Saccharomyces boulardii safe and effective for acute diarrhea in children

By Will Boggs MD

NEW YORK (Reuters Health) - The probiotic Saccharomyces boulardii may be used safely to relieve acute diarrhea in children, researchers from Iran report.

Fluid and electrolyte replacement is the treatment of choice for dehydration caused by diarrhea, but S. boulardii has also been shown in numerous trials to be effective in the management of diarrhea, the authors note.

Dr. Vajihe Akbari from Isfahan University of Medical Sciences and colleagues systematically reviewed 22 published studies with a total of 2440 patients (1225 intervention, 1215 controls) that assessed the efficacy and safety of S. boulardii for the treatment of childhood diarrhea.

The daily dose of S. boulardii for most of the trials was 1 to 10 billion colony-forming units, and the duration of treatment ranged from 5 to 10 days.

Only four studies were rated as good, with 13 rated as fair and susceptible to some bias and five rated as poor and at high risk for bias, according to the June 23 Pediatrics online report.

The use of S. boulardii was associated with a 19.7-hour shorter duration of diarrhea, but there was significant heterogeneity among the studies.

The duration of diarrhea was reduced in all cause subgroups (rotavirus, Entamoeba histolytica, and nonspecific cause), and the reduction in duration was greater in mild diarrhea than in severe diarrhea. The data hinted that higher doses of S. boulardii might have been more effective than lower doses.

S. boulardii also reduced the stool frequency on day 2 and the risk of diarrhea on day 4, compared with the control groups.

The rates of vomiting and the duration of fever did not differ significantly between S. boulardii groups and controls.

None of the studies reported any serious adverse effects related to S. boulardii treatment.

The researchers note, though, that the studies in their review were performed in previously healthy children, not those susceptible to complications (those with malnutrition or immune deficiency, for example).

"This systematic review recommends using S. boulardii as adjunct therapy in acute childhood diarrhea," the authors conclude. "It is necessary to conduct more trials to define the best dosage of S. boulardii for diarrhea from different causes."

"Further clinical studies are needed to identify causes of diarrhea for each participant, and specially more studies should be performed in children who have bacterial and parasitic diarrhea," they add.

Dr. M. Ratna Sudha from Unique Biotech Ltd. in Hyderabad, India has also reported on the effects of S. boulardii in patients with acute diarrhea. She told Reuters Health by email, "Saccharomyces boulardii is a proven probiotic in the treatment of diarrhea. It is a safe alternative to antibiotics without compromising on the efficacy. It comes under the GRAS category and hence can be prescribed without any hesitation."

"As Saccharomyces boulardii is a yeast, it is resistant to antibiotics unlike the other probiotics and hence can be consumed along with antibiotics," Dr. Sudha said. "Saccharomyces boulardii is effective even when stored at room temperature unlike the other probiotics."

Unique Biotech markets a specific strain of S. boulardii that it isolated and characterized.

Dr. Meeta Amit Burande from D Y Patil Medical College in Kolhapur, India recently published the results of a study of S. boulardii treatment of acute diarrhea in children. She told Reuters Health via email, "In acute pediatric diarrhea, apart from rehydration therapy and zinc, probiotics should be included in all cases, and S. boulardii may be preferred for the same."

"S. boulardii may have other potential benefits, and research should be expanded to explore the efficacy in adults and noninfectious etiology, especially in diabetic neuropathy associated diarrhea," Dr. Burande added.

Dr. Akbari did not respond to a request for comments.

SOURCE: http://bit.ly/1pv6wK8

Pediatrics 2014;134:e176-e191.

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