Alternate Title

  • S. boulardii

Related Terms

  • Brewer’s yeast, Florastor®, Florastor® Kids, Hansen CBS 5926, Lactobacillus, Lactobacillus acidophilus, Lactobacillus bulgaricus, Lactobacillus gasseri, Lactobacillus GG, Lactobacillus plantarum, Perenterol®, probiotic, S. boulardii, Saccharomyces cerevisiae, Saccharomyces salivarius, Saccharomyces thermophilus, Saccharomycetaceae (family), Ultra-Levure®, yeast.
  • Note: There is debate as to whether Saccharomyces boulardii is a subspecies of Saccharomyces cerevisiae or a separate entity. Traditional techniques cannot distinguish the two, but manufacturers of Saccharomyces boulardii claim that the two yeasts are separate species.

Background

  • Saccharomyces boulardii is a non-pathogenic yeast strain that has been used for treatment and prevention of diarrhea. Saccharomyces boulardii is classified as a “probiotic,” or a microorganism that when ingested may have a positive influence on the host’s health. Probiotics may exert their effects on the gastrointestinal system directly, or may modulate the immune system in a larger scope.
  • Human studies indicate Saccharomyces boulardii may prevent antibiotic-associated diarrhea, Clostridium difficile diarrhea in combination with antibiotic therapy, diarrhea associated with tube feeds, and acute childhood diarrhea. Promising initial studies have shown that Saccharomyces boulardii may be beneficial in treating diarrhea associated with HIV.
  • The German Commission E has approved the use of Saccharomyces boulardii for symptomatic treatment of acute diarrhea, prophylactic and symptomatic treatment of diarrhea during travel, treatment of diarrhea occurring while tube feeding, use as an adjuvant for chronic acne, for a dietary supplementation, and for a source of B vitamins and protein.

Evidence Table

    Disclaimer

    These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

    Diarrhea (antibiotic associated)

    There is good evidence that concurrent use of Saccharomyces boulardii with antibiotic therapy reduces the incidence of developing antibiotic-associated diarrhea (AAD) (Clostridium difficile and other). In general, positive results occur only when Saccharomyces boulardii is continued for several days to several weeks after the course of antibiotics is stopped. Duplication of these results should still be attempted to confirm these findings.

    Diarrhea in children

    Several trials suggest efficacy of Saccharomyces boulardii in the treatment of diarrhea in childhood. Further studies are still required. Use of Saccharomyces boulardii may be advantageous in both the reduction of stool frequency per day and the duration of diarrhea in this age group.

    Antibacterial (amebiasis)

    Evidence from one clinical trial supports improvement of symptoms and in patients with amebiasis treated with Saccharomyces boulardii, in addition to standard therapy. Further clinical trials are required before a firm recommendation can be made.

    Crohn’s disease

    Evidence supports mild improvement of symptoms and quality of life in patients with Crohn’s disease who use Saccharomyces boulardii. More clinical trials are required before a firm recommendation can be made in this area.

    Diarrhea (Clostridium difficile)

    With the introduction of broad-spectrum antibiotics into clinical practice, Clostridium difficile infection has become a common cause of infectious diarrhea in hospitalized patients. For treatment of recurrent Clostridium difficile-associated diarrhea, Saccharomyces boulardii may decrease recurrences by about 50%, especially when combined with high-dose vancomycin. Further studies are still required.

    Diarrhea (HIV associated)

    While only small studies have been performed, treatment with Saccharomyces boulardii may improve quality of life for AIDS patients with chronic diarrhea. As fungemia has been associated with Saccharomyces boulardii administration in patients with central lines, care should be exercised in treating these patients.

    Diarrhea (prevention during tube feeding)

    Preliminary evidence supports the use of Saccharomyces boulardii for this indication. However, the role of antibiotics in the results is unclear. More studies should be performed before a strong recommendation can be made.

    Diarrhea (traveler’s)

    Although evidence supports the use of Saccharomyces boulardii for other forms of diarrhea, little evidence exists to support standard treatment with Saccharomyces boulardii for traveler’s diarrhea. More studies need to be performed.

