Saccharomyces cerevisiae var. boulardii in daily medical practice: current indications and scientific evidence Review article
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Published:
May 31, 2026
Keywords:
Saccharomyces boulardii, antibiotic associated diarrhea, H. pylori eradication, acute diarrhea, traveler’s diarrhea
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Abstract
Saccharomyces boulardii (S. boulardii) is a nonpathogenic yeast strain isolated in 1923 in Indochina by Henri Boulard during his studies on the antidiarrheal effects of lychee peels consumed by local people. S. boulardii is the only yeast strain with which double-blind, placebo-controlled clinical trials have been conducted. In clinical practice, it is present in the form of live, lyophilized cells, administered as powder or gelatin capsules. When administered orally, S. boulardii only temporarily colonizes the human gastrointestinal tract. Steady state, as measured by concentration in the large intestine, is achieved after 2–3 days of administration, and complete elimination from the stool occurs 6–7 days after cessation of administration. Unlike bacterial probiotics, S. boulardii is naturally resistant to antibiotics, with the exception of antifungal preparations. S. boulardii exhibits antisecretory (i.e., antidiarrheal) activity in infections caused by V. cholerae and C. difficile. Many clinical studies and meta-analyses cited in the publication have demonstrated its effectiveness in treating or preventing conditions such as acute diarrhea, antibiotic-associated diarrhea, traveler’s diarrhea, C. difficile-associated diarrhea, and H. pylori therapy. For best results, S. boulardii should be administered immediately and at a sufficient dose recommended for the specific use by both the manufacturer and the studies.
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Albrecht, P. (2026). Saccharomyces cerevisiae var. boulardii in daily medical practice: current indications and scientific evidence. Medycyna Faktow (J EBM), 19(1(70), 21-27. https://doi.org/10.24292/01.MF.0126.3
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References
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3. McCullough MJ, Clemons KV, McCusker JH et al. Stevens D.A. Species identyfication and virulence attributes of Saccharomyces boulardii (nom. inval.) J Clin Microb. 1998; 36(9): 2613-7.
4. Elmer G, Moyer K, Vega R et al. Pharmacokinetic studies of S. boulardii in patients with HIV-related chronic diarrhoea in healthy volunteers. XIX Int Congress on Microb Ecol and Disease Rome, 1994 (abstract book).
5. Neut C, Mahieux S, Dubreuil LJ. Antibiotic susceptibility of probiotic strains: is it reasonable to combine probiotics with antibiotics? Med Male Infect. 2017; 7: 477-83.
6. Moré MI, Swidsinski A. Saccharomyces boulardii CNCM I-745 supports regeneration of the intestinal microbiota after diarrheic dysbiosis – a review. Clin Exp Gastroenterol. 2015; 8: 237-55.
7. Boddy AV, Elmer GW, McFarland LV et al. Influence of antibiotics on the recovery of S. boulardii in rats. Pharmaceutic Res. 1991; 8: 796-800.
8. Blehaut H, Massot J, Elmer GW et al. Disposition kinetics of Saccharomyces boulardii in man and rat. Biopharm Drugs Dispos. 1989; 10: 353-64.
9. Toothaker RD, Elmer GW. Prevention of clindamycin-induced mortality in hamsters by Saccharomyces boulardii. Antimicrob Agents Chemother. 1984; 26 (4): 552-6.
10. Corthier G, Dubos F, Ducluzeau R. Prevention of Clostridium difficile induced mortality in gnotobiotic mice by Saccharomyces boulardii. Can J Microbiol. 1986; 32(11): 894-6.
11. Castex F, Corthier G, Jouvert S et al. Prevention of Clostridium difficile induced experimental pseudomembranous colitis by Saccharomyces boulardii: a scanning electron microscopic and microbiological study. J Gen Microbiol. 1990; 136 (6): 1085-9.
12. Pothoulakis C, Kelly CP, Joshi MA et al. Saccharomyces boulardii inhibits Clostridium difficile toxin A binding and enterotoxicity in rat ileum. Gastroenterology. 1993; 104(4): 1108-15.
13. Brandao R, Castro IM, Bambirra EA et al. Intracellular signal triggered by cholera toxin in S. boulardii and Saccharomyces cerevisiae. Appl Environ Microbiol. 1998; 64: 564-8.
