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MMW - Fortschritte der Medizin

, Volume 156, Supplement 1, pp 18–22 | Cite as

Saccharomyces boulardii bei Antibiotika-assoziierter Diarrhöe

  • George MicklefieldEmail author
Article

Zusammenfassung

Hintergrund:

Die Antibiotika-assoziierte Diarrhöe (AAD) ist eine häufige Nebenwirkung einer Antibiotikatherapie. Das klinische Spektrum reicht von milden und selbstlimitierenden Verläufen bis zu lebensbedrohlichen Verläufen wie pseudomembranöser Kolitis oder toxischem Megakolon. Die Therapie erfolgt symptomatisch, Antidiarrhoika (z. B. auf Basis von Saccharomyces boulardii) gelten als Mittel der Wahl.

Methode:

In einer Übersicht wird die Studienlage zur prophylaktischen Wirkung von S. boulardii bei AAD dargestellt.

Ergebnisse:

In 14 von 17 Studien mit insgesamt 4627 Patienten wurde durch die Gabe von S. boulardii ein protektiver Effekt zwischen 43,7 % und 87,3 % erzielt. Eine Metaanalyse (5 Studien, 1076 Patienten) zeigte eine signifikante Senkung des AAD-Risikos von 17,2 % auf 6,7 %, eine weitere Metaanalyse (4 Studien zur H. pylori-Eradikationstherapie, 1215 Patienten) von 12,2 % auf 5,6 %.

Schlussfolgerung:

Für die Hefe S. boulardii besteht eine sehr gute Evidenz in der Prävention der AAD besonders für hospitalisierte Erwachsene. Durch die gleichzeitige Gabe von S. boulardii zum Antibiotikum wird das Risiko für das Auftreten einer AAD statistisch mehr als halbiert.

Schlüsselwörter

Antibiotika-assoziierte Diarrhöe Saccharomyces boulardii Probiotika Clostridium difficile Prävention 

Saccharomyces boulardii in the treatment and prevention of antibiotic-associated diarrhea

Abstract

Background:

Antibiotic-associated diarrhea (AAD) is the most frequent side effect of antibiotic therapy. Clinical signs and symptoms comprise mild and self-limiting courses of diarrhea as well as life threatening courses like pseudomembranous colitis or toxic megacolon. Therapy is symptomatic, antidiarrheal drugs like Saccharomyces boulardii are the therapy of choice.

Method:

Available studies on S. boulardii in the prevention of AAD are presented as a review.

Results:

In 14 out of 17 studies including 4,627 patients the administration of S. boulardii achieved a protective effect between 43.7 % and 87.3 %. A meta-analysis (5 studies, 1,076 patients) showed a significant reduction of the risk to develop an AAD from 17.2 % to 6.7 %, in a further meta-analysis (4 studies on eradication of H. pylori, 1.215 patients) the significant reduction was from 12.2 % to 5.6 %.

Conclusion:

There is very good evidence for the yeast S. boulardii to be effective in the prevention of AAD especially in hospitalized adults. The simultaneous administration of S. boulardii to antibiotics resulted in a significant reduction to develop AAD by more than half.

Keywords

Antibiotic-associated diarrhea Saccharomyces boulardii Probiotics Clostridium difficile Prevention 

