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S. boulardii CNCM I-745 is recommended by international guidelines for addressing diarrhea

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International society recommendations for the use of Saccharomyces boulardii to address diarrhea and dysbiosis.

On the strength of its clinical evidence to prevent, treat and recover from diarrhea, the yeast probiotic S. boulardii has been included in recommendations for addressing diarrhea in adults and children by multiple international societies.1-6

 

Recommendations of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) for children1,2

These evidence-based guidelines for the management of acute gastroenteritis in children were first developed by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society of Paediatric Infectious Diseases (ESPID) in 2008. An update in 2014 included recommendations for the use of probiotics.1

In 2016, the working group for the ESPGHAN developed recommendations for the use of probiotics to prevent antibiotic-associated diarrhea in children.2

 

  • Strong recommendation for the use of S. boulardii to prevent antibiotic-associated diarrhea in children.2
  • Recommendation for the use of S. boulardii to prevent Clostridium difficile-associated diarrhea in children.2
  • Strong recommendation for the active treatment of acute gastroenteritis with S. boulardii in addition to oral rehydration solution to reduce the duration and intensity of symptoms in children (Evidence strength I, grade of recommendation A).1

 

Recommendations of the World Gastroenterology Organisation (WGO) 2017 for adults and children:3

(Internal code : 20.22)

Based on evidence from well-designed clinical trials, the WGO recommends the use of the unique specific strain S. boulardii CNCM I-745 for multiple disorders in adults and children associated with diarrhea. These are the only global guidelines for diarrhea.3

Children:

  • The use S. boulardii CNCM I-745 for the prevention of antibiotic-associated diarrhea (evidence level 1).3
  • The use of S. boulardii CNCM I-745 to reduce Helicobacter pylori eradication therapies-associated gastrointestinal side effects (evidence level 2).3
  • The use of S. boulardii CNCM I-745 for the treatment of acute gastroenteritis (evidence level 1).3

Adults:

  • The use of S. boulardii CNCM I-745 to prevent antibiotic-associated diarrhea (evidence level 1).3
  • The use of S. boulardii CNCM I-745 for the prevention of recurrent Clostridium difficile-associated diarrhea (evidence level 3).3
  • The use of S. boulardii CNCM I-745 to reduce H. pylori eradication therapies-associated gastrointestinal side effects (evidence level 1).3
  • The use of S. boulardii CNCM I-745 for the treatment of acute diarrhea (evidence level 2)3

 

Recommendations for probiotics in paediatric and adult gastrointestinal diseases in the Asia-Pacific region 2017:4,5

A working group of international experts in gastroenterology from Asia-Pacific countries (Australia, China, India, Indonesia, Japan, South Korea, and Singapore) plus countries outside of the region (US, UK, Uruguay, The Netherlands, and Italy) created recommendations for the use of probiotics.

These guidelines had a strong recommendation for the use of the specific strain S. boulardii CNCM I-745.
The main considerations of the epidemiology and etiology of gastrointestinal diseases in the Asia-Pacific region and evidence to support the use of probiotics.4,5

Children:

  • S. boulardii CNCM I-745 may be considered for the prevention of antibiotic-associated diarrhea (quality of evidence: good).4
  • S. boulardii CNCM I-745 may be considered for the prevention of Clostridium difficile-associated diarrhea (quality of evidence : low).4
  • S. boulardii CNCM I-745 may be considered for the prevention of Helicobacter pylori eradication therapy-associated side effects.4
  • S. boulardii CNCM I-745 should be considered for the treatment of acute gastroenteritis in conjunction with rehydration therapy (compelling level of evidence).4

Adults:

  • Recommendation for the use of S. boulardii to reduce the frequency of antibiotic-associated diarrhea.5
  • Recommendation for the use of S. boulardii to reduce the frequency of Clostridium difficile-associated diarrhea.5

 

Recommendations of the Latin-American expert consensus group for the use of probiotics in paediatric gastroenterology:6

Through a critical and comprehensive review of the literature, this working group developed evidence-based guidelines for paediatric gastrointestinal conditions.6

  • High level recommendation for the use of S. boulardii for the prevention of antibiotic-associated diarrhea (evidence level 1b). 6
  • High level recommendation for the use of S. boulardii to treat acute infectious diarrhea (evidence level 1a).6

 

Management of Helicobacter pylori infection – Maastricht V/Florence Consensus Report 2016:7

Forty-three experts from 24 countries examined new data related to Helicobacter pylori to provide recommendations based on the best available evidence and relevance in regards to the management of Helicobacter pylori infection.7

Statement 9 of the consensus report states: only certain probiotics have been shown to be effective in reducing GI side effects caused by H. pylori eradication therapies. Specific strains should be chosen only upon the basis of a demonstrated clinical efficacy (moderate level of evidence/strong grade of recommendation).

  • The efficacy of S. boulardii to reduce H. pylori eradication therapies-associated gastrointestinal side effects has  been extensively investigated and demonstrate that it reduces the risk and overall adverse effects.7

 

 

Internal code : 20.33

References

  • 01 . Guarino A, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. Journal of pediatric gastroenterology and nutrition. 2014; 59(1): 132-152.
  • 02 . Szajewska H, et al. Probiotics for the prevention of antibiotic-associated diarrhea in children. Journal of Pediatric Gastroenterology and Nutrition. 2016; 62(3): 495-506.
  • 03 . Guarner et al. Probiotics and prebiotics. World Gastroenterology Organisation Global Guidelines. February 2017. https://www.worldgastroenterology.org/guidelines/global-guidelines/probiotics-and-prebiotics/probiotics-and-prebiotics-english. Last accessed 19th December 2019.
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  • 04 . Cameron D, et al. Probiotics for gastrointestinal disorders: proposed recommendations for children of the Asia-Pacific region. World J Gastroenterol. 2017; 23(45):7952-7964.
  • 05 . Ghoshal UC, et al. The role of the microbiome and the use of probiotics in gastrointestinal disorders in adults in the Asia‐Pacific region‐background and recommendations of a regional consensus meeting. Journal of gastroenterology and Hepatology. 2018; 33(1): 57-69.
  • 06 . Cruchet S, et al. The Use of Probiotics in Pediatric Gastroenterology: A Review of the Literature and Recommendations by Latin-American Experts. Pediatr Drugs. 2015; 17:199–216.
  • 07 . Malfertheiner P, et al. Management of Helicobacter pylori infection—the Maastricht V/Florence consensus report. Gut. 2017; 66(1): 6-30.
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