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Saccharomyces boulardii (S. boulardii) is a probiotic yeast with several key benefits for intestinal health, particularly in the context of Clostridioides difficile (C. difficile) infection (CDI).
Key Benefits:
1. Inhibition of Pathogens: S. boulardii produces proteases that inactivate C. difficile toxins A and B, reducing their pathogenicity.
2. Immune Modulation: It enhances the immune response by increasing the production of secretory IgA and modulating cytokine production.
3. Gut Barrier Function: S. boulardii helps maintain and restore the integrity of the intestinal barrier, reducing permeability and preventing translocation of pathogens.
Evidence for CDI Recurrence Prevention:
Several studies support the use of S. boulardii in preventing recurrent CDI:
• A multicenter double-blind RCT demonstrated a significant reduction in CDI recurrence when S. boulardii was used alongside metronidazole or vancomycin in patients with a history of recurrent CDI (RR 0.43, 34.6% with S. boulardii vs. 64.7% with placebo).
• A follow-up study showed benefits in a subgroup treated with high-dose vancomycin and S. boulardii, with a recurrence rate of 16.7% compared to 50% with placebo.
• A controlled prospective intervention study indicated that S. boulardii significantly reduced CDI rates in hospitalized patients receiving antibiotics (OR = 0.06, 95% CI 0.02-0.16).
Dosage:
The typical dosage used in clinical studies is 1 g/day, which corresponds to approximately 5 billion CFU, administered in divided doses.
Guideline Recommendations:
The American College of Gastroenterology (ACG) guidelines acknowledge the potential role of S. boulardii in preventing recurrent CDI, particularly in patients with a history of recurrence.
In summary, S. boulardii has demonstrated efficacy in reducing the recurrence of CDI, particularly when used in conjunction with standard antibiotic therapy in patients with a history of recurrent infections.
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