Systematic review with meta‐analysis: Saccharomyces boulardii in the prevention of antibiotic‐associated diarrhoea

Abstract

Summary Background Antibiotic‐associated diarrhoea is a common complication of antibiotic use, but it can be prevented with administration of probiotics. Aim To update our 2005 meta‐analysis on the effectiveness of Saccharomyces boulardii in preventing antibiotic‐associated diarrhoea in children and adults. Methods The Cochrane Library, MEDLINE, and EMBASE databases were searched up until May 2015, with no language restrictions, for randomised controlled trials; additional references were obtained from reviewed articles. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Results Twenty‐one randomised controlled trials (4780 participants), among which 16 were new trials, met the inclusion criteria for this updated systematic review. Administration of S. boulardii compared with placebo or no treatment reduced the risk of antibiotic‐associated diarrhoea (as defined by the study investigators) in patients treated with antibiotics from 18.7% to 8.5% (risk ratio, RR: 0.47; 95% CI: 0.38–0.57, number needed to treat, NNT: 10; 95% CI: 9–13). In children, S. boulardii reduced the risk from 20.9% to 8.8% (6 randomised controlled trials, n=1653, RR: 0.43, 95% CI: 0.3–0.6); in adults, from 17.4% to 8.2% (15 randomised controlled trials, n=3114, RR: 0.49, 95% CI: 0.38–0.63). Moreover, S. boulardii reduced the risk of Clostridium difficile‐associated diarrhoea; however, this reduction was significant only in children (2 randomised controlled trials, n = 579, RR: 0.25; 95% CI: 0.08–0.73) and not in adults (9 randomised controlled trials, n = 1441, RR: 0.8, 95% CI: 0.47–1.34). Conclusions This meta‐analysis confirms that S. boulardii is effective in reducing the risk of antibiotic‐associated diarrhoea in children and adults.

Saccharomyces boulardii Administration Changes Gut Microbiota and Attenuates D-Galactosamine-Induced Liver Injury

“…A great number of clinical trials and pre-clinical studies demonstrate the efficacy and safety of S. boulardii for various disease indications 24, 25 , such as irritable bowel syndrome, Crohn’s disease, and diarrhea with different causes. Recently, further evidence suggests that S. boulardii can promote the liver function and ameliorate liver fibrosis 26 , hepatic steatosis 27 , and hepatic injury induced by infection 28 .…”

Epidemiology, Diagnosis, and Management of Clostridium difficile Infection in Patients with Inflammatory Bowel Disease

“…The role of probiotics in CDI remains poorly defined, based on a paucity of high quality evidence. Meta-analyses of numerous small studies have suggested an adjunctive role when taken alongside other antimicrobials in prevention of initial episodes and recurrence (95–98). One large RCT was unable to demonstrate a benefit of probiotics in reducing incident CDI, but did observe a trend toward reduction and with only 1% of the study population developing CDI, it was likely underpowered to detect a true difference (99).…”

Probiotic Bacterial and Fungal Strains: Claims with Evidence

“…In children, the reduction was from 20.9 to 8.8% (6 RCTs, n = 1,653, RR 0.43, 95% CI 0.30-0.60, NNT 9, 95% CI 7-12), and in adults, from 17.4 to 8.2% (15 RCTs, n = 3,114, RR 0.49, 95% CI 0.38-0.63, NNT 11, 95% CI 9-15) [11]. …”

“…The same meta-analysis found that S. boulardii administration reduced the risk of C. difficile -associated diarrhea; however, this reduction was statistically significant only in children (2 RCTs, n = 579, RR 0.25, 95% CI 0.08-0.73) and not in adults (9 RCTs, n = 1,441, RR 0.8, 95% CI 0.47-1.34) [11]. …”