14. Gopalan S, Ganapathy S, Mitra M et al. Unique Properties of Yeast Probiotic Saccharomyces boulardii CNCM I-745: A Narrative Review. Cureus. 2023; 15(10): e46314.
15. Kaźmierczak-Siedlecka K, Ruszkowski J, Fic M et al. Saccharomyces boulardii CNCM I-745: A Non-bacterial Microorganism Used as Probiotic Agent in Supporting Treatment of Selected Diseases. Curr Microbiol. 2020; 77(9): 1987-96.
16. Guarino A, Lo Vecchio A, Dias JA et al. Universal Recommendations for the Management of Acute Diarrhea in Nonmalnourished Children. J Pediatr Gastroenterol Nutr. 2018; 67(5): 586-93.
17. Padayachee M, Visser J, Viljoen E et al. Efficacy and safety of Saccharomyces boulardii in the treatment of acute gastroenteritis in the pediatric population: a systematic review. S Afr J Clin Nutr. 2019; 32: 358-69.
18. Szajewska H, Kołodziej M, Zalewski BM. Systematic review with meta-analysis: Saccharomyces boulardii for treating acute gastroenteritis in children – a 2020 update. Aliment Pharmacol Ther. 2020; 51: 678-88.
19. Fu H, Li J, Xu X et al. Effectiveness and safety of Saccharomyces boulardii for the treatment of acute gastroenteritis in the pediatric population: a systematic review and meta-analysis of randomized controlled trials. Comput Math Methods Med. 2022; 2022: 6234858.
20. Szajewska H, Canani RB, Guarino A et al.; ESPGHAN Working Group for Probiotics Prebiotics. Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Children. J Pediatr Gastroenterol Nutr. 2016; 62(3): 495-506.
21. 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. 2005; 21(5): 583-90.
22. McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol. 2010; 16: 2202-22.
23. McFarland LV, Goh S. Preventing pediatric antibiotic-associated diarrhoea and Clostridium difficile infections with probiotics: a meta-analysis. World J Meta-Anal. 2013; 1: 102-20.
24. Szajewska H, Kołodziej M. Systematic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Aliment Pharmacol Ther. 2015; 42: 793-801.
25. Yang Q, Hu Z, Lei Y et al. Overview of systematic reviews of probiotics in the prevention and treatment of antibiotic-associated diarrhea in children. Front Pharmacol. 2023; 14: 1153070.
26. Surawicz CM, McFarland LV, Elmer G et al. Treatment of recurrent Clostridium difficile colitis with vancomycin and Saccharomyces boulardii. Am J Gastroenterol. 1989; 84: 1285-7.
27. McFarland L, Surawicz CM, Greenberg RN et al. A randomized placebo controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA. 1994; 271: 1913-8.
28. McFarland LV, Surawicz CM, Greenberg RN et al. Prevention of betalaktam associated diarrhoea by Saccharomyces boulardii compared with placebo. Am J Gastroenterol. 1995; 90: 439-48.
29. Tariq R, Waqas TM, Maham H et al. Systematic Review and Meta-Analysis: Safety and Efficacy of Saccharomyces boulardii for Prevention of Clostridioides difficile Infection. Journal Gastrointest Infections. 2023; 12: 94-100.
30. Esmaeilinezhad Z, Ghosh NR, Walsh CM et al. Probiotics for the prevention of Clostridioides difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev. 2025; 9(9): CD006095.
31. Li M, Xie Y. Efficacy and safety of Saccharomyces boulardii as an adjuvant therapy for the eradication of Helicobacter pylori: a meta-analysis. Front Cell Infect Microbiol. 2025; 15: 1441185.
32. 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. 1993; 111(9): 152-6.
33. McFarland LV. Meta-analysis of probiotics for the prevention of traveler’s diarrhea. Travel Med Infect Dis. 2007; 5(2): 97-105.
34. Alharbi BF, Alateek AA. Investigating the influence of probiotics in preventing Traveler’s diarrhea: Meta-analysis based systematic review. Travel Med Infect Dis. 2024; 59: 102703.
35. Abid R, Waseem H, Ali J et al. Probiotic yeast saccharomyces: back to nature to improve human health. J Fungi (Basel). 2022; 8: 444.