    Irritable bowel syndrome (IBS)

    One clinical trial exists to support treatment with Saccharomyces boulardii for irritable bowel syndrome. Additional study is required before a firm recommendation can be made.

    Nutritional support (premature infants)

    One clinical trial exists investigating the addition of Saccharomyces boulardii to nutritional support for premature infants. No evidence was found for lipid gut absorption or increased weight gain. A benefit was noted on gut flora. Additional study is needed.

*Key to grades:

Tradition

    Disclaimer

    The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Dosing

    Disclaimer

    The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

  • Adults (18 years and older):

    • In large multicenter trials, few (if any) side effects have been noted in patients taking Saccharomyces boulardii for up to 15 months. Regardless of diarrhea type, Saccharomyces boulardii is often taken in doses of 500-2,000 milligrams in divided daily doses (three or four times daily). The brand name product, Ultra-Levure®, has been studied in doses of 2-4 capsules daily for up to eight months. For antibiotic-associated diarrhea, 1 gram daily for three days following completion of antibiotics has been used. Two sachets per day containing 5×10 colony forming units (CFU) per sachet has also been used for four weeks. One capsule twice daily has been used; duration was not noted. 250-500mg twice daily for up to two weeks following antibiotics has been used. Four capsules Ultra-Levure® daily for eight months has been used.
  • Children (younger than 18 years):

    • The most commonly used dose for Saccharomyces boulardii in children for the treatment of diarrhea is 250-600 milligrams daily for up to five days. This has been given alone and in combination with antibiotics.

Safety

    Disclaimer

    The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

  • Allergies

    • Avoid in individuals with a known allergy or hypersensitivity to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Saccharomyces boulardii use may be associated with itching, urticaria (“hives”), and generalized skin eruptions.
  • Side Effects and Warnings

    • Saccharomyces boulardii has been generally well tolerated in human studies for treatment of various diarrheal disorders. Symptoms of Saccharomyces cerevisiae infection included septic shock in more than one patient and fever in another. Symptoms of sepsis (infection) included increased white blood cell count, abdominal meteorism (swelling from gas), and respiratory insufficiency. In general, contamination occurred in patients with an indwelling vascular catheter.
    • Constipation, increased thirst, flatulence (gas), and bloating have been associated with Saccharomyces boulardii use. Use cautiously in patients with constipation.
    • Saccharomyces boulardii fungemia (fungal infection) has occurred. Avoid in patients with a yeast infection. Symptoms included septic shock in more than one patient and fever in another. Symptoms of sepsis include white blood cell count increase, abdominal meteorism, and respiratory insufficiency. In general, contamination occurred in patients with an indwelling vascular catheter.
    • Saccharomyces boulardii use may also cause Quincke’s edema (swelling) or increases or decreases in blood pressure when used with MAOIs.
  • Pregnancy and Breastfeeding

    • Saccharomyces boulardii is not recommended in pregnant or breastfeeding women due to a lack of available scientific evidence.

Interactions

    Disclaimer

    Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

  • Interactions with Drugs

    • Concomitant antibiotic treatment may change gastrointestinal flora, subsequently increasing steady state levels of Saccharomyces boulardii in humans. According to various clinical trials, use of Saccharomyces boulardii in combination with antibiotics decreases the frequency and duration of diarrhea. Caution is also advised when taking Saccharomyces boulardii with other antidiarrheal agents due to additive effects.
    • Use of antifungal agents may result in decreased efficacy of Saccharomyces boulardii.
    • Use of metronidazole plus iodoquinol plus Saccharomyces boulardii was more effective than metronidazole plus iodoquinol alone for reducing diarrhea associated with amebiasis (intestinal infection). Similarly, use of mesalamine plus Saccharomyces boulardii may be more effective than mesalamine alone for reducing diarrhea associated with Crohn’s disease. These may be examples of positive interactions.
    • Saccharomyces boulardii taken in combination with monoamine oxidase inhibitors (MAOIs) may lower blood pressure.
  • Interactions with Herbs and Dietary Supplements

