Systematic review with meta‐analysis: Saccharomyces boulardii for treating acute gastroenteritis in children—a 2020 update

Abstract

Summary Background There is still controversy with regard to the efficacy of individual probiotic strains for the management of acute gastroenteritis. Aim To update evidence on use of Saccharomyces boulardii for treating acute gastroenteritis in children. Methods The Cochrane Library, MEDLINE and EMBASE databases were searched from inception to December 2019 for randomised controlled trials (RCTs) that compared use of S boulardii with no S boulardii (defined as placebo or no treatment). The grey literature was searched through Google search. Authors of the original papers and S boulardii manufacturers were contacted for additional data. Results Twenty‐nine RCTs (among them, 20 newly identified trials) were included. Only 38% of trials adequately generated their randomisation sequence, only 17% adequately concealed allocation and only one trial adequately blinded participants, study personnel and outcome assessors. However, 83% provided complete outcome data. None of the trials evaluated the effect of S boulardii on stool volume. Compared with placebo or no treatment, S boulardii use reduced the duration of diarrhoea (23 RCTs, n = 3450, mean difference −1.06 day, 95% CI −1.32 to −0.79; high heterogeneity [I2 = 90%]) (very low quality of evidence). S boulardii use was also associated with a reduced duration of hospitalisation (8 RCTs, n = 999, mean difference −0.85 day, 95% CI −1.35 to −0.34; I2 = 91%) (very low quality of evidence). S boulardii reduced the risk of diarrhoea on day 2 to day 7 (low quality of evidence). Conclusions In children with acute gastroenteritis, low‐ to very low‐quality evidence suggests that S boulardii confers a benefit for several diarrhoeal outcomes.

Probiotics in Pediatrics. A Review and Practical Guide

“…S. boulardii CNCM I-745 should be given at a dose of 250–750 mg a day, for 5–7 days [ 18 ]. A recent meta-analysis, including 29 RCTs, concluded that adding S. boulardii CNCM I-745 to standard rehydration therapy reduced the duration of diarrhea with one day and efficiency was only seen when administered within 72 h after the onset of symptoms [ 19 ]. Another meta-analysis by Feizizadeh et al showed on the other hand no clear beneficial effect in children with acute diarrhea.…”

Saccharomyces Cerevisiae Var. Boulardii Probiotic Yeasts As Etiological Agents Of Oportunistic Infections In Humans

“…Dzięki drożdżom możliwa stała się produkcja hormonów stosowanych w leczeniu cukrzycy, w tym prekursorów insuliny czy glukagonu, a także hormonu wzrostu (somatotropiny) [67,70]. Innymi przykładami enzymów wytwarzanych heterologicznie w komórkach drożdży są: galaktozydaza, glukoamylaza, α-amylaza oraz inwertaza [38,78,115]. Drożdże S. cerevisiae znalazły również zastosowanie w inżynierii wakcynacyjnej.…”

“…Drożdże S. cerevisiae var. boulardii posiadają szereg właściwości umożliwiających profilaktykę i leczenie wielu zaburzeń ze strony układu pokarmowego, między innymi biegunki związanej z antybiotykoterapią (najczęściej Clostridioides difficile), czy zakażeń wywoływanych przez patogeny jelitowe, takie jak: Shigella flexneri, enterokrwotoczne szczepy Escherichia coli, czy Candida albicans [17,33,90,109,111,114,115]. Pomimo dowiedzionej skuteczności preparatów probiotycznych i ich szerokiej dostępności, mechanizmy działania probiotyków nie są w pełni poznane.…”

Which Probiotic Is the Most Effective for Treating Acute Diarrhea in Children? A Bayesian Network Meta-Analysis of Randomized Controlled Trials

“…The derangement of intestinal microflora is the hallmark of diarrhea [5]. Probiotics are live microorganisms and have been proved to be beneficial for treating diarrhea [6,7]. Probiotics show antidiarrheal activity via several mechanisms, including promoting intestinal microflora balance, enhancing host immunity, and enhancing the gut barrier function [5,[8][9][10][11].…”

“…Probiotics were recommended as adjuncts to effectively alleviate and treat diarrhea by clinical practice guidelines and numerous studies [7,[13][14][15]. Traditional pairwise meta-analysis only focused on one probiotic and failed to find the most effective probiotic [6,[16][17][18]. The most effective probiotic for children with acute diarrhea remains controversial.…”