< LEADERBOARD/s/saccharomyces-boulardiiGut & probiotics

Saccharomyces boulardii

Also sold as: S. boulardii · Saccharomyces cerevisiae var. boulardii · CNCM I-745

A live probiotic yeast studied chiefly during antibiotic treatment and gastrointestinal infections. Benefits depend on the indication and studied strain; invasive infection is a serious risk in vulnerable patients.

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NERD_PROTOCOL // EVIDENCE_MATRIXper goal

Research

EnergyNo established evidence

Energy: No established human energy benefit in this dossier; this UI goal denotes missing evidence, not a negative energy RCT.

REALITY CHECK // Antibiotic-associated diarrhea evidence does not prove that this yeast treats SIBO, Candida or inflammatory bowel disease. Strain-specific data and viable CFU matter; high-risk patients can develop fungemia even though routine outpatient tolerance is often good.

Levels: how we grade evidence. Grey = evidence of no benefit; amber = evidence it makes this goal worse.

Ratings are self-reported by a self-selected group of users: how it felt, not proof that it works.

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Check your bottle

Compare what your label says with what was used in trials. This is a trial range, not a personal prescription.

Enter the amount from your label to see the result.

How it was studied

01 // STUDIED_DOSE_RANGE

Product-specific, not generic mg

Dossier preparations 250-500 mg/day; no universal CFU conversion or generic calculator target.

02 // TIMING_&_MATRIX

During antibiotics

Antibacterial coadministration is compatible; avoid hot liquid and concurrent antifungal treatment without review.

03 // EVALUATION_WINDOW

Indication-specific course

Acute diarrhea and antibiotic courses differ from weeks-long IBS/SIBO pilots; indefinite use is not validated.

04 // SAFETY_&_QUALITY_GATE

Fungemia gate

Avoid in critical illness, immunocompromise and with central venous catheters.

UPPER LIMIT // No numerical nutrient UL is established. Safety is determined chiefly by host infection risk, not a reassuring dose ceiling; long-term healthy-user RCT safety is limited.

NERD'S NOTENerd Protocols · a clinical and sports dietitian based in the EU

Summary

The strongest evidence concerns prevention of antibiotic-associated diarrhea, not general wellness. A 21-RCT meta-analysis (4780 participants) reported RR 0.47 (95% CI 0.38-0.57), risk 18.7% to 8.5% and NNT 10 (9-13). These findings must be paired with the fungemia warning for high-risk patients.

Mechanism

A live yeast can survive antibacterial treatment and transiently act in the gut. It does not permanently colonize; the dossier reports disappearance roughly 2-5 days after stopping. Proposed gut effects do not establish a Candida treatment or universal probiotic superiority.

Typical studied dose

The dossier describes 250-500 mg/day for specific lyophilized preparations, often labeled about 5-10 billion CFU. That is not a universal mg-to-CFU conversion: strain, viable count at expiry and product potency must match. No generic mass target is enabled in the calculator.

Upper limit

No numerical nutrient UL is established. Safety is determined chiefly by host infection risk, not a reassuring dose ceiling; long-term healthy-user RCT safety is limited.

POPULAR_STACKScombos with n ≥ 5

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Forms and label traps

Forms compared
Form on label	Active content	Studied range / day	Absorption & GI tolerance	Verdict
CNCM I-745 lyophilized capsule Best for: Checking the strain used in relevant trials.	Unstandardized: active content unknown	no comparable trial range	Survives gut passage; strain identity and viable CFU at expiry must be documented. Transient gas or bloating may occur.	Studied standard SOURCE-SPECIFIC Mass-to-CFU conversion is product-specific; calculator target unavailable. PMID 32472262
CNCM I-745 sachet Best for: A format for people unable to swallow capsules.	Unstandardized: active content unknown	no comparable trial range	Same strain can be supplied in powder; avoid hot liquids. Usually well tolerated in appropriate outpatients.	Caution CHECK PREPARATION No generic mg equivalence; avoid catheter contamination and vulnerable hosts. PMID 32472262
Unspecified-strain S. boulardii Best for: Identifying evidence and quality gaps.	Unstandardized: active content unknown	no comparable trial range	Species name alone does not establish equivalent strain potency. Tolerance cannot establish strain equivalence.	Caution CHECK PREPARATION Require strain and viable CFU through shelf life; no generic clinical target.

Common label traps

TRAP_01 // Several studies prove SIBO treatment
Only small pilots/RCTs in selected contexts exist; no robust strain-specific meta-analysis is supplied.
TRAP_02 // It treats intestinal Candida
Antagonism or a yeast label is not proof of clinical antifungal efficacy.
TRAP_03 // Any generic is equivalent
A species label and claimed CFU do not establish the studied strain or viability.

