Systematic review with meta-analysis: Saccharomyces boulardii for treating acute gastroenteritis in children—a 2020 update

Abstract

Background: There is still controversy with regard to the efficacy of individual probiotic strains for the management of acute gastroenteritis. Aim: To update evidence on use of Saccharomyces boulardii for treating acute gastroenteritis in children. Methods: The Cochrane Library, MEDLINE and EMBASE databases were searched from inception to December 2019 for randomised controlled trials (RCTs) that compared use of S boulardii with no S boulardii (defined as placebo or no treatment). The grey literature was searched through Google search. Authors of the original papers and S boulardii manufacturers were contacted for additional data. Results: Twenty-nine RCTs (among them, 20 newly identified trials) were included. Only 38% of trials adequately generated their randomisation sequence, only 17% adequately concealed allocation and only one trial adequately blinded participants, study personnel and outcome assessors. However, 83% provided complete outcome data. None of the trials evaluated the effect of S boulardii on stool volume. Compared with placebo or no treatment, S boulardii use reduced the duration of diarrhoea (23 RCTs, n = 3450, mean difference −1.06 day, 95% CI −1.32 to −0.79; high heterogeneity [I2 = 90%]) (very low quality of evidence). S boulardii use was also associated with a reduced duration of hospitalisation (8 RCTs, n = 999, mean difference −0.85 day, 95% CI −1.35 to −0.34; I2 = 91%) (very low quality of evidence). S boulardii reduced the risk of diarrhoea on day 2 to day 7 (low quality of evidence). Conclusions: In children with acute gastroenteritis, low- to very low-quality evidence suggests that S boulardii confers a benefit for several diarrhoeal outcomes.