05) to detect a clinically meaningful difference based on effect size estimates based on the PROVAP study, requiring a total sample size of 208 pat

AIM: To evaluate the efficacy of combination therapy with rifaximin and Saccharomyces boulardii CNCM I-745 versus rifaximin monotherapy in patients with small intestinal bacterial overgrowth (SIBO) associated with long-term proton pump inhibitor (PPI) use. MATERIALS AND METHODS: A prospective comparative study with two parallel groups was conducted. Eligible patients were those on continuous long-term PPI therapy (> 3 months) with confirmed SIBO. SIBO was diagnosed in all patients using a lactulose Hydrogen/Methane Breath Test (HMBT). Symptom severity was assessed using the validated "7 × 7" Questionnaire, and Quality of Life (QoL) was evaluated using the SF-36 Health Status Survey. Enrolled patients were randomized into two groups based on a 7-day treatment regimen: Group 1 received rifaximin (400 mg twice daily); Group 2 received rifaximin (400 mg twice daily) plus the probiotic Saccharomyces boulardii CNCM I-745 (Enterol® drug product, Biocodex, France; 500 mg twice daily). SIBO eradication was confirmed via repeat lactulose HMBT, and symptom severity/QoL were reassessed 4 weeks after treatment completion. RESULTS: 108 patients were enrolled (mean age 38.7 ± 8.9 years; 65.7% female). Mean PPI treatment duration at enrollment was 4.81 months (95% confidence interval 4.15-5.46). At 4-week follow-up, repeat lactulose HMBT showed SIBO persistence in 41.5% of Group 1 (n = 22/53) versus 21.8% in Group 2 (n = 12/55; p = 0.038). Statistically significant resolution of diarrhea was observed only in Group 2 (p = 0.033). The final median "7 × 7" Questionnaire score was significantly lower in Group 2 (p = 0.0010). Both groups showed significant trends toward QoL improvement on the SF-36 survey. CONCLUSION: This prospective comparative study demonstrates that combination therapy with rifaximin and Saccharomyces boulardii CNCM I-745 appears more effective than rifaximin monotherapy for SIBO eradication, symptom regression, and QoL improvement in patients with PPI-associated SIBO. Publisher: Цель. Изучение эффективности комбинированной терапии с применением рифаксимина и Saccharomyces boulardii CNCM I-745 у пациентов с синдромом избыточного бактериального роста (СИБР) на ф

BACKGROUND: Bismuth quadruple therapy (BQT) remains a cornerstone of first-line Helicobacter pylori eradication. However, its efficacy is increasingly undermined by antibiotic resistance, while frequent adverse events reduce its tolerability. Probiotics have been proposed as adjunctive agents to improve eradication outcomes and mitigate side effects, though their specific role in combination with BQT has yet to be fully established. METHODS: We conducted an extensive search of PubMed, Embase, Web of Science, and Cochrane Library for randomized controlled trials (RCTs) published through November 2024. Eligible studies compared H. pylori eradication rates and adverse events between probiotic-supplemented BQT (PBQT) and standard BQT in infected patients. RESULTS: Nineteen randomized controlled trials with 2973 samples were included. PBQT significantly improved H. pylori eradication rates compared to BQT alone (pooled odds ratio [OR] = 1.49, 95% confidence interval [CI] 1.20-1.85; P = 0.0004), with low heterogeneity (I² = 0%). Subgroup analyses demonstrated that both Saccharomyces boulardii (OR = 1.62; P < 0.05) and multi-strain probiotics (OR = 1.66; P < 0.05) significantly enhanced eradication rates. Concomitant administration of probiotics with antibiotics also yielded significant benefits (OR = 1.48, 95% CI 1.14-1.92; P = 0.003). PBQT demonstrated superior efficacy in the initial-treatment subgroup (OR = 1.48; P = 0.003) and among patients aged ≥18 y (OR = 1.47; P = 0.005). Regional subgroup analysis revealed a significant improvement in eradication rates for studies conducted in East Asia (OR = 1.66; P = 0.003). Antibiotic-specific subgroup analysis indicated a significant benefit of probiotics in the amoxicillin-clarithromycin BQT subgroup (OR = 1.59; P = 0.01). Overall, adverse events were significantly lower in the PBQT group (OR = 0.44, 95% CI 0.27-0.70, P = 0.0006), especially diarrhoea (OR = 0.33, 95% CI 0.21-0.52, P < 0.00001) and nausea (OR = 0.29, 95% CI 0.11-0.79, P = 0.02). CONCLUSIONS: Adding probiotics, particularly S. boulardii or multi-strain combinations, to BQT significantly improves eradication efficacy and decreases treatment-related adverse

