Saccharomyces boulardii is a probiotic yeast that supports the digestive system and skin health by providing a barrier to harmful pathogens. The strongest evidence for consideration of this supplement’s use is included here. Probiotics work in general by lowering intestinal pH, decreasing numbers of harmful organisms, and improving immune response. Saccharomyces boulardii has been found to be effective in treating antibiotic associated diarrhea, Clostridium difficile colitis, and acne. It is generally advised that a probiotic supplement should contain several billion microorganisms for it to be effective. Probiotics are considered safe and well tolerated in patients with an intact immune system, however caution should be taken in patients who are critically ill, on chemotherapy or immunocompromised. The most common side-effects include bloating and flatulence. (1)
Probiotics and antibiotic associated diarrhea:
Saccharomyces boulardii and antibiotic associated diarrhea: Researchers analyzed 5 randomized clinical trials (n=1076) of Saccharomyces boulardii (S boulardii) and found a significantly protective effect for antibiotic-associated diarrhea (AAD). Compared with placebo, S boulardii was associated with a 57% risk reduction in AAD. (2)
A review of double-blind trials: Probiotics such as saccharomyces boulardii and lactobacillus may have a protective effect against antibiotic-associated diarrhea (AAD) and clostridium difficile colitis caused by bacteria in the gut. A review of the literature found 3 randomized, double-blind, controlled clinical trials that report beneficial effects of S boulardii in AAD. Two separate double-blind controlled studies showed the benefits of Lactobacillus acidophilus and bulgaricus. Some other studies, not double-blind, report beneficial effect of Lactobacillus rhamnosus GG, Bifidobacterium longum and Enterococcus faecium SF68. (3)
A meta-analysis on 25 randomized controlled trials: A meta-analysis reviewed 25 randomized controlled trials (RTCs) examining the use of probiotics for the prevention of antibiotic-associated diarrhea (AAD) and 6 randomized controlled trials of probiotic therapy for the treatment/prevention of clostridium difficile colitis (CDD). Results show that probiotics significantly reduced the relative risk of AAD by 57% and CDD by 41%. The meta-analysis revealed that Lactobacillus rhamnosus GG, S. boulardii, and various mixtures of two probiotic strains significantly reduced the frequency of AAD. However, only S. boulardii decreased the recurrence of CDD. (4)
Probiotic supplementation and acne:
Results of a randomized, placebo-controlled clinical trial with 139 acne patients demonstrated that Saccharomyces cerevisiae Hansen CBS 5926 (Perenterol) also known as Saccharomyces boulardii healed or substantially improved acne in over 80% of the treatment group, compared to 26% in the placebo group. The results of the study were rated by physicians as very good/good in 74.3% of the patients receiving the treatment, as compared with 21.7% in the placebo group. There were no serious adverse side effects reported in this 5-month study. (5)
Assessment and Plan: Saccharomyces boulardii
- Saccharomyces boulardii has been found in at least 2 well designed meta-analyses to be effective in treating antibiotic associated diarrhea with a relative risk reduction of over 50% (2,3,4).
- Saccharomyces boulardii reduced the relative risk of Clostridium difficile colitis by 41% while also reducing the rate of recurrence (4).
- A randomized, placebo-controlled clinical trial by Weber G,et al found that Saccharomyces boulardii healed or substantially improved acne in over 80% of the treatment group, compared to 26% in the placebo group (5).
- Saccharomyces boulardii can be considered for use just prior to or at the same time as starting antibiotics. It is generally advised that a probiotic supplement should contain several billion microorganisms for it to be effective.
- Adverse reactions and interactions of Saccharomyces boulardii include the following: Saccharomyces boulardii appears safe and well tolerated in patients with an intact immune system, but caution should be taken in patients who are critically ill, on chemotherapy or immunocompromised. The most common side-effects include bloating and flatulence (1). In a 5 month, study, there were no serious adverse side effects reported (5).
References:
1.Williams NT. Probiotics. Am J Health Syst Pharm. 2010 Mar 15;67(6):449-58. http://www.ncbi.nlm.nih.gov/pubmed/20208051
2.Szajewska H, Mrukowicz J. Meta-analysis: non-pathogenic yeast Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Aliment Pharmacol Ther 2005 Sep 1; 22(5): 365-72. http://www.ncbi.nlm.nih.gov/pubmed/16128673
3.Cremonini F, Di Caro S, Santarelli L, et al. Probiotics in antibiotic-associated diarrhoea. Dig Liver Dis. 2002 Sep;34 Suppl 2:S78-80. http://www.ncbi.nlm.nih.gov/pubmed/12408447
4.McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol. 2006 Apr;101(4):812-822. http://www.ncbi.nlm.nih.gov/pubmed/16635227
5.Weber G, Adamczyk A, Freytag S. [Treatment of acne with a yeast preparation]. [Article in German] Fortschr Med. 1989 Sep 10;107(26):563-6. http://www.ncbi.nlm.nih.gov/pubmed/2530145