Saccharomyces boulardii
Sources réglementaires consultées
Indications approuvées
- Traitement symptomatique de la diarrhée aiguë non spécifique et prévention et traitement symptomatique de la diarrhée associée aux antibiotiques chez l'adulte et l'adolescent de plus de 12 ans.
Contre-indications
Absolues
- Hypersensibilité aux levures, notamment Saccharomyces boulardii; cathéter veineux central; état critique ou immunodépression en raison du risque de fongémie.
Mises en garde cliniques
- Mise en garde encadrée · Des cas de fongémie et de sepsis, parfois mortels, ont été rapportés surtout chez les personnes avec cathéter veineux central, état critique ou immunodépression. Ne pas ouvrir les gélules près de ces patients; utiliser des gants et une hygiène des mains. — CIMA, Ficha técnica Ultra-Levura
Interactions médicamenteuses
- SévèreAntifúngicos orales o sistémicos
Mécanisme: La levadura viva puede ser inactivada por el tratamiento antifúngico.
Recommandation: No administrar conjuntamente.
CIMA, Ficha técnica Ultra-Levura
Effets indésirables
Communs (≥1%)
Flatulencia · Estreñimiento
Rares mais graves
Fungemia · Sepsis · Reacción anafiláctica · Angioedema
Grossesse et allaitement
Il n'existe pas de données pendant l'allaitement; évaluer le rapport bénéfice-risque.
Bibliographie récente (PubMed)
Revisión narrativa sobre propiedades y usos de S. boulardii; no sustituye las contraindicaciones de la ficha técnica.
Clostridioides difficile is the most common causative agent of antibiotic-associated diarrhea. This spore forming, obligate anaerobic, gram-positive bacillus is becoming responsible for an increasing number of infections worldwide, both in community and in hospital settings, whose severity can vary widely from an asymptomatic infection to a lethal disease. While discontinuation of antimicrobial agents and antibiotic treatment of the infection remain the cornerstone of therapy, more recent fecal microbiota transplantation has also been valid as a therapy. The use of probiotics, especially Saccharomyces boulardii CNCM I-745 have become valid forms of prevention therapy. Although there are studies in adults with microbiota-targeted new generation therapies and Clostridium difficile vaccines, there are no data in the paediatric age group yet.
Probiotics are widely used in paediatrics, but efficacy varies by strain and indication. In 2023, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Special Interest Group on Gut Microbiota and Modifications issued strain-specific recommendations for gastrointestinal disorders. This review summarises studies published since 2024 to assess whether new evidence warrants changes to these recommendations. Lacticaseibacillus rhamnosus GG (LGG) and Saccharomyces boulardii are recommended for preventing antibiotic-associated diarrhoea. LGG, S. boulardii , Limosilactobacillus reuteri DSM 17938, or the combination of L. rhamnosus 19070-2 and L. reuteri DSM 12246 may be considered in acute gastroenteritis. For infant colic, recommendations include L. reuteri DSM 17938 or Bifidobacterium lactis BB-12 in breast-fed infants; for functional abdominal pain, L. reuteri DSM 17938 or LGG. No probiotics are recommended for constipation. For prevention of necrotising enterocolitis, weak recommendations include LGG or a combination of B. infantis BB-02, B. lactis BB-12 and Streptococcus thermophilus TH-4. There is no recommendation for or against probiotic-supplemented formulas. Recent trials have not provided sufficient evidence to justify changes to the ESPGHAN recommendations. Evidence for probiotic use in paediatrics is confined to a few strains and indications. Larger multicentre studies with standardised preparations and clearly defined outcomes are still needed.
Dysbiosis is a clinical condition marked by altered gut microbiota resulting from external and internal host factors. It is strongly associated with gastrointestinal and extraintestinal alterations, so its symptomatology is broad and nonspecific. To date, gaps remain that limit professionals from making a timely diagnosis and prescribing the appropriate treatment. We aim to synthesize existing literature regarding clinical parameters for the early detection of patients with intestinal dysbiosis and the clinical events in which the use of probiotics as adjuvant therapy is most frequently reported. A scoping review of the literature was conducted in PubMed, Embase, Cochrane, and BVS (Biblioteca Virtual en Salud in Spanish) databases for articles published in the last 5 years. Primary studies and literature reviews related to clinical presentation, dysbiosis screening, and probiotics as adjuvant therapy for adult and pediatric patients were included. Twenty-three articles were retrieved in which the most frequently reported symptoms were abdominal distension, abdominal pain, and diarrhea. Chronic and metabolic diseases where the conditions most strongly associated with dysbiosis. Depending on symptomatology and etiology, dysbiosis is often treated with probiotics. Dysbiosis, often linked to diarrhea, should be considered with other symptoms like abdominal distension and pain, along with predisposing conditions and patient risk factors. Probiotics are commonly used as co-adjuvant treatments for antibiotic-associated diarrhea, irritable bowel syndrome, and childhood allergic diseases. The most commonly used probiotics were Weizmannia coagulans (formerly B. coagulans), Alkalihalobacillus clausii (formerly Bacillus clausii), Lacticaseibacillus rhamnosus, Limosilactobacillus reuteri, and Saccharomyces boulardii.
Preterm birth, C-sections, antibiotics, and limited breastfeeding contribute to the increase in noncommunicable diseases. Our objective was to perform a descriptive review of probiotic use in pediatrics, focused on Lactobacillus rhamnosus GG. Certain probiotics have demonstrated to be effective in acute diarrhea and antibiotic-associated diarrhea. L. rhamnosus GG and Saccharomyces boulardii may shorten their duration and symptoms. L. reuteri DSM 17938 and L. rhamnosus GG were effective to manage infant colic. The use of this strain in infant formulas for cow's milk protein allergy may promote an earlier tolerance acquisition. In relation to the prevention of atopic dermatitis, the administration of L. rhamnosus GG during pregnancy reduced its development in the infant. The use of probiotics as adjuvants is a possibility to consider in current pediatric practice. El parto prematuro, las cesáreas, los antibióticos y la lactancia materna limitada contribuyen al aumento de enfermedades crónicas no transmisibles. El objetivo fue realizar una revisión descriptiva del uso de probióticos en pediatría, con foco en la cepa Lactobacillus rhamnosus GG. Ciertos probióticos han demostrado ser eficaces en la diarrea aguda y en la diarrea asociada a antibióticos. L. rhamnosus GG y Saccharomyces boulardii pueden acortar la duración y los síntomas. L. reuteri DSM 17938 y L. rhamnosus GG fueron efectivos para el abordaje del cólico del lactante. El uso de esta cepa en fórmulas infantiles para alergia a las proteínas de leche de vaca promovería la adquisición más temprana de tolerancia. En la prevención de dermatitis atópica, la administración de L. rhamnosus GG durante el embarazo redujo su manifestación en el bebé. El empleo de probióticos como coadyuvantes es una posibilidad para considerar en la práctica pediátrica actual.