BACKGROUND: Pediatric acute gastroenteritis (PAGE) is a common cause of morbidity and mortality, especially in children under five years old. Therapeutic strategies including probiotics have been investigated, but trials from non-English speaking countries may not be easily accessible. AIM: To determine the efficacy of Saccharomyces boulardii compared to controls for treating PAGE in children receiving standard rehydration therapy in trials conducted in China. METHODS: Systematic review and meta-analysis using literature search with Google Scholar, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure and China Biology Medicine disc (from inception to June 30, 2024) of randomized, controlled trials comparing S. boulardii CNCM I-745 to controls for the treatment of PAGE in children conducted in China. Independent data extraction by two reviewers. Standard meta-analysis methods were applied and random-effect or fixed-effects models were used depending upon the degree of heterogeneity using standardized mean differences for continuous data and relative risk estimates for dichotomous outcomes. The risk of bias for each study was determined and heterogeneity was measured by I2. RESULTS: Of 851 articles screened, 10 RCTs (1125 participants) met the inclusion criteria, and none were found in non-Chinese databases. S. boulardii CNCM I-745 was found to significantly reduce the duration of PAGE (SMD=-1.63 days, 95% CI -2.08, -1.18), improve the total effectiveness rating (RR=1.22, 95% CI 1.16, 1.28) and significantly more participants were cured (RR=1.47, 95% CI 1.30, 1.67). The finding that S. boulardii significantly reduced the levels of two pro-inflammatory cytokines (TNF-α and IL8) has not been reported in previous meta-analyses of PAGE. CONCLUSION: S. boulardii CNCM I-745 is an effective treatment for PAGE and was well tolerated in trials done in China. SYSTEMATIC REVIEW REGISTRATION: www.crd.york.ac.uk/PRSPERO, identifier CRD 42024567537.

PURPOSE: Acute gastrointestinal (GI) toxicities are common side effects of pelvic radiotherapy in gynecologic cancers. Although bacterial probiotics show promise, there is limited evidence for yeast-based probiotics such as Saccharomyces boulardii. This study aimed to evaluate the efficacy of S. boulardii in preventing acute radiation-induced GI toxicities in patients undergoing pelvic radiotherapy for cervical and endometrial cancers. METHODS: A prospective, randomized, double-blind, controlled trial was conducted with 60 patients receiving definitive or postoperative pelvic radiotherapy. Patients were randomized to receive either S. boulardii (250 mg/day) or a placebo, starting one week before radiotherapy and continuing throughout treatment. Acute GI toxicities were assessed weekly using the Common Terminology Criteria for Adverse Events (CTCAE) version 5. Stool consistency and inflammatory markers were also monitored. The primary outcome was the reduction in the severity of diarrhea and other GI symptoms. RESULTS: S. boulardii significantly reduced the incidence of type 6 and 7 stool consistency at week 3 (p = 0.01). However, despite this transient improvement, the treatment group experienced a significantly higher incidence of diarrhea at week 4 compared to the control group (p = 0.03). Overall, no significant differences were found between the groups in terms of cumulative GI toxicities or anti-diarrheal medication use, with diarrhea remaining the most common acute GI toxicity in both groups. CONCLUSION: No consistent effect of S. boulardii was observed across the measured outcomes, and its overall efficacy in preventing acute radiation-induced enteritis remains inconclusive. Further studies with larger sample sizes are warranted. TRIAL REGISTRATION: The study was registered with the Thai Clinical Trials Registry (TCTR20210204013) on 04 February 2021. © 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Clostridioides difficile infection (CDI) is a significant cause of hospital-acquired diarrhea, leading to high morbidity, recurrence, and healthcare costs. Probiotics like Saccharomyces boulardii show potential as an adjunct therapy to standard CDI treatment, but further trials are needed to confirm their efficacy. This study assessed the efficacy and safety of S. boulardii combined with vancomycin for treating mild to moderate CDI. 120 CDI patients diagnosed with positive stool toxin test were randomly assigned to receive two capsules of 250 mg of S. boulardii or a placebo every 12 h alongside 125 mg of vancomycin every 6 h for 10 days. The primary endpoint was the clinical cure rate, with secondary endpoints including recurrence, global cure rate, and diarrheal outcomes. Clinical cure rates were similar between groups (98.4% vs. 98.3%), but the combination group had a significantly higher global cure rate (96.6% vs. 85.3%, p = 0.044) and lower recurrence rate (1.7% vs. 13.1%, p = 0.032). No significant differences were found in diarrheal outcomes, functional ability, or adverse events. No patients discontinued treatment due to intolerance. In conclusion, adding S. boulardii to vancomycin reduced CDI recurrence without affecting functional recovery or increasing adverse events. © 2025. The Author(s).

