Parasitology Research

, Volume 108, Issue 3, pp 541–545 | Cite as

Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection

  • Ener Cagri DinleyiciEmail author
  • Makbule Eren
  • Nihal Dogan
  • Serap Reyhanioglu
  • Zeynel Abidin Yargic
  • Yvan Vandenplas
Original Paper


Although many Blastocystis infections remain asymptomatic, recent data suggest it also causes frequent symptoms. Therapy should be limited to patients with persistent symptoms and a complete workup for alternative etiologies. The goal of this study was to compare the natural evolution (no treatment) to the efficacy of Saccharomyces boulardii (S. boulardii) or metronidazole for the duration of diarrhea and the duration of colonization in children with gastrointestinal symptoms and positive stool examination for Blastocystis hominis. This randomized single-blinded clinical trial included children presenting with gastrointestinal symptoms (abdominal pain, diarrhea, nausea–vomiting, flatulence) more than 2 weeks and confirmed B. hominis by stool examination (B. hominis cysts in the stool with microscopic examination of the fresh stool). The primary end points were clinical evaluation and result of microscopic stool examination at day 15. Secondary end points were the same end points at day 30. Randomization was performed by alternating inclusion: group A, S. boulardii (250 mg twice a day, Reflor®) during 10 days; group B, metronidazole (30 mg/kg twice daily) for 10 days; group C, no treatment. At day 15 and 30 after inclusion, the patients were re-evaluated, and stool samples were examined microscopically. On day 15, children that were still symptomatic and/or were still B. hominis-infected in group C were treated with metronidazole for 10 days. There was no statistically significant difference between the three study groups for age, gender, and the presence of diarrhea and abdominal pain. On day 15, clinical cure was observed in 77.7% in group A (n, 18); in 66.6% in group B (n, 15); and 40% in group C (n:15) (p < 0.031, between groups A and C). Disappearance of the cysts from the stools on day 15 was 80% in group B, 72.2% in group A, and 26.6% in group C (p = 0.011, between group B and group C; p = 0.013, between group A and group C). At the end of the first month after inclusion, clinical cure rate was 94.4% in group A and 73.3% in group B (p = 0.11). Parasitological cure rate for B. hominis was very comparable between both groups (94.4% vs. 93.3%, p = 0.43). Metronidazole or S. boulardii has potential beneficial effects in B. hominis infection (symptoms, presence of parasites). These findings challenge the actual guidelines.


Irritable Bowel Syndrome Metronidazole Tinidazole Clinical Cure Rate Amebiasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study presents as a poster presentation in the 43rd Annual Meeting of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) in 9–12 June 2010 at Istanbul, and the abstract of this study was published in a supplemental issue in the Journal of Pediatric Gastroenterology and Nutrition.


