Behaviour of Saccharomyces boulardii in recurrent Clostridium difficile disease patients

G. W. Elmer, L. V. McFarland, C. M. Surawicz, L. Danko, R. N. Greenberg

Research output: Contribution to journalArticlepeer-review

63 Scopus citations


Background: Despite recent interest in therapeutic microorganisms taken orally, little is known about the pharmacodynamics of these agents in a target population of patients with disease. The present study reports the stool concentrations of Saccharomyces boulardii in a patient population with Clostridium difficile disease (CDD) and correlates stool concentrations with efficacy. Methods: Patients with recurrent CDD all received a 10-day standard antibiotic regimen together with 28 days of S. boulardii or placebo. Stool samples were collected from patients at various time points and assayed for S. boulardii. Results: The mean concentration of S. boulardii of patients who recurred was 2.5 x 104 CFU/g compared to 1 x 106 CEU/g in patients that did not recur (P = 0.02). Patients with low yeast concentrations in their stools (< 104/g) recurred more often (14/15, 93%) compared with patients with higher levels (19/35, 54%, P = 0.007). Clearance of S. boulardii was rapid; only 4% had positive stools 3 days after stopping dosing. Conclusions: After chronic dosing of S. boulardii, patients with low stool concentrations had a higher likelihood of recurrence of CDD. Stool concentrations were also lower during periods of diarrhoea. These results show the importance of characterizing the dynamics of a therapeutic microorganism in patients with disease, as kinetic studies in healthy volunteers may not give a true reflection of the disturbed microecology in the disease state.

Original languageEnglish
Pages (from-to)1663-1668
Number of pages6
JournalAlimentary Pharmacology and Therapeutics
Issue number12
StatePublished - 1999

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)


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