title: Systematic review and meta-analysis of Saccharomyces boulardii in adult patients.
abstract: This article reviews the evidence for efficacy and safety of Saccharomyces boulardii (S. boulardii) for various disease indications in adults based on the peer-reviewed, randomized clinical trials and pre-clinical studies from the published medical literature (Medline, Clinical Trial websites and meeting abstracts) between 1976 and 2009. For meta-analysis, only randomized, blinded controlled trials unrestricted by language were included. Pre-clinical studies, volunteer studies and uncontrolled studies were excluded from the review of efficacy and meta-analysis, but included in the systematic review. Of 31 randomized, placebo-controlled treatment arms in 27 trials (encompassing 5029 study patients), S. boulardii was found to be significantly efficacious and safe in 84% of those treatment arms. A meta-analysis found a significant therapeutic efficacy for S. boulardii in the prevention of antibiotic-associated diarrhea (AAD) (RR = 0.47, 95% CI: 0.35-0.63, P < 0.001). In adults, S. boulardii can be strongly recommended for the prevention of AAD and the traveler's diarrhea. Randomized trials also support the use of this yeast probiotic for prevention of enteral nutrition-related diarrhea and reduction of Helicobacter pylori treatment-related symptoms. S. boulardii shows promise for the prevention of C. difficile disease recurrences; treatment of irritable bowel syndrome, acute adult diarrhea, Crohn's disease, giardiasis, human immunodeficiency virus-related diarrhea; but more supporting evidence is recommended for these indications. The use of S. boulardii as a therapeutic probiotic is evidence-based for both efficacy and safety for several types of diarrhea.
authors.forename: Lynne V
authors.initials: LV
authors.lastname: McFarland
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000075202:Contraindications; D003967:Diarrhea / Q000209:etiology / Q000517:prevention & control; D004750:Enteral Nutrition / Q000009:adverse effects; D019317:Evidence-Based Medicine; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology / Q000517:prevention & control; D007422:Intestines / Q000382:microbiology; D017410:Practice Guidelines as Topic; D019936:Probiotics / Q000009:adverse effects / Q000627:therapeutic use*; D012440:Saccharomyces / Q000145:classification; D014195:Travel; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
references.citation: Emerg Infect Dis. 2008 Jun;14(6):929-31
references.pmid: 18507904
references.citation: J Clin Microbiol. 2001 Feb;39(2):551-9
references.pmid: 11158105
references.citation: Clin Infect Dis. 1996 Jan;22(1):200-1
references.pmid: 8825013
references.citation: BMC Microbiol. 2007 Sep 27;7:86
references.pmid: 17900343
references.citation: Pediatrics. 2002 Apr;109(4):678-84
references.pmid: 11927715
references.citation: Nat Clin Pract Gastroenterol Hepatol. 2008 Jan;5(1):40-8
references.pmid: 18174906
references.citation: CMAJ. 2006 Aug 15;175(4):377-83
references.pmid: 16908901
references.citation: Curr Opin Gastroenterol. 2008 Jan;24(1):4-10
references.pmid: 18043225
references.citation: Pediatr Res. 1994 Oct;36(4):522-7
references.pmid: 7816529
references.citation: Am J Clin Nutr. 2006 Jun;83(6):1256-64; quiz 1446-7
references.pmid: 16762934
references.citation: Inflamm Bowel Dis. 2008 May;14(5):709-20
references.pmid: 18095316
references.citation: Can Vet J. 2003 Dec;44(12):982-3
references.pmid: 14703084
references.citation: Rev Med Chil. 2009 May;137(5):719-20