36. Feizizadeh S, Salehi-Abargouei A, Akbari V. Efficacy and safety of Saccharomyces boulardii for acute diarrhea. Pediatrics. 2014; 134: e176-91.
37. Moré MI, Swidsinski A. Saccharomyces boulardii CNCM I-745 supports regeneration of the intestinal microbiota after diarrheic dysbiosis – a review. Clin Exp Gastroenterol. 2015; 8: 237-55.
38. Karpa KD. Probiotics for Clostridium difficile diarrhea: putting it into perspective. Ann Pharmacother. 2007; 41: 1284-7.
39. Hennequin C, Kauffmann-Lacroix C, Jobert A et al. Possible role of catheters in Saccharomyces boulardii fungemia. Eur J Clin Microbiol Infect Dis. 2000; 19: 16-20.
2. Bruneel M, Patte F. Proprietes vitaminiques B (in vitro et in vivo) d’une levure du genre Saccharomyces (S. boulardii 17) prescrite lors de la prophylaxie et du traitement des accidents dus aux antibiotiques. La Clinique. 1972; 67: 19-204.
3. McCullough MJ, Clemons KV, McCusker JH et al. Stevens D.A. Species identyfication and virulence attributes of Saccharomyces boulardii (nom. inval.) J Clin Microb. 1998; 36(9): 2613-7.
4. Elmer G, Moyer K, Vega R et al. Pharmacokinetic studies of S. boulardii in patients with HIV-related chronic diarrhoea in healthy volunteers. XIX Int Congress on Microb Ecol and Disease Rome, 1994 (abstract book).
5. Neut C, Mahieux S, Dubreuil LJ. Antibiotic susceptibility of probiotic strains: is it reasonable to combine probiotics with antibiotics? Med Male Infect. 2017; 7: 477-83.
6. Moré MI, Swidsinski A. Saccharomyces boulardii CNCM I-745 supports regeneration of the intestinal microbiota after diarrheic dysbiosis – a review. Clin Exp Gastroenterol. 2015; 8: 237-55.
7. Boddy AV, Elmer GW, McFarland LV et al. Influence of antibiotics on the recovery of S. boulardii in rats. Pharmaceutic Res. 1991; 8: 796-800.
8. Blehaut H, Massot J, Elmer GW et al. Disposition kinetics of Saccharomyces boulardii in man and rat. Biopharm Drugs Dispos. 1989; 10: 353-64.
9. Toothaker RD, Elmer GW. Prevention of clindamycin-induced mortality in hamsters by Saccharomyces boulardii. Antimicrob Agents Chemother. 1984; 26 (4): 552-6.
10. Corthier G, Dubos F, Ducluzeau R. Prevention of Clostridium difficile induced mortality in gnotobiotic mice by Saccharomyces boulardii. Can J Microbiol. 1986; 32(11): 894-6.
11. Castex F, Corthier G, Jouvert S et al. Prevention of Clostridium difficile induced experimental pseudomembranous colitis by Saccharomyces boulardii: a scanning electron microscopic and microbiological study. J Gen Microbiol. 1990; 136 (6): 1085-9.
12. Pothoulakis C, Kelly CP, Joshi MA et al. Saccharomyces boulardii inhibits Clostridium difficile toxin A binding and enterotoxicity in rat ileum. Gastroenterology. 1993; 104(4): 1108-15.
13. Brandao R, Castro IM, Bambirra EA et al. Intracellular signal triggered by cholera toxin in S. boulardii and Saccharomyces cerevisiae. Appl Environ Microbiol. 1998; 64: 564-8.
14. Gopalan S, Ganapathy S, Mitra M et al. Unique Properties of Yeast Probiotic Saccharomyces boulardii CNCM I-745: A Narrative Review. Cureus. 2023; 15(10): e46314.
15. Kaźmierczak-Siedlecka K, Ruszkowski J, Fic M et al. Saccharomyces boulardii CNCM I-745: A Non-bacterial Microorganism Used as Probiotic Agent in Supporting Treatment of Selected Diseases. Curr Microbiol. 2020; 77(9): 1987-96.
16. Guarino A, Lo Vecchio A, Dias JA et al. Universal Recommendations for the Management of Acute Diarrhea in Nonmalnourished Children. J Pediatr Gastroenterol Nutr. 2018; 67(5): 586-93.
