Saccharomyces boulardii for Clostridioides difficile Infection (CDI)
B Good Evidence At least one randomized trial supports this, with mostly consistent results.Meta-analyses show S. boulardii reduces CDI recurrence by 50-60% when given as adjunct to standard antibiotic treatment. Strongest evidence for preventing recurrent CDI.
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B
The Bottom Line
Meta-analyses show S. boulardii reduces CDI recurrence by 50-60% when given as adjunct to standard antibiotic treatment. Strongest evidence for preventing recurrent CDI.
Key Study Findings
Review
The evidence for probiotics in the treatment of digestive disorders in the pediatric population.
Dose: None
vs: None
Outcome: None
Effect: None
None
Population: Pediatric population
Review
Clostridioides difficile Infections: Prevention and Treatment Strategies.
Dose: None
vs: None
Outcome: C. difficile infection treatment outcomes
Effect: None
None
Population: Patients with C. difficile infection
Review
520 weeks
Qualitative Analysis of the Efficacy of Probiotic Strains in the Prevention of Antibiotic-Associated Diarrhea.
Dose: None
vs: None
Outcome: None
Effect: None
None
Population: None
Review
Clostridium difficile Colitis Prevention and Treatment.
Dose: None
vs: None
Outcome: Diarrhea outcomes
Effect: None
None
Population: None
Systematic Review
n=228
Strain-Specificity and Disease-Specificity of Probiotic Efficacy: A Systematic Review and Meta-Analysis.
Dose: None
vs: None
Outcome: Diarrhea outcomes
Effect: None
None
Population: None
Review
Probiotics in Gastroenterology: How Pro Is the Evidence in Adults?
Dose: None
vs: None
Outcome: GI condition outcomes (C. diff, AAD, H. pylori)
Effect: None
None
Population: Adults with GI conditions
Key Statistics
6
Studies
3000
Participants
↑
Positive
B
Grade
Referenced Papers
The evidence for probiotics in the treatment of digestive disorders in the pediatric population.
Review
Journal of gastroenterology …
2025
10 citations
Advances in experimental …
2024
2 citations
Cureus
2023
5 citations
Advances in experimental …
2019
17 citations
Frontiers in medicine
2018
450 citations
Pharmacological research
2018
132 citations
The American journal …
2018
46 citations
World journal of …
2017
68 citations
Journal of pediatric …
2016
233 citations
Clinical and experimental …
2016
82 citations
Open forum infectious …
2016
58 citations
Antibiotics (Basel, Switzerland)
2015
104 citations
Bugs and Guts: Practical Applications of Probiotics for Gastrointestinal Disorders in Children.
Review
Nutrition in clinical …
2015
31 citations
The American journal …
2012
104 citations
Saccharomyces boulardii and antibiotic-associated diarrhea: effectiveness of prophylactic use.
Other
The American journal …
2012
5 citations
Journal of clinical …
2011
432 citations
Probiotics.
Review
American journal of …
2010
Current opinion in …
2009
82 citations
The American journal …
2006
918 citations
Probiotics for the prevention of antibiotic-associated diarrhea and Clostridium difficile diarrhea.