references.pmid: 19701565
references.citation: Curr Infect Dis Rep. 2002 Feb;4(1):70-77
references.pmid: 11853660
references.citation: Poult Sci. 1994 Nov;73(11):1766-70
references.pmid: 7862617
references.citation: BMJ. 1997 Dec 6;315(7121):1533-7
references.pmid: 9432252
references.citation: Nestle Nutr Workshop Ser Pediatr Program. 2009;64:201-13; discussion 213-7, 251-7
references.pmid: 19710524
references.citation: Travel Med Infect Dis. 2007 Mar;5(2):97-105
references.pmid: 17298915
references.citation: Am J Gastroenterol. 2000 Jan;95(1 Suppl):S2-4
references.pmid: 10634218
references.citation: Aliment Pharmacol Ther. 1999 Dec;13(12):1663-8
references.pmid: 10594402
references.citation: Eur J Gastroenterol Hepatol. 2005 Dec;17(12):1357-61
references.pmid: 16292090
references.citation: Biopharm Drug Dispos. 1989 Jul-Aug;10(4):353-64
references.pmid: 2758101
references.citation: Med Sci Monit. 2006 Apr;12(4):PI19-22
references.pmid: 16572062
references.citation: PLoS Genet. 2009 May;5(5):e1000483
references.pmid: 19436717
references.citation: J Clin Microbiol. 2005 Mar;43(3):1133-7
references.pmid: 15750073
references.citation: Gastroenterology. 1993 Apr;104(4):1108-15
references.pmid: 8462799
references.citation: Eur J Gastroenterol Hepatol. 2003 Jun;15(6):697-8
references.pmid: 12840682
references.citation: Biol Pharm Bull. 2008 Feb;31(2):266-72
references.pmid: 18239285
references.citation: Z Gastroenterol. 1993 Feb;31(2):129-34
references.pmid: 8465554
references.citation: Am J Gastroenterol. 2006 Jan;101(1):124-32
references.pmid: 16405544
references.citation: Lancet. 1994 Jan 15;343(8890):171-2
references.pmid: 7904014
references.citation: Clin Infect Dis. 2008 Feb 1;46 Suppl 2:S73-5; discussion S144-51
references.pmid: 18181727
references.citation: Pediatr Int. 2009 Feb;51(1):156-8
references.pmid: 19371301
references.citation: Nephrol Dial Transplant. 2000 May;15(5):571-4
references.pmid: 10809792
references.citation: J Pediatr Gastroenterol Nutr. 1993 May;16(4):419-25
references.pmid: 8315551
references.citation: Rev Inst Med Trop Sao Paulo. 2009 Mar-Apr;51(2):59-65
references.pmid: 19390732
references.citation: Anaerobe. 2008 Oct;14(4):229-33
references.pmid: 18511310
references.citation: Biometrics. 1994 Dec;50(4):1088-101
references.pmid: 7786990
references.citation: Hong Kong Med J. 2007 Dec;13(6):436-41
references.pmid: 18057431
references.citation: Scand J Gastroenterol. 1992;27(3):196-200
references.pmid: 1502481
references.citation: Pediatr Res. 2006 Jul;60(1):24-9
references.pmid: 16690953
references.citation: Dig Dis Sci. 2008 Mar;53(3):704-11
references.pmid: 17717743
references.citation: Clin Infect Dis. 2008 Feb 1;46 Suppl 2:S76-9; discussion S144-51
references.pmid: 18181728
references.citation: Br J Gen Pract. 2007 Dec;57(545):953-9
references.pmid: 18252070
references.citation: Microb Pathog. 2002 May;32(5):219-25
references.pmid: 12071678
references.citation: Inflamm Bowel Dis. 2009 Feb;15(2):300-10
references.pmid: 18626975
references.citation: N Engl J Med. 1989 Jan 26;320(4):204-10
references.pmid: 2911306
references.citation: Appl Environ Microbiol. 1999 Nov;65(11):4949-56
references.pmid: 10543808
references.citation: J Clin Gastroenterol. 2008 Mar;42(3):239-43
references.pmid: 18223503
references.citation: Clin Infect Dis. 1995 Jun;20(6):1581
references.pmid: 7548528
references.citation: Infect Immun. 2003 Feb;71(2):766-73
references.pmid: 12540556
references.citation: J Infect. 1998 Mar;36(2):171-4