Literatur

  1. 1.
    Bartlett JG. Antibiotic-associated diarrhea. N Engl J Med 346 (2002), 334–339.PubMedCrossRefGoogle Scholar
  2. 2.
    McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol 101 (2006), 1–11.CrossRefGoogle Scholar
  3. 3.
    Mock M, Halfmann A, Herrmann M, von Müller L. Aktuelles zur Epidemiologie von Clostridium difficile. Epid Bull 26 (2013), 241–244.Google Scholar
  4. 4.
    Szajewska H, Mrukowicz J. Meta-analysis: non-pathogenic yeast Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Aliment Pharmacol Ther 22 (2005), 365–372.PubMedCrossRefGoogle Scholar
  5. 5.
    Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibioticassociated diarrhea. J Am Med Assoc 307 (2012), 1959–1969.CrossRefGoogle Scholar
  6. 6.
    Breves G, Faul K, Schröder B, Holst H, Caspary WF, Stein J. Application of the colon-simulation technique for studying the effects of Saccharomyces boulardii on basic parameters of porcine cecal microbial metabolism disturbed by clindamycin. Digestion 61 (2000), 193–200.PubMedCrossRefGoogle Scholar
  7. 7.
    Clausen MR, Bonnén H, Tvede M, Mortensen PB. Colonic fermentation to short-chain fatty acids is decreased in antibiotic-associated diarrhoea. Gastroenterology 101 (1991), 1497–1504.PubMedGoogle Scholar
  8. 8.
    Fachinformation Imodium, Stand Februar 2012.Google Scholar
  9. 9.
    Schwabe U, Paffrath D (Hrsg). Arzneiverordnungsreport 2013, Springer Verlag, Berlin Heidelberg 2013.Google Scholar
  10. 10.
    Breves G, Holst H. Probiotische Hefen. In: Bischoff SC (Hrsg). Probiotika, Präbiotika und Synbiotika. Georg Thieme Verlag, Stuttgart 2009, 144–150.Google Scholar
  11. 11.
    Adam J, Barret A, Barret-Bellet C. Essais cliniques contrôlés en double insu de l’ultra-levure lyohilisée: étude multicentrique par 25 médicins de 388 cas. Gaz Med Fr 84 (1977), 2072–2078.Google Scholar
  12. 12.
    Benhamou PH, Berlier P, Danjou G, Plique O, Jessueld D, Dupont C. La diarrhea associée aux antibiotiques chez l’enfant: une etude informatisée en double aveugle chez des patients ambulatoires comparant un agent protecteur et un agent probiotique. Méd Chir Dig 28 (1999), 163–168.Google Scholar
  13. 13.
    Bravo MV, Bunout D, Leiva L, et al. Effect of probiotic Saccharomyces boulardii on prevention of antibiotic-associated diarrhea in adult outpatients with amoxicillin treatment. Rev Med Chil 136 (2008), 981–988.PubMedCrossRefGoogle Scholar
  14. 14.
    Can M, Besirbellioglu BA, Avci IY, Beker CM, Pahsa A. Prophylactic Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea: a prospective study. Med Sci Monit 12 (2006) I19–I22.Google Scholar
  15. 15.
    Cindoruk M, Erkan G, Karakan T, Dursun A, Unal S. Efficacy and safety of Saccharomyces boulardii in the 14-day triple anti-Helicobacter pylori therapy: a prospective randomized placebo-controlled doubleblind study. Helicobacter 12 (2007), 309–316.PubMedCrossRefGoogle Scholar
  16. 16.
    Cremonini F, Di Caro S, Covino M, et al. Effect of different probiotic preparations on anti-helicobacter pylori therapy-related side effects: a parallel group, triple blind, placebo-controlled study. Am J Gastroenterol 97 (2002), 2744–2749.PubMedCrossRefGoogle Scholar
  17. 17.
    Duman DG, Bor S, Ozutemiz O, et al. Efficacy and safety of Saccharomyces boulardii in prevention of antibiotic-associated diarrhoea due to Helicobacterpylori eradication. Eur J Gastroenterol Hepatol 17 (2005), 1357–1361.PubMedCrossRefGoogle Scholar
  18. 18.
    Erdeve O, Tiras U, Dallar Y. The probiotic effect of Saccharomyces boulardii in a pediatric age group. J Trop Pediatr 50 (2004), 234–236.PubMedCrossRefGoogle Scholar
  19. 19.
    Hurduc V, Plesca D, Dragomir D, Sajin M, Vandenplas Y. A randomized, open trial evaluating the effect of Saccharomyces boulardii on the eradication rate of Helicobacter pylori infection in children. Acta Paediatr 98 (2009), 127–131.PubMedCrossRefGoogle Scholar
  20. 20.
    Kotowska M, Albrecht P, Szajewska H. Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea in children: a randomized double-blind placebo-controlled trial. Aliment Pharmacol Ther 21 (2005), 583–590.PubMedCrossRefGoogle Scholar