  1. Besirbellioglu BA, Ulcay A, Can M, Erdem H, Tanyuksel M, Avci IY, Araz E, Pahsa A (2006) Saccharomyces boulardii and infection due to Giardia lamblia. Scand J Infect Dis 38:479–481CrossRefPubMedGoogle Scholar
  2. Dagci H, Kurt O, Demirel M, Ostan I, Azizi NR, Mandiracioglu A, Yurdagül C, Tanyüksel M, Eroglu E, Ak M (2008) The prevalence of intestinal parasites in the province of Izmir, Turkey. Parasitol Res 103(4):839–845CrossRefPubMedGoogle Scholar
  3. Dinleyici EC, Eren M, Yargic ZA, Dogan N, Vandenplas Y (2009) 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 J Trop Med Hyg 80:953–955PubMedGoogle Scholar
  4. Eren M, Dinleyici EC, Vandenplas Y (2010) Clinical efficacy comparison of Saccharomyces boulardi and yoghurt fluid in acute non-bloody diarrhea in children: a randomized, controlled, open label study. Am J Trop Med Hyg 82(3):488–491CrossRefPubMedGoogle Scholar
  5. Eroglu F, Genc A, Elgun G, Koltas IS (2009) Identification of Blastocystis hominis isolates from asymptomatic and symptomatic patients by PCR. Parasitol Res 105(6):1589–1592CrossRefPubMedGoogle Scholar
  6. Htwe K, Yee KS, Tin M, Vandenplas Y (2008) Effect of Saccharomyces boulardii in the treatment of acute watery diarrhea in Myanmar children: a randomized controlled study. Am J Trop Med Hyg 78:214–216PubMedGoogle Scholar
  7. Hussain R, Jaferi W, Zuberi S, Baqai R, Abrar N, Ahmed A, Zaman V (1997) Significantly increased IgG2 subclass antibody levels to Blastocystis hominis in patients with irritable bowel syndrome. Am J Trop Med Hyg 56:301–306PubMedGoogle Scholar
  8. Jones MS, Whipps CM, Ganac RD, Hudson NR, Boroom K (2009) Association of Blastocystis subtype 3 and 1 with patients from an Oregon community presenting with chronic gastrointestinal illness. Parasitol Res 104(2):341–345CrossRefPubMedGoogle Scholar
  9. Kurugöl Z, Koturoğlu G (2005) Effects of Saccharomyces boulardii in children with acute diarrhoea. Acta Paediatr 94:44–47CrossRefPubMedGoogle Scholar
  10. Mansour-Ghanaei F, Dehbashi N, Yazdanparast K, Shafaghi A (2003) Efficacy of Saccharomyces boulardii with antibiotics in acute amoebiasis. World J Gastroenterol 9:1832–1833PubMedGoogle Scholar
  11. Moghaddam DD, Ghadirian E, Azami M (2005) Blastocystis hominis and the evaluation of efficacy of metronidazole and trimethoprim/sulfamethoxazole. Parasitol Res 96:273–275CrossRefPubMedGoogle Scholar
  12. Nigro L, Larocca L, Massarelli L, Patamia I, Minniti S, Palermo F, Cacopardo B (2003) A placebo-controlled treatment trial of Blastocystis hominis infection with metronidazole. J Travel Med 10(2):128–130CrossRefPubMedGoogle Scholar
  13. Rossignol JF, Kabil SM, Said M, Samir H, Younis AM (2005) Effect of nitazoxanide in persistent diarrhea and enteritis associated with Blastocystis hominis. Clin Gastroenterol Hepatol 3:987–991CrossRefPubMedGoogle Scholar
  14. Szajewska H, Skórka A, Dylag M (2007) Meta-analysis: Saccharomyces boulardii for treating acute diarrhoea in children. Aliment Pharmacol Ther 25:257–264CrossRefPubMedGoogle Scholar
  15. Tan KS, Singh M, Yap EH (2002) Recent advances in Blastocystis hominis research: hot spots in terra incognita. Int J Parasitol 32:789–804CrossRefPubMedGoogle Scholar
  16. Vandenplas Y, Benninga M (2009) Probiotics and functional gastrointestinal disorders in children. J Pediatr Gastroenterol Nutr 48(Suppl 2):S107–S109CrossRefPubMedGoogle Scholar
  17. Villarruel G, Rubio DM, Lopez F, Cintioni J, Gurevech R, Romero G, Vandenplas Y (2007) Saccharomyces boulardii in acute childhood diarrhoea: a randomized, placebo-controlled study. Acta Paediatr 96:538–541CrossRefPubMedGoogle Scholar
  18. Yakoob J, Jafri W, Jafri N, Khan R, Islam M, Beg MA, Zaman V (2004) Irritable bowel syndrome: in search of an etiology: role of Blastocystis hominis. Am J Trop Med Hyg 70:383–385PubMedGoogle Scholar
  19. Yakoob J, Jafri W, Beg MA, Abbas Z, Naz S, Islam M, Khan R (2010a) Irritable bowel syndrome: is it associated with genotypes of Blastocystis hominis. Parasitol Res 106(5):1033–1038CrossRefPubMedGoogle Scholar
  20. Yakoob J, Jafri W, Beg MA, Abbas Z, Naz S, Islam M, Khan R (2010b) Blastocystis hominis and Dientamoeba fragilis in patients fulfilling irritable bowel syndrome criteria. Parasitol Res 107(3):679–684CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Ener Cagri Dinleyici
    • 1
    Email author
  • Makbule Eren
    • 2
  • Nihal Dogan
    • 3
  • Serap Reyhanioglu
    • 1
  • Zeynel Abidin Yargic
    • 1
  • Yvan Vandenplas
    • 4
  1. 1.Department of PediatricsEskisehir Osmangazi University Faculty of MedicineEskisehirTurkey
  2. 2.Department of Pediatrics, Division of Pediatric Gastroenterology and HepatologyEskisehir Osmangazi University Faculty of MedicineEskisehirTurkey
  3. 3.Department of ParasitologyEskisehir Osmangazi University, Faculty of MedicineEskisehirTurkey
  4. 4.Universitair Ziekenhuis Brussel Kinderen, Vrije Universiteit BrusselBrusselsBelgium

Personalised recommendations