references.pmid: 9570649
references.citation: Aliment Pharmacol Ther. 2005 Sep 1;22(5):365-72
references.pmid: 16128673
references.citation: Clin Infect Dis. 2008 Feb 1;46 Suppl 2:S53-7
references.pmid: 18181723
references.citation: Infez Med. 2008 Dec;16(4):227-9
references.pmid: 19155689
references.citation: J Int Med Res. 2007 Mar-Apr;35(2):201-12
references.pmid: 17542407
references.citation: Clin Infect Dis. 2005 Dec 1;41(11):1559-68
references.pmid: 16267727
references.citation: PLoS Biol. 2008 Nov 18;6(11):e280
references.pmid: 19018661
references.citation: J Clin Microbiol. 1998 Sep;36(9):2613-7
references.pmid: 9705402
references.citation: Clin Infect Dis. 2007 Nov 1;45(9):1141-51
references.pmid: 17918075
references.citation: J Anim Sci. 2009 Mar;87(3):922-34
references.pmid: 19028865
references.citation: J Med Assoc Thai. 2007 Mar;90(3):513-7
references.pmid: 17427529
references.citation: Clin Infect Dis. 2008 Feb 15;46(4):497-504
references.pmid: 18197759
references.citation: World J Gastroenterol. 2005 Oct 21;11(39):6165-9
references.pmid: 16273644
references.citation: Clin Exp Immunol. 2009 Apr;156(1):78-87
references.pmid: 19161443
references.citation: Aliment Pharmacol Ther. 2009 Oct 15;30(8):826-33
references.pmid: 19706150
references.citation: Acta Med Port. 1981 Mar-Apr;3(2):143-5
references.pmid: 7032230
references.citation: J Hosp Infect. 2000 Jul;45(3):235-7
references.pmid: 10896804
references.citation: Mycoses. 2009 Jan;52(1):29-34
references.pmid: 18627477
references.citation: Clin Infect Dis. 1995 Jun;20 Suppl 2:S266-8
references.pmid: 7548571
references.citation: Dig Dis Sci. 2004 Aug;49(7-8):1311-7
references.pmid: 15387362
references.citation: Parasitol Res. 2009 Sep;105(3):681-7
references.pmid: 19404678
references.citation: Gastroenterology. 1989 Apr;96(4):981-8
references.pmid: 2494098
references.citation: J Gen Appl Microbiol. 2005 Apr;51(2):83-92
references.pmid: 15942869
references.citation: Clin Infect Dis. 2008 Feb 1;46 Suppl 2:S67-72; discussion S144-51
references.pmid: 18181726
references.citation: Gastroenterol Clin Biol. 1986 Jan;10(1):13-6
references.pmid: 3956910
references.citation: Am J Gastroenterol. 2002 Nov;97(11):2744-9
references.pmid: 12425542
references.citation: Jpn J Antibiot. 2007 Aug;60(4):221-41
references.pmid: 18018419
references.citation: Comp Immunol Microbiol Infect Dis. 2007 Jul;30(4):261-8
references.pmid: 17434586
references.citation: Am J Infect Control. 2007 May;35(4):237-53
references.pmid: 17482995
references.citation: Antimicrob Agents Chemother. 1984 Oct;26(4):552-6
references.pmid: 6517545
references.citation: Gastroenterology. 2008 Aug;135(2):568-79
references.pmid: 18570896
references.citation: Fortschr Med. 1993 Mar 30;111(9):152-6
references.pmid: 8486328
references.citation: Rev Med Chil. 2008 Aug;136(8):981-8
references.pmid: 18949181
references.citation: Digestion. 1996;57(2):95-104
references.pmid: 8786007
references.citation: BMJ. 2007 Jul 14;335(7610):80
references.pmid: 17604300
references.citation: Intensive Care Med. 1997 May;23(5):517-23
references.pmid: 9201523
references.citation: Clin Vaccine Immunol. 2008 Sep;15(9):1472-82
references.pmid: 18579692
references.citation: JAMA. 1994 Jun 22-29;271(24):1913-8
references.pmid: 8201735
references.citation: J Pediatr Gastroenterol Nutr. 2008 May;46(5):608-11
references.pmid: 18493222
references.citation: Rev Iberoam Micol. 2009 Jun 30;26(2):155-60
references.pmid: 19631167
references.citation: Clin Infect Dis. 2006 Mar 1;42(5):e35-44
