Saccharomyces boulardii CNCM I-745

S. boulardii CNCM I-745 is one of the most studied probiotics with convincing evidence in antibiotic-associated diarrhoea. AEMPS registered Enterol (Biocodex) with the indication of AAD prevention and treatment in adults and children. McFarland 2010 (meta-analysis of 31 RCTs) showed AAD risk reduction with S. boulardii added to antibiotic therapy, RR ~0.53. Cochrane Goldenberg 2017 included S. boulardii among first-choice strains (alongside LGG). ESPGHAN 2014 in children on antibiotics lists S. boulardii and LGG as options with confirmed efficacy. AGA 2020 does not routinely recommend probiotics in adults but allows them in C. difficile high-risk groups (elderly, hospitalised, broad-spectrum antibiotic users). Dose: 250-500 mg twice daily from antibiotic day 1, continued 7 days after antibiotic completion.

S. boulardii is used as adjunct in acute infectious gastroenteritis. ESPGHAN 2014 in children with acute gastroenteritis lists S. boulardii and LGG as options with confirmed efficacy for modest diarrhoea duration reduction (~1 day). After negative Schnadower 2018 and Freedman 2018 RCTs for LGG, AGA 2020 revised its position and does not routinely recommend probiotics in acute infectious gastroenteritis. Distinction: S. boulardii has a separate evidence base with less negative results, but no PECARN-level RCTs have been conducted. Primary therapy for acute gastroenteritis is oral rehydration (ORS); for severe dehydration – intravenous infusion. S. boulardii may be considered as adjunct for moderate diarrhoea without dehydration signs but not as substitute for rehydration.

AEMPS registered Enterol with the indication of travellers diarrhoea prevention in adults. McFarland 2010 meta-analysis included several travellers diarrhoea RCTs with moderate episode frequency reductions on prophylactic S. boulardii 500-1000 mg/day 5 days before and during travel to endemic regions. Effect is modest and incomplete – does not replace basic food and water safety practices. ISTM 2017 states: probiotics are an option for low/medium risk; for high risk – discussion of ciprofloxacin or rifaximin where indicated. For established travellers diarrhoea, primary therapy is oral rehydration; for bacterial aetiology – azithromycin or ciprofloxacin. S. boulardii may be used as adjunct, not as substitute.