S. boulardii supplements may reduce risk of antibiotic-associated diarrhea: Meta-analysis

By Stephen DANIELLS

- Last updated on GMT

Image © iStockPhoto / Jezperklauzen
Image © iStockPhoto / Jezperklauzen

Related tags: Clostridium difficile

Probiotic supplements containing Saccharomyces boulardii may reduce the risk of antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea, says a new meta-analysis of 21 randomized controlled trials.

Scientists from the Medical University of Warsaw report that data from 4,780 participants indicated that S. boulardii ​was associated with a 9% reduction in the risk of antibiotic-associated diarrhea (AAD) in adults and a 12% reduction in risk in children.

A beneficial effect was also observed for C. difficile​-associated diarrhea (CDAD), but only in children, they wrote in Alimentary Pharmacology & Therapeutics​.

The issue

Antibiotics treatment is known to disturb the beneficial bacteria that live in the gut, and it may allow other harmful bacteria like C. difficile​ to take hold. Although some people infected with C. difficile​ show no symptoms, others suffer diarrhea or colitis.

Because CDAD is expensive to treat many research groups have investigated if and how probiotic foods and supplements may offer a safe, low-cost way to help reduce the risk of CDAD.

Probiotics are defined by FAO/WHO as ‘Live microorganisms which when administered in adequate amounts confer a health benefit on the host’.

Meta-analysis details

The new meta-analysis is an update of a 2005 meta-analysis by the same Warsaw-based scientists, and 16 of the trials identified were new. The 21 RCTs were identified from the Cochrane Library, MEDLINE, and EMBASE databases up until May 2015.

The pooled data indicated that S. boulardii ​reduced AAD from 17.4% to 8.2% in adults, while the risk was reduced from 20.9% to 8.8% in children.

The probiotic was also associated with a reduction in the risk of CDAD, but only in children.

“This systematic review and meta-analysis has confirmed our previous findings that ​S. boulardii administration, concomitantly with antibiotics, compared with placebo or no intervention, reduces the risk of AAD in adults and children treated with antibiotics for any reason,”​ they wrote.

“The optimal dose of probiotics, including ​S. boulardii, has not been established,” ​they added. “However, at least one recent study showed that probiotic efficacy improves in a dose-dependent manner.

“In the current systematic review and meta-analysis, various doses of ​S. boulardii were used with no clear dose-dependent effect. Until more data on the optimal dose of ​S. boulardii become available, a daily dose of not less than 250 mg but not more than 500 mg in children and not more than 1000 mg in adults could be used to match the doses used in RCTs.”

Source: Alimentary Pharmacology & Therapeutics
October 2015, Volume 42, Issue 7, pages 793–801, doi: 10.1111/apt.13344
“Systematic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea”
Authors: H. Szajewska, M. Kołodziej

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