BACKGROUND: Helicobacter pylori (H. pylori) infection is a common chronic infection, and there are over half of the global population infected with H. pylori. It is still controversial whether the supplementation of Saccharomyces boulardii (S. boulardii) to bismuth quadruple therapy is beneficial for H. pylori eradication. AIM: To determine the effects of S. boulardii supplementation to bismuth quadruple therapy on H. pylori eradication. METHODS: We performed a systematic literature search across PubMed, Embase, Web of Science, and China National Knowledge Infrastructure for articles published up to October 2023. We calculated the pooled relative risk (RR) with the 95% confidence interval (CI). Statistical analyses were conducted using Stata/SE 15.1 software. RESULTS: Ten randomized controlled trials were included. Notably, S. boulardii supplementation to bismuth quadruple therapy significantly improved H. pylori eradication rates (RR = 1.08, 95% CI: 1.04-1.12) and reduced the incidence of total adverse effects (RR = 0.53, 95% CI: 0.45-0.62). Specifically, it reduced the incidence of some gastrointestinal adverse effects and nonspecific adverse effects, including diarrhea (RR = 0.28, 95% CI: 0.22-0.36), constipation (RR = 0.32, 95% CI: 0.18-0.55), abdominal distention (RR = 0.39, 95% CI: 0.26-0.59), nausea (RR = 0.59, 95% CI: 0.36-0.97), and rash (RR = 0.49, 95% CI: 0.28-0.86). In the subgroup analysis, long-term eradication duration (> 10 days; RR = 1.08, 95% CI: 1.04-1.13) and S. boulardii supplementation to be started and stopped at the same time as eradication treatment (RR = 1.09, 95% CI: 1.04-1.14) were found to significantly improve the eradication rate regardless of the S. boulardii dose (500 mg/day, RR = 1.10, 95% CI: 1.03-1.17; 1000 mg/day, RR = 1.08, 95% CI: 1.03-1.12). CONCLUSIONS: The addition of S. boulardii to bismuth quadruple therapy significantly increased H. pylori eradication rates and decreased the adverse effects. We recommend adding 500 mg/day S. boulardii concurrently with bismuth quadruple therapy and continuing this therapy for > 10 days for optimal H. pylori eradication efficacy. © 2025. The Author(s).

To determine the potential benefit of adding Saccharomyces boulardii (S. boulardii) probiotic supplementation to conventional treatments in asthmatic patients.In this randomized, double-blinded, and placebo-controlled trial 50 asthmatic patients were enrolled. The eligible subjects received either S. boulardii (N=25) or placebo (N=25) added to conventional treatments for three months. Spirometry parameters (FEV1, FVC, FEV1/FVC, and FEF 25-75%) and blood test parameters (CBC, eosinophil percentage, IgE, IL-5, ESR and CRP) were measured and compared at baseline and after treatment completion.The mean age was 39.22±12.55 years. As compared to baseline values, a significant improvement was noted in FEV1 in patients who received S. boulardii (p=0.026). Although the changes in FEV1, FVC, FEV1/FVC, and FEF 25-75% were comparable between the study groups, the differences were not statistically significant (p ˃ 0.05). In addition, patients who received probiotic showed lower levels of IL-5 and IgE in comparison with patients who received placebo.Our findings showed that the addition of S. boulardii to conventional treatments partially improved the pulmonary function and was associated with reductions in IgE and IL-5 levels. Thieme. All rights reserved.