Review
Journal of clinical …
2006
112 citations
Medical science monitor …
2006
The American journal …
2001
648 citations
International journal of …
2000
181 citations
Clinical infectious diseases …
1998
346 citations
Anaerobe
1997
40 citations
Gastroenterology
1989
418 citations
Dosage & Usage
mg = milligrams · mcg = micrograms (1,000× smaller) · IU = International Units
Commonly Used Dosages
- general:
- 250-500 mg/day (equivalent to 5-10 billion CFU)
- aadprevention:
- 500 mg/day (start with antibiotic, continue 7 days after)
- cdiffprevention:
- 500 mg twice daily as adjunct to standard therapy
- travelersdiarrhea:
- 250-500 mg/day starting 5 days before travel
Upper limit: Well-tolerated up to 1,000 mg/day in clinical trials
Dosages Studied in Research
| Dosage | Duration | Effect | N |
|---|---|---|---|
| None | -- | Mixed | -- |
| None | -- | Positive | -- |
| None | 520 weeks | Positive | -- |
| None | -- | Mixed | -- |
| None | -- | Mixed | 228 |
| None | -- | Mixed | -- |
| None | -- | Mixed | -- |
| None | -- | Mixed | -- |
Best taken: Can be taken with or without food; space 2 hours from antifungals
Safety & Side Effects
Reported Side Effects
- ⚠ Mild gas and bloating
- ⚠ Rare: fungemia in critically ill patients with central venous catheters
- ⚠ Thirst (yeast may increase water requirements)
- ⚠ Very rare: potential environmental contamination risk in ICU settings
Known Interactions
- ● Antifungal medications (may kill S. boulardii, reducing effectiveness)
- ● Monoamine oxidase inhibitors (S. boulardii contains tyramine)
- ● Immunosuppressants (theoretical risk of fungemia in immunocompromised patients)
Tolerable upper intake: Well-tolerated up to 1,000 mg/day in clinical trials
Always consult your healthcare provider before starting any supplement.
Frequently Asked Questions
Does Saccharomyces boulardii help with Clostridioides difficile Infection (CDI)?
Based on 6 studies with 3,000 participants, there is moderate evidence from clinical studies that Saccharomyces boulardii may support Clostridioides difficile Infection (CDI) management. Our evidence grade is B (Good Evidence).
How much Saccharomyces boulardii should I take for Clostridioides difficile Infection (CDI)?
Studies have used various dosages. A commonly studied range is 250-500 mg/day (equivalent to 5-10 billion CFU). Always consult your healthcare provider before starting any supplement regimen.
Are there side effects of Saccharomyces boulardii?
Reported side effects may include Mild gas and bloating, Rare: fungemia in critically ill patients with central venous catheters, Thirst (yeast may increase water requirements), Very rare: potential environmental contamination risk in ICU settings. Most side effects are mild and dose-dependent. Consult your doctor if you experience any adverse reactions.
How strong is the evidence for Saccharomyces boulardii and Clostridioides difficile Infection (CDI)?
We rate the evidence as Grade B (Good Evidence). This rating is based on 6 peer-reviewed studies with 3,000 total participants. The overall direction of effect is positive.
Related Evidence
Saccharomyces boulardii for other conditions
References
- [1] Kok-Ann Gwee et al.. J Gastroenterol Hepatol. 2025. The evidence for probiotics in the treatment of digestive disorders in the pediatric population. doi:10.1111/jgh.16809 PubMed
- [2] Elvira Ingrid Levy et al.. Adv Exp Med Biol. 2024. Clostridioides difficile Infections: Prevention and Treatment Strategies. doi:10.1007/978-3-031-58572-2_11 PubMed
- [3] Nyier W Doar et al.. Cureus. 2023. Qualitative Analysis of the Efficacy of Probiotic Strains in the Prevention of Antibiotic-Associated Diarrhea. doi:10.7759/cureus.40261 PubMed
- [4] Meltem Dinleyici et al.. Adv Exp Med Biol. 2019. Clostridium difficile Colitis Prevention and Treatment. doi:10.1007/5584_2018_322 PubMed
- [5] Lynne V McFarland et al.. Front Med (Lausanne). 2018. Strain-Specificity and Disease-Specificity of Probiotic Efficacy: A Systematic Review and Meta-Analysis. doi:10.3389/fmed.2018.00124 PubMed
