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Open Forum Infect Dis. 2016 Jan 29;3(1):ofw011. doi: 10.1093/ofid/ofw011. eCollection 2016 Jan.

Saccharomyces boulardii to Prevent Antibiotic-Associated Diarrhea: A Randomized, Double-Masked, Placebo-Controlled Trial.

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Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine.
Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
Department of Tropical Medicine at the Bernhard Nocht Institute , German Armed Forces Hospital of Hamburg.
Clinical Research Unit , Bernhard Nocht Institute for Tropical Medicine.
Infectious Disease Epidemiology , Bernhard Nocht Institute for Tropical Medicine.
Department of Medicine II , Klinikum Vest GmbH , Marl.
Department of Internal Medicine , Federal Armed Forces Hospital Ulm.
Department of Medicine I , University Medical Center Hamburg-Eppendorf.
Bethesda Krankenhaus Bergedorf, Klinik fur Innere Medizin.
Department of Internal Medicine, Division for Tropical Medicine and Infectious Diseases , Rostock University Medical Center.
Medical Clinic I , Hospital of Saarbrücken.
Department of Internal Medicine , Agaplesion Diakonieklinikum Hamburg.
I. Department of Internal Medicine, Johannes-Gutenberg-Universität Mainz, University Medical Centre; I. Department of Internal Medicine, Constance Hospital.
Diakoniekrankenhaus Rotenburg (Wümme) GmbH, Zentrum für Pneumologie.
Institute of Biostatistics and Clinical Research , University of Münster.
Department of Medicine I, University Medical Center Hamburg-Eppendorf; Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.



Antibiotic-associated diarrhea (AAD) and Clostridium difficile-associated diarrhea (CDAD) are common complications of antibiotic use. Data on the efficacy of probiotics to prevent AAD and CDAD are unclear. We aimed to evaluate the efficacy of Saccharomyces boulardii to prevent AAD and CDAD in hospitalized adult patients.


 We conducted a multicenter, phase III, double-masked, randomized, placebo-controlled trial in hospitalized patients who received systemic antibiotic treatment in 15 hospitals in Germany between July 2010 and October 2012. Participants received Perenterol forte 250 mg capsules or matching placebo twice per day within 24 hours of initiating antibiotic treatment, continued treatment for 7 days after antibiotic discontinuation, and were then observed for 6 weeks.


 Two thousand four hundred forty-four patients were screened. The trial was stopped early for futility after inclusion of 477 participants. Two hundred forty-six patients aged 60.1 ± 16.5 years and 231 patients aged 56.5 ± 17.8 were randomized to the S boulardii group and the placebo group, respectively, with 21 and 19 AADs in the respective groups (P = .87). The hazard ratio of AAD in the S boulardii group compared with the placebo group was 1.02 (95% confidence interval, .55-1.90; P = .94). Clostridium difficile-associated diarrhea occurred in 0.8% of participants (4 of 477). Nine serious adverse events were recorded in the S boulardii group, and 3 serious adverse events were recorded in the placebo group. None were related to study participation.


 We found no evidence for an effect of S boulardii in preventing AAD or CDAD in a population of hospitalized patients without particular risk factors apart from systemic antibiotic treatment. Identifier.  NCT01143272.


Clostridium difficile-associated diarrhea; Saccharomyces boulardii; antibiotic-associated diarrhea; probiotic; randomized controlled trial

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