Sprint interval training (SIT), which consists of vigorous-intensity exercise interspersed with periods of rest or low-intensity exercise, can improve human anaerobic performance. Probiotic strains, including yeasts (e.g. Saccharomyces boulardii; Sb), have beneficial effects on human health; however, evidence regarding the effects of probiotics on anaerobic performance is unavailable. The current study investigated whether Sb supplementation influences the SIT-induced changes to the following performance variables: peak (PPO) and mean (MPO) power output. Fifteen healthy individuals (twelve men and three women) were randomly divided into two groups: placebo (PLA; n=8) and Sb (n=7). The individuals performed six SIT sessions on a cycle ergometer (four to seven 30-s all-out sprints thrice weekly). During the training period, participants ingested a capsule containing PLA or at least 1×109 Sb cells daily for 14 days. Performance-related variables were compared between the first and last training sessions. Sb supplementation did not influence the changes in PPO and MPO across the two weeks of training (P>0.05); therefore, the data from both groups were analyzed collectively to assess performance changes induced by SIT. Training increased PPO, an index of anaerobic power, in the sixth session compared to the first session (by 8±11% in the first sprint; +1.0±1.2 W/kg; P=0.008) but did not change MPO. In conclusion, short-term SIT improved the participants' anaerobic performance (power), as evidenced by increased PPO. Sb supplementation did not affect the improved anaerobic power caused by SIT.

BACKGROUND: Currently, Vonoprazan (VPZ) and amoxicillin dual regimen (VA-dual) has not achieved satisfied efficacy as the first-line treatment for Helicobacter pylori (H. pylori) infection in China. Thus, we aimed to determine the effect of VA-dual plus Saccharomyces boulardii (S. boulardii) on H. pylori eradication rate. METHODS: Naive H. pylori-infected patients were randomly allocated to the ECAB group [20-mg esomeprazole, 500-mg clarithromycin, 1000-mg amoxicillin, and 220-mg bismuth twice/day for 14 days] or the VAS group [20-mg VPZ twice/day, 750-mg amoxicillin three times/day, and 250-mg S. boulardii twice/day for 10 days]. Factors associated with eradication success were explored, and cost-effectiveness analyses were also performed. RESULTS: Herein, 126 patients were finally included and randomly assigned to the two groups in a 1:1 ratio. The H. pylori eradication rates of VAS and ECAB groups by intention-to-treat analysis were 87.3% and 88.9% (P = 1.000) and by per-protocol analysis were 87.3% and 91.8% (P = 0.560), respectively. The ECAB group had a significantly higher incidence of adverse events than the VAS group. Superior H. pylori eradication in the VAS group was related to small body surface area and being a non-smoker. The cost-effectiveness ratio of the VAS group was less than that of the ECAB group. CONCLUSIONS: Addition of S. boulardii to VA-dual for 10 days is as effective as the 14-days bismuth-based quadruple regimen while ensuring fewer adverse events and lesser cost. This regimen is particularly suitable for low-BSA patients or non-smokers. TRIAL REGISTRATION: Chinese Clinical trial Registry No. ChiCTR2100055101 31/12/2021. © 2024. The Author(s).