references.pmid: 16447101
references.citation: Arch Microbiol. 2009 Aug;191(8):623-30
references.pmid: 19526225
references.citation: Int J Food Microbiol. 2005 Jul 15;102(2):221-30
references.pmid: 15992621
references.citation: BMJ. 2007 Nov 17;335(7628):1033
references.pmid: 17977817
references.citation: J Gen Microbiol. 1990 Jun;136(6):1085-9
references.pmid: 2200843
references.citation: Dig Dis Sci. 2000 Jul;45(7):1462-4
references.pmid: 10961730
references.citation: Future Microbiol. 2008 Oct;3(5):563-78
references.pmid: 18811240
references.citation: Mycoses. 1999;42(4):261-4
references.pmid: 10424093
references.citation: Infect Immun. 1996 Dec;64(12):5225-32
references.pmid: 8945570
references.citation: MedGenMed. 2006 Jul 26;8(3):20
references.pmid: 17406160
references.citation: Eur J Clin Microbiol Infect Dis. 2000 Jan;19(1):16-20
references.pmid: 10706174
references.citation: Anaerobe. 2009 Dec;15(6):274-80
references.pmid: 19825425
references.citation: Clin Infect Dis. 2002 Feb 1;34(3):346-53
references.pmid: 11774082
references.citation: Am J Gastroenterol. 2006 Apr;101(4):812-22
references.pmid: 16635227
references.citation: CMAJ. 2005 Oct 25;173(9):1037-42
references.pmid: 16179431
references.citation: Appl Environ Microbiol. 2007 Apr;73(8):2458-67
references.pmid: 17293506
references.citation: Infect Immun. 2000 Oct;68(10):5998-6004
references.pmid: 10992512
references.citation: Dig Dis Sci. 2010 Apr;55(4):911-9
references.pmid: 19437118
references.citation: World J Gastroenterol. 2003 Aug;9(8):1832-3
references.pmid: 12918131
references.citation: Am J Gastroenterol. 1989 Oct;84(10):1285-7
references.pmid: 2679049
references.citation: Infect Control Hosp Epidemiol. 2008 Sep;29(9):823-8
references.pmid: 18643746
references.citation: Eur J Gastroenterol Hepatol. 2007 Sep;19(9):795-9
references.pmid: 17700266
references.citation: Can J Microbiol. 2004 Aug;50(8):615-21
references.pmid: 15467787
references.citation: Med Oncol. 2009;26(3):350-7
references.pmid: 19067257
references.citation: Yeast. 2008 Jul;25(7):501-12
references.pmid: 18615862
references.citation: Scand J Gastroenterol. 2000 Feb;35(2):160-5
references.pmid: 10720113
references.citation: BMC Med Res Methodol. 2004 Mar 16;4:5
references.pmid: 15070427
references.citation: J Clin Gastroenterol. 2005 May-Jun;39(5):385-9
references.pmid: 15815206
references.citation: Adv Ther. 2009 Aug;26(8):795-804
references.pmid: 19672568
references.citation: World J Gastroenterol. 2008 May 7;14(17):2650-61
references.pmid: 18461650
references.citation: J Appl Microbiol. 2002;93(4):521-30
references.pmid: 12234334
references.citation: Am J Gastroenterol. 2002 Jul;97(7):1769-75
references.pmid: 12135033
references.citation: Scand J Gastroenterol. 2008;43(12):1489-96
references.pmid: 18777247
references.citation: J Gen Appl Microbiol. 2008 Aug;54(4):221-7
references.pmid: 18802321
references.citation: Cochrane Database Syst Rev. 2007 Apr 18;(2):CD004827
references.pmid: 17443557
references.citation: Infect Immun. 1999 Jan;67(1):302-7
references.pmid: 9864230
references.citation: Aliment Pharmacol Ther. 2007 Sep 15;26(6):767-78
references.pmid: 17767461
references.citation: Acta Paediatr. 2005 Dec;94(12):1747-51
references.pmid: 16421034
references.citation: Dig Dis Sci. 2009 Jan;54(1):15-8
references.pmid: 18528758
references.citation: Rev Salud Publica (Bogota). 2009 Jan-Feb;11(1):72-81
references.pmid: 19721981
references.citation: Am J Gastroenterol. 1995 Mar;90(3):439-48
references.pmid: 7872284