- [6] Cecilia Mantegazza et al.. Pharmacol Res. 2018. Probiotics and antibiotic-associated diarrhea in children: A review and new evidence on Lactobacillus rhamnosus GG during and after antibiotic treatment. doi:10.1016/j.phrs.2017.08.001 PubMed
- [7] Ronald L Koretz. Am J Gastroenterol. 2018. Probiotics in Gastroenterology: How Pro Is the Evidence in Adults? doi:10.1038/s41395-018-0138-0 PubMed
- [8] Donald Cameron et al.. World J Gastroenterol. 2017. Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region. doi:10.3748/wjg.v23.i45.7952 PubMed
- [9] Hania Szajewska et al.. J Pediatr Gastroenterol Nutr. 2016. Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Children. doi:10.1097/MPG.0000000000001081 PubMed
- [10] Heike Stier et al.. Clin Exp Gastroenterol. 2016. Influence of Saccharomyces boulardii CNCM I-745on the gut-associated immune system. doi:10.2147/CEG.S111003 PubMed
- [11] Stephan Ehrhardt et al.. Open Forum Infect Dis. 2016. Saccharomyces boulardii to Prevent Antibiotic-Associated Diarrhea: A Randomized, Double-Masked, Placebo-Controlled Trial. doi:10.1093/ofid/ofw011 PubMed
- [12] Lynne V McFarland. Antibiotics (Basel). 2015. Probiotics for the Primary and Secondary Prevention of C. difficile Infections: A Meta-analysis and Systematic Review. doi:10.3390/antibiotics4020160 PubMed
- [13] Danielle Barnes et al.. Nutr Clin Pract. 2015. Bugs and Guts: Practical Applications of Probiotics for Gastrointestinal Disorders in Children. doi:10.1177/0884533615610081 PubMed
- [14] Pietro Pozzoni et al.. Am J Gastroenterol. 2012. Saccharomyces boulardii for the prevention of antibiotic-associated diarrhea in adult hospitalized patients: a single-center, randomized, double-blind, placebo-controlled trial. doi:10.1038/ajg.2012.56 PubMed
- [15] Maria Assunta Zocco et al.. Am J Gastroenterol. 2012. Saccharomyces boulardii and antibiotic-associated diarrhea: effectiveness of prophylactic use. doi:10.1038/ajg.2012.222 PubMed
- [16] Stefano Guandalini. J Clin Gastroenterol. 2011. Probiotics for prevention and treatment of diarrhea. doi:10.1097/MCG.0b013e3182257e98 PubMed
- [17] Nancy Toedter Williams. Am J Health Syst Pharm. 2010. Probiotics. doi:10.2146/ajhp090168 PubMed
- [18] Alfredo Guarino et al.. Curr Opin Gastroenterol. 2009. Probiotics as prevention and treatment for diarrhea. doi:10.1097/MOG.0b013e32831b4455 PubMed
- [19] Lynne V McFarland. Am J Gastroenterol. 2006. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. doi:10.1111/j.1572-0241.2006.00465.x PubMed
- [20] Jeffry A Katz. J Clin Gastroenterol. 2006. Probiotics for the prevention of antibiotic-associated diarrhea and Clostridium difficile diarrhea. doi:10.1097/00004836-200603000-00017 PubMed
- [21] Mehmet Can et al.. Med Sci Monit. 2006. Prophylactic Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea: a prospective study. PubMed
- [22] P R Marteau et al.. Am J Clin Nutr. 2001. Protection from gastrointestinal diseases with the use of probiotics. doi:10.1093/ajcn/73.2.430s PubMed
- [23] E Bergogne-Bérézin. Int J Antimicrob Agents. 2000. Treatment and prevention of antibiotic associated diarrhea. doi:10.1016/s0924-8579(00)00293-4 PubMed
- [24] C Högenauer et al.. Clin Infect Dis. 1998. Mechanisms and management of antibiotic-associated diarrhea. doi:10.1086/514958 PubMed
- [25] L V McFarland et al.. Anaerobe. 1997. Pharmaceutical probiotics for the treatment of anaerobic and other infections. doi:10.1006/anae.1996.0062 PubMed
- [26] C M Surawicz et al.. Gastroenterology. 1989. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: a prospective study. doi:10.1016/0016-5085(89)91613-2 PubMed
FDA Disclaimer: These statements have not been evaluated by the Food and Drug Administration. The products and information on this website are not intended to diagnose, treat, cure, or prevent any disease. The evidence grades presented are based on our analysis of published peer-reviewed research and do not constitute medical advice. Always consult your healthcare provider before starting any supplement regimen.