OBJECTIVES: To evaluate the preventive effects of Saccharomyces boulardii powder and tetragenous viable Bifidobacterium tablets on antibiotic-associated diarrhea (AAD) in infants and young children. METHODS: Children under three years old admitted to the Department of Pediatrics, Affiliated Hospital of Xuzhou Medical University due to non-gastrointestinal infections and requiring antibiotic treatment from July to December 2023 were enrolled. The children were randomly divided into a control group (n=47), a Saccharomyces boulardii group (n=70), and a Bifidobacterium group (n=65) using a random number table method. The control group received antibiotics and symptomatic supportive treatment according to relevant clinical guidelines. In addition to the treatment given to the control group, the Saccharomyces boulardii group and the Bifidobacterium group were respectively administered with Saccharomyces boulardii powder and tetragenous viable Bifidobacterium tablets. Based on the duration of probiotic use (7 days, 14 days, and 21 days), the Saccharomyces boulardii group was further divided into 7 d, 14 d, and 21 d subgroups, and similarly for the Bifidobacterium group. The incidence of AAD and ratio of cocci to bacilli in feces were compared among the groups after treatment. RESULTS: The incidence rate of AAD in both the Saccharomyces boulardii group and the Bifidobacterium group was lower than that in the control group (P<0.017). The duration of AAD and the length of hospital stay were shorter in the Saccharomyces boulardii and Bifidobacterium groups compared to the control group (P<0.05). In the control group, the ratio of cocci to bacilli in feces on days 7, 14, and 21 was higher than on day 1 (P<0.05). Within-group comparisons showed that the ratio of cocci to bacilli in feces on day 14 in the Bifidobacterium 14 d and 21 d groups were lower than on day 1 (P<0.05); and the ratios on day 14 in the control group, Saccharomyces boulardii 14 d group, Saccharomyces boulardii 21 d group, Bifidobacterium 14 d group, and Bifidobacterium 21 d group were lower than on day 7 (P<0.05). The ratios on day 21 in the control group and the Saccharomyces boulardii 21 d group were lo

Obesity is often accompanied by low-grade chronic inflammation and metabolic syndrome. It has been established that microbiota influences many physiological processes, including the development of obesity, and dysbiosis has been observed in obese individuals. In this study, we aimed to evaluate the impact of a new probiotic formulation, containing two probiotic strains and the bioactive compound octacosanol, on body weight, metabolic parameters, and concentrations of certain adipocytokines and appetite-regulating hormones in obese women. This double blind placebo-controlled supplementary intervention study included twenty-five women in the intervention group and twenty-three in the placebo group, and it lasted 12 weeks. Daily oral supplementation included 7 × 1010 CFU of Lactiplantibacillus plantarum 299v (DSM9843), 5 × 109 CFU of Saccharomyces cerevisiae var. boulardii (DBVPG6763), and 40 mg of octacosanol or placebo. Body weight, metabolic parameters, adipocytokines, and appetite-regulating hormones were assessed before (T0) and after the intervention (T1). After the intervention, significantly lower median concentrations of CRP (p = 0.005) and IL-6 (p = 0.012) were measured in the intervention group than the baseline, while the median concentrations of ghrelin (p = 0.026) and HDL-cholesterol (p = 0.03) were significantly increased. The intervention group had lower CRP levels (p = 0.023) and higher ghrelin levels (p = 0.006) than the placebo group. Significant changes in BMI between groups were not observed. In summary, although the new probiotic formulation showed beneficial effects on IL-6, CRP, HDL, and ghrelin levels, its potential effects on regulating triglyceride, insulin, and glucose levels require further studies before the novel dietary intervention could be considered a useful adjuvant therapy and an effective strategy for the management of obesity and obesity-associated comorbidities.

To assess the effectiveness and safety of combining Saccharomyces boulardii powder with triple therapy as a primary approach for eradicating H. pylori infection, a total of 144 patients who tested positive for H. pylori and diagnosed with non-ulcer dyspepsia underwent endoscopy at two national centers between June 2017 and March 2019 were included. The patients were categorized into three groups using a subsection randomization method and received initial H. pylori eradication treatments. Microbial composition, eradication rates, symptom alleviation, and adverse reactions were monitored on the 14th and 44th days post-treatment. According to PP analysis showed the eradication rates for the SRAC group was 75%, BRAC was 93.18% and RAC was 65.2%. Group BRAC exhibited a marginally higher eradication rate compared to other groups. However, patients receiving Saccharomyces boulardii treatment exhibited an overall reduction in initial dyspepsia symptoms by the end of the treatment period. When employed as a primary strategy, the combination of Saccharomyces boulardii powder with triple therapy displayed notable efficacy and smaller gastrointestinal side effects in eradicating initial H. pylori infections among non-ulcer dyspepsia patients. Moreover, this approach demonstrated advantages in alleviating symptoms, exhibited favorable tolerance, and maintained a high level of clinical safety. © 2024. The Author(s).