references.citation: Clin Infect Dis. 2000 Oct;31(4):1012-7
references.pmid: 11049785
references.citation: Scand J Infect Dis. 2006;38(6-7):479-81
references.pmid: 16798698
references.citation: Lancet. 2001 Jan 20;357(9251):189-93
references.pmid: 11213096
references.citation: Infect Control Hosp Epidemiol. 2007 Nov;28(11):1219-27
references.pmid: 17926270
references.citation: Am J Clin Nutr. 2009 Jan;89(1):240-7
references.pmid: 19056551
references.citation: Nutr J. 2007 Oct 24;6:30
references.pmid: 17958896
references.citation: Aliment Pharmacol Ther. 2005 Mar 1;21(5):583-90
references.pmid: 15740542
references.citation: Scand J Gastroenterol. 2008;43(7):842-8
references.pmid: 18584523
references.citation: Acta Paediatr. 2009 Jan;98(1):127-31
references.pmid: 18681892
references.citation: Infect Immun. 1995 Feb;63(2):478-85
references.pmid: 7822013
references.citation: J Surg Res. 2010 May 1;160(1):139-44
references.pmid: 19375719
references.citation: Ann Microbiol (Paris). 1982 Nov-Dec;133(3):491-501
references.pmid: 6762128
references.citation: Br J Surg. 2000 Nov;87(11):1448-54
references.pmid: 11091231
references.citation: Can J Microbiol. 1991 Apr;37(4):315-7
references.pmid: 1913342
references.citation: Lett Appl Microbiol. 2009 Dec;49(6):738-44
references.pmid: 19780950
references.citation: J Am Board Fam Pract. 2000 Mar-Apr;13(2):138-40
references.pmid: 10764197
references.citation: Gastroenterology. 2006 Dec;131(6):1812-25
references.pmid: 17087945
references.citation: Eur J Pediatr. 2009 Mar;168(3):253-65
references.pmid: 19096876
references.citation: Z Gastroenterol. 2007 Aug;45(8):715-7
references.pmid: 17701862
references.citation: J Appl Bacteriol. 1996 Sep;81(3):251-6
references.pmid: 8810053
references.citation: J Infect Dis. 1990 Sep;162(3):678-84
references.pmid: 2387993
references.citation: N Engl J Med. 1991 Oct 17;325(16):1132-6
references.pmid: 1891021
references.citation: Int J Food Microbiol. 2005 Sep 15;103(3):295-304
references.pmid: 16099314
references.citation: Meded Rijksuniv Gent Fak Landbouwkd Toegep Biol Wet. 2001;66(3b):535, 537-42
references.pmid: 15954650
references.citation: Appl Environ Microbiol. 1991 Oct;57(10):3049-51
references.pmid: 1746964
references.citation: Gastroenterology. 2009 May;136(6):2015-31
references.pmid: 19462507
references.citation: Acta Paediatr. 2010 Feb;99(2):279-82
references.pmid: 19839955
references.citation: Appl Environ Microbiol. 1998 Feb;64(2):564-8
references.pmid: 9464394
references.citation: J Appl Microbiol. 2008 Dec;105(6):1919-28
references.pmid: 19120638
references.citation: J Biol Chem. 2006 Aug 25;281(34):24449-54
references.pmid: 16816386
references.citation: J Pediatr Gastroenterol Nutr. 2003 Jul;37(1):22-6
references.pmid: 12827001
references.citation: Helicobacter. 2007 Aug;12(4):309-16
references.pmid: 17669103
references.citation: J Clin Pharm Ther. 2000 Apr;25(2):101-9
references.pmid: 10849187
references.citation: Sem Hop. 1983 May 5;59(18):1409-12
references.pmid: 6306827
references.citation: Am J Physiol Gastrointest Liver Physiol. 2008 Jan;294(1):G295-306
references.pmid: 18032474
references.citation: Pharm Res. 1993 Nov;10(11):1615-9
references.pmid: 8290474
references.citation: Curr Opin Gastroenterol. 2007 Nov;23(6):679-92
references.pmid: 17906447
references.citation: Clin Ther. 2000 Jan;22(1):91-102
references.pmid: 10688393
references.citation: JAMA. 1996 Mar 20;275(11):870-6
references.pmid: 8596226
references.citation: Dig Dis Sci. 1999 Nov;44(11):2359-68
references.pmid: 10573387