Saccharomyces Boulardii


Saccharomyces boulardii (Sack-arr-oh-my-seez B-oo-l-arr-d-ee)


S. boulardii is a non-pathogenic yeast microbe with properties that protect it against antibiotics. (10) It was first discovered in lychee and mangosteen fruit, and is now cultivated for use in supplements as lyophilized powders, capsules, or liquid beverages. (12, 18) Lyophilized S. boulardii powders are stable for up to one year, when stored at room temperature without exposure to moisture. (11)

Main Medical Uses

Evidence supports the use of S. boulardii in the treatment of acute, antibiotic-associated, HIV-related, and traveler’s diarrhea. It has also been used in the treatment of Helicobacter pylori, irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD). Furthermore, studies support the use of S. boulardii in preventing nutrient-associated diarrhea and recurrence of Clostridium difficile infection. (14, 18)

Dosing and Administration

For an explanation of the classes of evidence, please see the Rating Scales for Evidence-Based Decision Support.

Adverse Effects

S. boulardii is generally regarded as safe, however, an increased risk of non-infectious adverse effects, such as biliary tract stenosis, fistulas, lienalis-steal syndrome, abdominal hemorrhage, and acute renal failure, has been found in specific groups (i.e., transplant patients or patients with pancreatitis). (25) Rare cases of fungemia associated with S. boulardii have also been reported. (18)

Associated Depletions and Interactions

S. boulardii may decrease the side effects of standard triple therapy in the treatment of H. pylori (e.g. clarithromycin, amoxicillin, acid suppressors lansoprazole or omeprazole). (18) S. boulardii may also decrease the occurrence of diarrhea associated with other antibiotics such as  β-lactams. (18) Theoretically, an inhibitory interaction exists between S. boulardii and antimycotics, fluconazole, itraconazole, and amphotericin B. (23)  S. boulardii may also induce a theoretical potentiating effect with certain antibiotics, specifically ampicillin and clindamycin. (2, 15) S. boulardii can increase the expression of the sodium/glucose cotransporter-1 (SGLT-1) and the uptake of glucose by brush border membranes. (4) Therefore, caution is recommended when taking S. boulardii with hypoglycemic drugs.

Mechanism of Action and Metabolism

S. boulardii reaches stable concentrations within three days of oral ingestion and is cleared from the body within three to five days if discontinued. (18) S. boulardii is not absorbed or metabolized by the body and is excreted in feces. (2, 15)

