C. difficile infection

Overview

Saccharomyces boulardii is the primary supplement studied for C. difficile infection, with 13 trials in this database. Evidence suggests this probiotic yeast may help prevent initial infection during antibiotic use and reduce recurrence when taken alongside standard antibiotics such as vancomycin or metronidazole.

Typical studied regimens include 500 mg twice daily during treatment for recurrence, and daily doses in the 10–30 billion CFU range for prevention during antibiotic courses. Recurrence rates after treatment can be substantial, and S. boulardii appears to lower that risk in available research. See the evidence reviews below for dosing and outcome details.

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Saccharomyces boulardii	★★★★★	Medium

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Evidence Review

Saccharomyces boulardii, a probiotic yeast, may help prevent and reduce the recurrence of C. difficile infection. About 6% to 25% of people treated for this infection experience it again. Taking S. boulardii 500 mg twice daily (equal to 20 billion CFUs a day) together with antibiotics such as vancomycin or metronidazole can lower the chance of the infection coming back.
To help prevent the first infection during antibiotic use, daily doses of 10–30 billion CFUs of S. boulardii have been shown to lower the risk by 53%–61% in adults and children. Some studies found it works better in children, reducing risk by about 75%, while others found no benefit in adults. In elderly hospital patients, probiotic use lowered infection rates in one study but showed no effect in another. Because the research is mixed, medical guidelines do not currently recommend probiotics like S. boulardii to prevent C. difficile infection.

Browse 13 studies5 meta-analyses

Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)2018

Updated IDSA/SHEA C. difficile guidelines discuss probiotics cautiously; routine S. boulardii prophylaxis was not strongly recommended.

Population: Adults

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RCTUse of prophylactic Saccharomyces boulardii to prevent Clostridium difficile infection in hospitalized patients: a controlled prospective intervention study2018n=1,389

Hospital-wide S. boulardii prophylaxis did not significantly reduce C. difficile infection rates versus usual care in a prospective study.

Effect: No Benefit
Population: Older adults
Participants: 1,389

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RCTProbiotics are effective at preventing Clostridium difficile-associated diarrhea: a systematic review and meta-analysis2016n=7,957

A meta-analysis found probiotics reduced C. difficile-associated diarrhea in adults and children, including S. boulardii regimens.

Effect: Benefit
Population: Adults
Participants: 7,957

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ObservationalSaccharomyces boulardii for the prevention of hospital onset Clostridium difficile infection2015n=1,000

Removing automatic S. boulardii prescribing was associated with higher hospital-onset C. difficile rates in a before-after study.

Effect: No Benefit
Population: Patients with hospital onset C
Participants: 1,000

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MetaSystematic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea2015n=3,114

A meta-analysis found S. boulardii reduced antibiotic-associated diarrhea risk versus control in adults and children.

Effect: Benefit
Population: Adults
Participants: 3,114

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MetaProbiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children2013n=8,218

A meta-analysis found probiotics reduced C. difficile-associated diarrhea in adults versus placebo, though strain-specific effects varied.

Effect: Benefit
Population: Adults
Participants: 8,218

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MetaProbiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta-analysis2012n=3,818

A systematic review found probiotics reduced C. difficile-associated diarrhea versus placebo or no treatment in antibiotic recipients.

Effect: Benefit
Population: Adults
Participants: 3,818

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Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA)2010

2010 IDSA guidelines for C. difficile infection updated diagnosis and treatment recommendations; probiotics were not first-line prevention.

Population: Adults

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MetaMeta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease2006n=3,164

A meta-analysis found probiotics reduced antibiotic-associated diarrhea and may reduce C. difficile disease risk.

Effect: Benefit
Participants: 3,164

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RCTSaccharomyces boulardii in the prevention of antibiotic-associated diarrhoea in children: a randomized double-blind placebo-controlled trial2005n=137

In 269 children on antibiotics, S. boulardii 250 mg twice daily reduced diarrhea versus placebo.

Effect: Benefit
Dose: 500 mg/day
Population: Adults
Participants: 137
Ages: 6 months–14 years

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Controlled trialThe search for a better treatment for recurrent Clostridium difficile disease: use of high-dose vancomycin combined with Saccharomyces boulardii2000

In recurrent C. difficile patients, S. boulardii plus standard antibiotics reduced further recurrences versus antibiotics alone in high-risk patients.

Effect: Benefit
Duration: 28 days
Dose: 1 g/day
Population: Patients with recurrent C. difficile disease

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RCTA randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease1994

In C. difficile-associated disease, S. boulardii plus vancomycin or metronidazole reduced recurrence versus antibiotics plus placebo.

Effect: Benefit
Duration: 4 weeks
Dose: 1 g/day
Population: Adults

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Clinical trialTreatment of recurrent Clostridium difficile colitis with vancomycin and Saccharomyces boulardii1989n=13

In 13 patients with recurrent C. difficile colitis, S. boulardii during vancomycin treatment reduced further recurrences versus historical controls.

Effect: Benefit
Duration: 30 days
Population: Patients with recurring C
Participants: 13

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Study distribution across 1 supplements for c. difficile infection (13 studies total).
Supplement	DEX	Studies	Meta-analyses	Share
Saccharomyces boulardii	★★★★★68%	13	5	100%

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