  21. 21.
    Lewis SJ, Potts LF, Barry RE. The lack of therapeutic effect of Saccharomyces boulardii in the prevention of antibiotic-related diarrhea in elderly patients. J Infection 36 (1998), 171–174.CrossRefGoogle Scholar
  22. 22.
    McFarland LV, Surawicz CM, Greenberg RN, et al. Prevention of β-Lactam-Associated Diarrhea by Saccharomyces boulardii Compared with Placebo. Am J Gastroenterol 90 (1995), 439–448.PubMedGoogle Scholar
  23. 23.
    Monteiro E, Fernandes JP, Vieira MR, et al. Doubleblind clinical trial on the effect of ultra-levure in the prophylaxis of antibiotic induced gastro-intestinal and mucocutaneous disorders. Acta Med Port 3 (1981), 143–145.PubMedGoogle Scholar
  24. 24.
    Pozzoni P, Riva A, Bellatorre AG, et al. Saccharomyces boulardii for the prevention of antibiotic-associated diarrhea in adult hospitalized patients: a singlecenter, randomized, double-blind, placebo-controlled trial. Am J Gastroenterol 107 (2012), 922–931.PubMedCrossRefGoogle Scholar
  25. 25.
    Shan L, Hou P, Wang Z, et al. Prevention and treatment of diarrhea with Saccharomyces boulardii in children with acute lower respiratory tract infections. Benef Microbes 4 (2013), 329–334.PubMedCrossRefGoogle Scholar
  26. 26.
    Song MJ, Park DI, Park JH, et al. The effect of probiotics and mucoprotective agents on PPI-based triple therapy for eradication of Helicobacter pyroli. Helicobacter 15 (2010), 206–213.PubMedCrossRefGoogle Scholar
  27. 27.
    Surawicz CM, Elmer GW, Speelman P, McFarland LV, Chinn J, van Belle G. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: a prospective study. Gastroenterology 96 (1989), 981–988.PubMedGoogle Scholar
  28. 28.
    Szajewska H, Horvath A, Piwowarczyk A. Meta-analysis: the effects of Saccharomyces boulardii supplementation on Helicobacter pylori eradication rates and side effects during treatment. Aliment Pharmacol Ther 32 (2010), 1069–1079.PubMedCrossRefGoogle Scholar
  29. 29.
    Oeztuerk H, Schroeder B, Beyerbach M, Breves G. Influence of living and autoclaved yeasts of Saccharomyces boulardii on in vitro ruminal microbial metabolism. J Dairy Sci 88 (2005), 2594–2600.PubMedCrossRefGoogle Scholar
  30. 30.
    Castex F, Corthier G, Jouvert S, et al. Prevention of experimental pseudomembranous cecitis by Saccharomyces boulardii: Topographical histology of the mucosa, bacterial counts, and analysis of toxin production. Microecology and Therapy 19 (1989), 241–250.Google Scholar
  31. 31.
    Corthier G, Dubos F, Ducluzeau R. Prevention of Clostridium difficile induced mortality in gnotobiotic mice by Saccharomyces boulardii. Can J Microbiol 32 (1986), 894–896.PubMedCrossRefGoogle Scholar
  32. 32.
    Krammer, M, Karbach U. Antidiarrheal action of the yeast saccharomyces boulardii in the rat small and large intestine by stimulating chloride absorption. Z Gastroenterol (Suppl 4) 31 (1993), 73–77.Google Scholar
  33. 33.
    Czerucka D, Roux I, Rampal P. Saccharomyces boulardii inhibits secretagogue-mediated adenosine 3’,5’-cyclic monophosphate induction in intestinal cells. Gastroenterology 106 (1994), 65–72.PubMedGoogle Scholar
  34. 34.
    Buts J-P, Dekeyser N, Stilmant C, Delem E, Smets F, Sokal E. Saccharomyces boulardii produces in rat small intestine a novel protein phosphatase that inhibits Escherichia coli endotoxin by dephosphorylation. Pediatr Res 60 (2006), 24–29.PubMedCrossRefGoogle Scholar
  35. 35.
    Castagliuolo I, LaMont JT, Nikulasson ST, Pothoulakis C. Saccharomyces boulardii protease inhibits Clostridium difficile toxin A effects in the rat ileum. Innfect Immun 64 (1996), 5225–5232.Google Scholar
  36. 36.
    Castagliuolo I, Riegler MF, Valenick L, LaMont JT, Pothoulakis C. Saccharomyces boulardii protease inhibits the effects of Clostridium difficile toxins A and B in human colonic mucosa. Infect Immun 67 (1999), 302–307.PubMedCentralPubMedGoogle Scholar

Copyright information

© Urban & Vogel 2014

Authors and Affiliations

  1. 1.MünchenDeutschland

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