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  1. Besirbellioglu, B. A., Ulcay, A., Can, M., Erdem, H., Tanyuksei, M., Avci, I. Y., … Pahsa, A. (2006). Saccharomyces boulardii and infection due to Giardia lamblia. Scandinavian Journal of Infectious Diseases, 38(6-7), 479-481.
  2. Boddy, A. V., Elmer, G. W., McFarland, L. V., & Levy, R. H. (1991). Influence of antibiotics on the recovery and kinetics of Saccharomyces boulardii in rats. Pharmaceutical Research, 8(6), 796-800.
  3. Buts, J., Bernasconi, P., Craynest, M. V., Maldague, P., & Meyer, R. D. (1986). Response of human and rat small intestinal mucosa to oral administration of saccharomyces boulardii. Pediatric Research, 20(2), 192-196.
  4. Buts, J., De Keyser, N., Marandi, S., Hermans, D., Sokal, E. M., Chae, Y. E., … Tulkens, P. M. (1999). Saccharomyces boulardii upgrades cellular adaptation after proximal enterectomy in rats. Gut, 45(1), 89-96.
  5. Buts, J., De Keyser, N., & Raedemaeker, L. D. (1994). Saccharomyces boulardii enhances rat intestinal enzyme expression by endoluminal release of polyamines. Pediatric Research, 36(4), 522-527.
  6. Buts, J., De Keyser, N., Stilmant, C., Delem, E., Smets, F., & Sokal, E. (2006). Saccharomyces boulardii produces in rat small intestine a novel protein phosphatase that inhibits escherichia coli endotoxin by dephosphorylation. Pediatric Research, 60(1), 24-29.
  7. Castagliuolo, I., Valenick, L., Riegler, M., Lamont, J., & Pothoulakis, C. (1999). Saccharomyces boulardii protease inhibits Clostridium difficile toxin a and b-induced effects in human colonic mucosa. Infection and Immunity,67(1), 302-307.
  8. Cavalheiro, M., & Teixeira, M. C. (2018). Candida biofilms: Threats, challenges, and promising strategies. Frontiers in Medicine, 5, 28.
  9. Claus, S. P., Tsang, T. M., Wang, Y., Cloarec, O., Skordi, E., Martin, F., . . . Nicholson, J. K. (2008). Systemic multicompartmental effects of the gut microbiome on mouse metabolic phenotypes. Molecular Systems Biology, 4, 219.
  10. Czerucka, D., Piche, T., & Rampal, P. (2007). Review article: Yeast as probiotics -Saccharomyces boulardii. Alimentary Pharmacology & Therapeutics, 26(6), 767-778.
  11. Graff, S., Chaumeil, J., Boy, P., Lai-Kuen, R., & Charrueau, C. (2008). Formulations for protecting the probiotic Saccharomyces boulardii from degradation in acidic condition. Biological & Pharmaceutical Bulletin, 31(2), 266-272.
  12. Hu, Y., Qin, H., Zhan, Z., Dun, Y., Zhou, Y., Peng, … Zhao, S. (2016). Biotechnology & Biotechnological Equipment, 30(1), 173-179.
  13. Hudson, L. E., Mcdermott, C. D., Stewart, T. P., Hudson, W. H., Rios, D., Fasken, M. B., … Lamb, T. J. (2016). Characterization of the probiotic yeast Saccharomyces boulardii in the healthy mucosal immune system. Plos One,11(4), 1-21.
  14. Kelesidis, T., & Pothoulakis, C. (2012). Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of gastrointestinal disorders. Therapeutic Advances in Gastroenterology, 5(2), 111-125.
  15. Klein, S. M., Elmer, G. W., McFarland, L. V., Surawicz, C. M., & Levy, R. H. (1993). Recovery and elimination of the biotherapeutic agent, Saccharomyces boulardii, in healthy human volunteers. Pharmaceutical Research, 10(11), 1615-1619.
  16. Leblanc, J. G., Chain, F., Martín, R., Bermúdez-Humarán, L. G., Courau, S., & Langella, P. (2017). Beneficial effects on host energy metabolism of short-chain fatty acids and vitamins produced by commensal and probiotic bacteria. Microbial Cell Factories, 16, 79.
  17. Martins, F. S., Vieira, A. T., Elian, S. D., Arantes, R. M., Tiago, F. C., Sousa, L. P., … Teixeira, M. M. (2013). Inhibition of tissue inflammation and bacterial translocation as one of the protective mechanisms of Saccharomyces boulardii against Salmonella infection in mice. Microbes and Infection, 15(4), 270-279.
  18. Mcfarland, L. V. (2010). Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World Journal of Gastroenterology, 16(18), 2202-2222.
  19. Moré, M. I., & Vandenplas, Y. (2018). Saccharomyces boulardii CNCM I-745 improves intestinal enzyme function: A trophic effects review. Clinical Medicine Insights: Gastroenterology, 11, 1-14.
  20. Pothoulakis, C. (2009). Review article: Anti-inflammatory mechanisms of action of Saccharomyces boulardii. Alimentary Pharmacology & Therapeutics, 30(8), 826-833.
  21. Sun, Y., Rajput, I. R., Arain, M. A., Li, Y., & Baloch, D. M. (2017). Oral administration of Saccharomyces boulardii alters duodenal morphology, enzymatic activity and cytokine production response in broiler chickens. Animal Science Journal, 88(8), 1204-1211.
  22. Szajewska, H., & Kołodziej, M. (2015). Systematic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Alimentary Pharmacology & Therapeutics, 42(7), 793-801.
  23. Tomičić, Z., Zupan, J., Matos, T., & Raspor, P. (2016). Probiotic yeast Saccharomyces boulardii (nom. nud.) modulates adhesive properties of Candida glabrata. Medical Mycology, 54(8), 835-845.
  24. Vilela, G.E., De Lourdes De Abreu Ferrari, M., Oswaldo Da Gama Torres, H., Guerra Pinto, A., Carolina Carneiro Aguirre, A., Paiva Martins, F., … Sales Da Cunha, A. (2008). Influence of Saccharomyces boulardii on the intestinal permeability of patients with Crohn’s disease in remission. Scandinavian Journal of Gastroenterology, 43(7), 842-848.
  25. Whelan, K., & Myers, C. E. (2010). Safety of probiotics in patients receiving nutritional support: A systematic review of case reports, randomized controlled trials, and nonrandomized trials. The American Journal of Clinical Nutrition, 91(3), 687-703.