A Meta Analysis on the Efficacy and Safety of Saccharomyces boulardii on Diarrrhea due to Amoebiasis in Children

Felizardo  N. Gatcheco,; Manuel Leon  F. Villanueva,; Ma. Grace  C. Rosales,

A Meta Analysis on the Efficacy and Safety of Saccharomyces boulardii on Diarrrhea due to Amoebiasis in Children

Manuel Leon F. Villanueva | Felizardo N. Gatcheco | Ma. Grace C. Rosales

Abstract:

Objective: To determine the efficacy and safety of Saccharomyces boulardii on diarrhea due to amoebiasis in children. Methods: The following electronic databases were searched through December 2015 for studies relevant to acute or bloody diarrhoea and S. boulardii: MEDLINE/PUBMED, and The Cochrane Library; additional references were obtained from local unpublished article. Randomized-controlled trials were included. Results: Three randomized-controlled trials (175 participants) met the inclusion criteria. Combined data from 3 randomized-controlled trials showed that S. boulardii significantly reduced the duration of diarrhea compared with control. The mean of diarrhea was significantly decreased by 0.70 days (95% CI, -1.05 to -0.34) under the fixed effects model. Under the random effects model, the mean duration of diarrhea was likewise significantly decreased by 0.71 days (95% CI, -1.20 to -0.23). The difference in duration of bloody diarrhea in days was significant between the 2 groups using the fixed effects (Z=4.17; p<0.0001) but not in the random effects model. The results also showed that there was a protective effect for cyst passage with the use of S.boulardii (RR=0.36; 95% CI:0.11 – 1.14) although it was not statistically significant. The mean duration of fever was significantly decreased by 0.13 days (95% CI, -0.17 to -0.08) both under the fixed and random effects model. Under the random effects model, no significant difference was noted in the duration of abdominal pain (Z= 1.01; p=0.31). No adverse effects were reported in all studies. Conclusion: S boulardii as an adjunct to metronidazole demonstrated advantages statistically compared to metronidazole alone for the treatment of acute diarrhea among children. The duration of diarrhea and fever was significantly shortened in those given S boulardii. The duration of bloody diarrhea appeared shorter in the S boulardii. No adverse effects were noted.

References:

Petri WA Jr, Singh U. Diagnosis and management of amebiasis. Clin Infect Dis 1999; 29: 1117-1125.
Petri W.A.Jr., Haque, R., Lyerly, D. and Vines, R.R. Estimating the Impact of amebiasis on health. Parasitol Today, 2002, 16:320-321.
R. B. Canani, S. Cucchiara, R. Cuomo, F. Pace, F. Papale. European Review for Medical and Pharmacological Sciences. Saccharomyces boulardii: A summary of the evidence for gastroenterology clinical practice in adults and children. 2011; 15: 809-822
Guandalini S, 2008. Probiotics for children with diarrhea: an update. J Clin Gastroenterol 42 (Suppl 2): S53-S57.
Van Niel C, Feudtner C, Garrison MM, Christakis DA. Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics 2002; 109: 678–84.
Huang JS, Bousvaros A, Lee JW, et al. Efficacy of probiotic use in acute diarrhea in children: a meta-analysis. Dig Dis Sci 2002; 47: 2625–34.
Allen SJ, Okoko B, Martinez E, et al. Probiotics for treating infectious diarrhoea. Cochrane Database Syst Rev 2003 (issue 4). Art. No.: CD003048.pub2. DOI:10.1002/14651858.CD003048.pub2.
F. Mansour-Ghanaei, N. Dehbashi, K. Yazdanparast, A. Shafaghi. Efficacy of Saccharomcyces boulardii with antibiotics in acute amoebiasis. World J Gastroenterol 2003;9(8):1832-1833
Higgins JPT, Green S, “Chapter 16: special topics in statistics,” in Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, J. P. T. Higgins, J. Deeks, and D. G. Altman, Eds., The Cochrane Collaboration, 2011, http://www.cochrane-handbook.org
Gonzalez-Ruiz, Haque R, Aguirre A, et al. Value of microscopy in the diagnosis of dysentery associated with invasive Entamoeba histolytica. J Clin Pathol 1994; 47: 236-239
Follmann D, Elliott P, Suh I, Cutler J. “Variance imputation for overviews of clinical trials with continuous response,” J Clin Epidemiol. 1992; 45 (7): 769–773.
Abrams KR, Gillies CL, Lambert PC, “Meta-analysis of heterogeneously reported trials assessing change from baseline,” Stat Med. 2005; 24 (24):3823–3844.
Dinleyici EC, Eren M, Yargic ZA, Dogan N, Vandeplas Y. Clinical Efficacy of Saccharomyces boulardii and Metronidazole compared to metronidazole alone in children with acute bloody diarrhea caused by amebiasis: A prospective, Randomized, open label study. Am JTrop Med Hyg.80(6), 2009, pp. 953–955
Şenay Savaş-Erdeve, Songul Gokay, Yıldız Dallar. Efficacy and safety of Saccharomyces boulardii in amebiasis associated diarrhea in children. Turk J Pediatr. 2009; 21: 220-224
Avellana, FP. Clinical Efficacy of Saccharomyces boulardii as an adjunct in the management of Acute Amoebiasis Among Pediatric Patients aged 9-60 months Admitted at Bulacan Medical Center from May to October 2015. Unpublished
Szajewska H, Skorka A, Dylag M. Meta-analysis: Saccharomyces boulardii. Ailment Phamacol Ther 2007; 25: 257-264.
Czerucka D, Piche T, Rampal P, 2007. Review article: yeast as probiotics–Saccharomyces boulardii . Aliment Pharmacol Ther 26:767–778.
Geyik MF, Aldemir M, Hosoglu S, et al. The effects of Saccharomyces boulardii on bacterial translocation in rats with obstructive jaundice. Ann R Coll Surg Engl. 2006;88(2):176–180.
World Health Organization. The Rational Use of Drugs in the Management of Acute Diarrhoea in Children. Geneva, Switzerland: World Health Organization, 1990.
Bassetti S, Frei R, Zimmerli W. Fungemia with Saccharomyces cerevisiae after treatment with S. boulardii. Am J Med 1998; 105: 71–2.
Rijnders BJA, Van Wijngaerden E, Verwaest C, Peetermans WE. Saccharomyces fungemia complicating S. Boulardii treatment in a non-immunocompromised host. Intensive Care Med 2000;26: 825.
Zunic P, Lacotte J, Pegoix M, et al. S. boulardii fungemia. Apropos of a case. Therapie 1991; 46: 498–9