17. Padayachee M, Visser J, Viljoen E et al. Efficacy and safety of Saccharomyces boulardii in the treatment of acute gastroenteritis in the pediatric population: a systematic review. S Afr J Clin Nutr. 2019; 32: 358-69.
18. Szajewska H, Kołodziej M, Zalewski BM. Systematic review with meta-analysis: Saccharomyces boulardii for treating acute gastroenteritis in children – a 2020 update. Aliment Pharmacol Ther. 2020; 51: 678-88.
19. Fu H, Li J, Xu X et al. Effectiveness and safety of Saccharomyces boulardii for the treatment of acute gastroenteritis in the pediatric population: a systematic review and meta-analysis of randomized controlled trials. Comput Math Methods Med. 2022; 2022: 6234858.
20. Szajewska H, Canani RB, Guarino A et al.; ESPGHAN Working Group for Probiotics Prebiotics. Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Children. J Pediatr Gastroenterol Nutr. 2016; 62(3): 495-506.
21. 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. 2005; 21(5): 583-90.
22. McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol. 2010; 16: 2202-22.
23. McFarland LV, Goh S. Preventing pediatric antibiotic-associated diarrhoea and Clostridium difficile infections with probiotics: a meta-analysis. World J Meta-Anal. 2013; 1: 102-20.
24. Szajewska H, Kołodziej M. Systematic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Aliment Pharmacol Ther. 2015; 42: 793-801.
25. Yang Q, Hu Z, Lei Y et al. Overview of systematic reviews of probiotics in the prevention and treatment of antibiotic-associated diarrhea in children. Front Pharmacol. 2023; 14: 1153070.
26. Surawicz CM, McFarland LV, Elmer G et al. Treatment of recurrent Clostridium difficile colitis with vancomycin and Saccharomyces boulardii. Am J Gastroenterol. 1989; 84: 1285-7.
27. McFarland L, Surawicz CM, Greenberg RN et al. A randomized placebo controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA. 1994; 271: 1913-8.
28. McFarland LV, Surawicz CM, Greenberg RN et al. Prevention of betalaktam associated diarrhoea by Saccharomyces boulardii compared with placebo. Am J Gastroenterol. 1995; 90: 439-48.
29. Tariq R, Waqas TM, Maham H et al. Systematic Review and Meta-Analysis: Safety and Efficacy of Saccharomyces boulardii for Prevention of Clostridioides difficile Infection. Journal Gastrointest Infections. 2023; 12: 94-100.
30. Esmaeilinezhad Z, Ghosh NR, Walsh CM et al. Probiotics for the prevention of Clostridioides difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev. 2025; 9(9): CD006095.
31. Li M, Xie Y. Efficacy and safety of Saccharomyces boulardii as an adjuvant therapy for the eradication of Helicobacter pylori: a meta-analysis. Front Cell Infect Microbiol. 2025; 15: 1441185.
32. 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. 1993; 111(9): 152-6.
33. McFarland LV. Meta-analysis of probiotics for the prevention of traveler’s diarrhea. Travel Med Infect Dis. 2007; 5(2): 97-105.
34. Alharbi BF, Alateek AA. Investigating the influence of probiotics in preventing Traveler’s diarrhea: Meta-analysis based systematic review. Travel Med Infect Dis. 2024; 59: 102703.
35. Abid R, Waseem H, Ali J et al. Probiotic yeast saccharomyces: back to nature to improve human health. J Fungi (Basel). 2022; 8: 444.
36. Feizizadeh S, Salehi-Abargouei A, Akbari V. Efficacy and safety of Saccharomyces boulardii for acute diarrhea. Pediatrics. 2014; 134: e176-91.
37. Moré MI, Swidsinski A. Saccharomyces boulardii CNCM I-745 supports regeneration of the intestinal microbiota after diarrheic dysbiosis – a review. Clin Exp Gastroenterol. 2015; 8: 237-55.
38. Karpa KD. Probiotics for Clostridium difficile diarrhea: putting it into perspective. Ann Pharmacother. 2007; 41: 1284-7.
39. Hennequin C, Kauffmann-Lacroix C, Jobert A et al. Possible role of catheters in Saccharomyces boulardii fungemia. Eur J Clin Microbiol Infect Dis. 2000; 19: 16-20.