    • Concomitant antibiotic treatment with herbs or supplements may change gastrointestinal flora, subsequently increasing steady state levels of Saccharomyces boulardii in humans. According to various clinical trials, use of Saccharomyces boulardii in combination with antibiotics decreases the frequency and duration of diarrhea.
    • Caution is also advised when taking Saccharomyces boulardii with other antidiarrheal herbs or supplements due to additive effects.
    • Use of antifungal herbs or supplements may result in decreased efficacy of Saccharomyces boulardii.
    • Saccharomyces boulardii taken in combination with herbs or supplements with monoamine oxidase inhibitor-like activity may lower blood pressure.

Attribution

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration ().

Bibliography

    Disclaimer

    Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to . Selected references are listed below.

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    View Abstract
  • Bleichner G, Blehaut H, Mentec H, et al. Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients. A multicenter, randomized, double-blind placebo-controlled trial. Intensive Care Med 1997;23(5):517-523.
    View Abstract
  • Can M, Besirbellioglu BA, Avci IY, et al. Prophylactic Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea: a prospective study. Med Sci Monit. 2006;12(4):I19-I22.
    View Abstract
  • Chouraqui JP, Dietsch J, Musial C, et al. Saccharomyces boulardii (SB) in the management of toddler diarrhea: a double-blind-placebo controlled study [abstract]. J Pediatr Gastroenterol Nutr 1995;20(4):463.
  • Dalmasso G, Loubat A, Dahan S, et al. Saccharomyces boulardii prevents TNF-alpha-induced apoptosis in EHEC-infected T84 cells. Res Microbiol 2006;157(5):456-465.
    View Abstract
  • De Preter V, Vanhoutte T, Huys G, et al. Effect of lactulose and Saccharomyces boulardii administration on the colonic urea-nitrogen metabolism and the bifidobacteria concentration in healthy human subjects. Aliment.Pharmacol Ther 4-1-2006;23(7):963-974.
    View Abstract
  • Facchinetti F, Nappi RE, Sances MG, et al. Effects of a yeast-based dietary supplementation on premenstrual syndrome. A double-blind placebo-controlled study. Gynecol Obstet Invest 1997;43(2):120-124.
    View Abstract
  • Geyik MF, Aldemir M, Hosoglu S, et al. The effects of Saccharomyces boulardii on bacterial translocation in rats with obstructive jaundice. Ann R.Coll Surg Engl. 2006;88(2):176-180.
    View Abstract
  • Kollaritsch H, Holst H, Grobara P, et al. [Prevention of traveler’s diarrhea with Saccharomyces boulardii. Results of a placebo controlled double-blind study]. Fortschr.Med 3-30-1993;111(9):152-156.
    View Abstract
  • Kotowska M, Albrecht P, Szajewska H. Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea in children: a randomized double-blind placebo-controlled trial. Aliment.Pharmacol.Ther. 3-1-2005;21(5):583-590.
    View Abstract
  • McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol. 2006;101(4):812-822.
    View Abstract
  • McFarland LV, Surawicz CM, Greenberg RN, et al. A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA 6-22-1994;271(24):1913-1918.
    View Abstract
  • Potts L, Lewis SJ, Barry R. Randomised double blind placebo controlled study of the ability of Saccharomyces boulardii to prevent antibiotic related diarrhoea. Gut 1996;38 (suppl 1):A61.
  • Sougioultzis S, Simeonidis S, Bhaskar KR, et al. Saccharomyces boulardii produces a soluble anti-inflammatory factor that inhibits NF-kappaB-mediated IL-8 gene expression. Biochem Biophys.Res Commun. 4-28-2006;343(1):69-76.
    View Abstract
  • Szajewska H, Ruszczynski M, Radzikowski A. Probiotics in the prevention of antibiotic-associated diarrhea in children: a meta-analysis of randomized controlled trials. J Pediatr 2006;149(3):367-372.
    View Abstract