Sirs, Previously, we have shown in a meta-analysis that Saccharomyces boulardii, a nonpathogenic probiotic yeast, is effective in treating acute gastroenteritis (AGE) in children.1 A number of studies have been published since this meta-analysis, some with negative results,2 prompting interest in re-evaluating the role of S. boulardii in the management of AGE. This letter summarizes the updated results from trials of S. boulardii performed in children with AGE.
The methods used in this meta-analysis are discussed in full detail in the original version of this review.1 In brief, the MEDLINE, EMBASE and the Cochrane Library databases, as well as major paediatric conference proceedings were searched from August 2006 (end date of last search) to August 2009. The pharmaceutical company, Biocodex (France) that manufactures S. boulardii was contacted to help identify published and unpublished data.
The updated meta-analysis included nine randomized controlled trials (RCTs)2–10 involving 1117 participants compared with five RCTs3–7 (619 participants) included in the original analysis. Overall, five studies were placebo-controlled. In the remaining trials, there was no additional intervention in the control group. The ages of the participants varied from 2 months to 12 years. The daily dose of the study product ranged from 250–750 mg. The duration of the intervention ranged from 5–7 days. The methodological quality of the trials varied. Tables with the updated characteristics of included and excluded trials are available upon request. A meta-analysis of seven RCTs2–5, 7, 9, 10 (944 participants) showed a reduction in the duration of the diarrhoea (weighted mean difference −1.08 day, 95% CI −1.64 to −0.53, random effects model) in those treated with S. boulardii compared with placebo (Figure 1).
In conclusion, this update of our meta-analysis of data from RCTs confirms that in otherwise healthy infants and children, the use of S. boulardii is associated with clinical benefits in the treatment of AGE, specifically a reduction in the duration of diarrhoea by approximately 1 day. As before, these findings should be interpreted with caution because of the methodological limitations and heterogeneity of some of the studies. The available evidence supports recent recommendations from two European societies that selected probiotics with proven clinical efficacy, such as S. boulardii or Lactobacillus GG that are administered in appropriate dosages, according to the strain and the patient population, may be used as an adjunct to rehydration therapy for the management of AGE in children.11