Prevention of beta-lactam-associated diarrhea by Saccharomyces boulardii compared with placebo.
OBJECTIVE
To determine the safety and efficacy of a new preventive agent for antibiotic-associated diarrhea (AAD) in patients receiving at least one beta-lactam antibiotic.


METHODS
A double-blinded, placebo-controlled, parallel group study was performed in a high-risk group of hospitalized patients receiving a new prescription for a beta-lactam antibiotic and having no acute diarrhea on enrollment. Lyophilized Saccharomyces boulardii or placebo (1 g/day) was given within 72 h of the start of the antibiotic(s) and continued until 3 days after the antibiotic was discontinued, after which the patients were followed for 7 wk.


RESULTS
Of the 193 eligible patients, significantly fewer, 7/97 (7.2%), patients receiving S. boulardii developed AAD compared with 14/96 (14.6%) on placebo (p = 0.02). The efficacy of S. boulardii for the prevention of AAD was 51%. Using a multivariate model to adjust for two independent risk factors for AAD (age and days of cephalosporin use), the adjusted relative risk was significantly protective for S. boulardii (RR = 0.29, 95% CI = 0.08, 0.98).


CONCLUSIONS
The prophylactic use of S. boulardii given with a beta-lactam antibiotic resulted in a significant reduction of AAD with no serious adverse reactions.
McFarland
L V
LV
Department of Medicinal Chemistry, University of Washington, Seattle.
Surawicz
C M
CM
Greenberg
R N
RN
Elmer
G W
GW
Moyer
K A
KA
Melcher
S A
SA
Bowen
K E
KE
Cox
J L
JL
D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification; D003967:Diarrhea / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control*; D004311:Double-Blind Method; D004363:Drug Utilization / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D012440:Saccharomyces; D013997:Time Factors; D015002:Yeast, Dried / Q000627:therapeutic use*; D047090:beta-Lactams
D000900:Anti-Bacterial Agents; D047090:beta-Lactams