Saccharomyces boulardii

Saccharomyces boulardii is an apathogenic yeast species used as a probiotic (see also microbiological therapy) to "normalize" the intestinal flora; it is mainly used for enteritis caused by the use of antibiotics.

The orally taken yeast fungi colonize the gastrointestinal tract in a relatively short time. By shifting the intestinal flora, pathogens that often cause diarrhoea are inhibited in their growth and suppressed. The probability of diarrhoea during or after taking antibiotics should also be reduced. The data available on this statement is not uniform and must be considered in a differentiated manner. For example, there are differences in the efficiency of this probiotic therapy approach between adults and children.

Adults: Antibiotic-associated diarrhoea (AAD) and Clostridium difficile-associated diarrhoea (CDAD) are frequent complications of antibiotic therapy. In a large randomized double-blind study at 15 German hospitals, no positive effects could be demonstrated in nearly 500 in-patients. This was also proven in meta-analyses.

Children and adolescents: In several meta-analyses with randomized placebo-controlled 32 studies (3938 participants) in children and adolescents (0-18 years) treated with antibiotics, it was possible to treat them with various antibiotics. Probiotics (Bacillus spp., Bifidobacterium spp., Clostridium butyricum, Lactobacilli spp., Lactococcus spp., Leuconostoc cremoris, Saccharomyces spp., or Streptococcus spp.), especially Lactobacillus rhamnosus and Saccharomyces boulardii, showed positive effects.

Effect of Saccharomyces boulardii is attributed in the naturopathic sense to various mechanisms (there are no scientifically reliable results):

• Germ competition and antibiosis
• Secretion of toxin cleaving proteases
• Induction of immunoglobulin A secretion
• activation of macrophages, granulocytes, NK cells
• Binding of pathogens (e.g. Escherichia coli) to mannose on the surface of Saccharomyces boulardii.
• Improvement of lactose tolerance
  

Persons with immunodeficiency should not be treated with probiotic preparations, as opportunistic infections and septic processes in immunocompromised persons have also been described.

Acute diarrhoea:

• Perenterol® forte capsules (250mg Saccharymyces boulardii) or Junior powder (in 1 sachet of 765mg powder = 250mg Sacchararoymces boulardii): For acute diarrhoea 2x1 Kps/day. For prevention of diarrhoea during antibiotic therapy in adults and children 1x1 Kps/day.
• Alternative: Perocur® forte capsules in analogue dosage.

Side effects exanthema, nausea, flatulence, abdominal pain, taste disorders, loss of appetite. In immunocompromised patients yeast sepsis may occur.

Perenterol® forte, Perocur® forte

In Germany and Austria, these medicines are not subject to prescription, but are available in pharmacies.

1. Flatley EA et al (2015) Saccharomyces boulardii for the prevention of hospital onset Clostridium difficile infection. J Gastrointestine Liver Dis 24:21-24.
2. Piarroux R et al (1999) Are live saccharomyces yeasts harmful to patients? Lancet 353:1851-1852.
3. Szajewska H et al(2016) ESPGHAN Working Group for ProbioticsPrebiotics. Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Children. J Pediatr Gastroenterol Nutr 62:495-506.
4. Szajewska H et al(2015) Systematic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Aliment Pharmacol Ther 42:793-801.
5. Xie C et al (2015) Probiotics for the prevention of antibiotic-associated diarrhoea in older patients: a systematic review. Travel Med Infect Dis 13:128-134.
6. Rüffer A (2012) Microbiological therapy. Beer AM, Adler M (Ed.) Guide to Naturopathy. Urban&Fischer Publisher S 278-284