Other outcomes studied

Outside the five leaderboard goals. Same evidence levels as above.

antibiotic_associated_diarrhea Strong · benefit
21 RCTs, n=4780: RR 0.47 (0.38-0.57), risk 18.7% to 8.5%, NNT 10 (9-13), in children and adults; avoid high-risk hosts.
PMID 26216624
c_difficile_diarrhea Limited · benefit
Pediatric subgroup RR 0.25 (0.08-0.73; 2 RCTs, n=579); adult subgroup nonsignificant RR 0.80 (0.47-1.34; 9 RCTs, n=1441). Not established as recurrent-CDI monotherapy.
PMID 26216624 PMID 20011734
pediatric_gastroenteritis Limited · benefit
23 RCTs, n=3450: diarrhea about 1.06 days shorter (CI -1.32 to -0.79) and hospitalization 0.85 days shorter; very low certainty and I-squared 90%. Rehydration remains essential.
PMID 32056266
h_pylori_adjuvant Moderate · benefit
18 RCTs, n=3592: eradication RR 1.09 (1.05-1.13), adverse events RR 0.47 (0.36-0.61), diarrhea RR 0.33 (0.23-0.47). An adjunct to eradication drugs, not a replacement.
PMID 31414551
travelers_diarrhea Limited · benefit
Mixed-probiotic meta-analyses cannot establish a dependable S. boulardii-specific effect.
PMID 38458507
ibs Limited · benefit
Small diarrhea-predominant IBS RCTs suggest quality-of-life/cytokine signals; no robust pooled strain-specific effect size.
PMID 21301358 PMID 24722560
ibd No established evidence
Monotherapy efficacy is unestablished; mixed-probiotic meta-analysis cannot isolate this yeast.
PMID 28294322
sibo Limited · benefit
A diarrhea-predominant IBS pilot and rifaximin-combination RCT in PPI-associated SIBO are narrow preliminary contexts, not established standalone treatment.
PMID 36630947 PMID 40884341

Reader questions

Take it with antibiotics or later?

Concurrent use underlies the AAD evidence. Antibacterial drugs do not kill the yeast; an antifungal is a different issue.

Is a cheaper strain equivalent?

Check the strain code and guaranteed viable CFU at expiry. The dossier emphasizes CNCM I-745; species alone does not prove equivalence.

Can it make symptoms worse?

Gas or bloating can occur. Immunocompromised, critically ill or catheterized patients face invasive-infection risk and should avoid self-use.

Stack interactions

Caution Antibacterial antibiotics [CAUTION // CONTEXT]
Compatible with the intended prevention strategy; routine time separation is not required in the dossier.
PMID 26216624
Danger Antifungal drugs [AVOID // HIGH-RISK]
They may kill or inhibit the probiotic yeast; product-specific advice is needed. This mechanism/label warning has no indexed interaction PMID here.
Danger Immunosuppression / central catheters [AVOID // HIGH-RISK]
Avoid because invasive Saccharomyces infection is documented; not merely an absorption interaction.
PMID 36806741 PMID 16267727

Red flags: interactions and who should avoid it

Interactions

Antibacterial antibiotics do not kill this yeast, so coadministration is the studied use and routine separation is not required by this dossier. Antifungal drugs can inactivate the organism. Immunosuppression is a major infection-risk context.

Avoid or ask a doctor first if

Avoid with immunocompromise, critical illness or a central venous catheter. Fungemia is documented, including in severely ill children. Do not handle/open live-yeast powder near vascular catheters. Pregnancy and breastfeeding require clinical advice. New fever or systemic illness in a high-risk patient requires urgent assessment.

Sources (PubMed, 12)

Systematic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea.
PMID 26216624 · 2015 · Systematic review and meta-analysis of RCTs
AAD prevention and distinct pediatric/adult C. difficile subgroup results.
Systematic review with meta-analysis: Saccharomyces boulardii for treating acute gastroenteritis in children-a 2020 update.
PMID 32056266 · 2020 · Systematic review and meta-analysis of RCTs
Very-low-certainty reduction in pediatric acute gastroenteritis duration.
Saccharomyces boulardii as an adjuvant therapy for Helicobacter pylori eradication: A systematic review and meta-analysis with trial sequential analysis.
PMID 31414551 · 2019 · Meta-analysis with trial sequential analysis
Modest adjunctive H. pylori eradication benefit and fewer treatment adverse events.
Investigating the influence of probiotics in preventing Traveler's diarrhea: Meta-analysis based systematic review.
PMID 38458507 · 2024 · Systematic review and meta-analysis
Traveler diarrhea data pool probiotics and do not isolate dependable strain efficacy.
A randomized, double-blind, placebo-controlled multicenter trial of saccharomyces boulardii in irritable bowel syndrome: effect on quality of life.
PMID 21301358 · 2011 · Randomized multicenter placebo-controlled trial
IBS quality-of-life findings.
Cytokine and clinical response to Saccharomyces boulardii therapy in diarrhea-dominant irritable bowel syndrome: a randomized trial.
PMID 24722560 · 2014 · Randomized trial
Clinical and cytokine outcomes in diarrhea-dominant IBS.
Probiotics are a good choice in remission of inflammatory bowel diseases: A meta analysis and systematic review.
PMID 28294322 · 2018 · Systematic review and meta-analysis
Mixed-probiotic IBD evidence, not proof of yeast monotherapy.
Impact of Saccharomyces boulardii CNCM I-745 on Bacterial Overgrowth and Composition of Intestinal Microbiota in Diarrhea-Predominant Irritable Bowel Syndrome Patients: Results of a Randomized Pilot Study.
PMID 36630947 · 2023 · Randomized pilot study
Narrow IBS bacterial-overgrowth and microbiota context.
[Study on the efficacy of combination therapy with rifaximin and Saccharomyces boulardii CNCM I-745 in patients with small intestinal bacterial overgrowth associated with long-term use of proton pump inhibitors].
PMID 40884341 · 2025 · Randomized comparative trial
Rifaximin combination in long-term-PPI-associated SIBO.
Epidemiology of Saccharomyces fungemia: A systematic review.
PMID 36806741 · 2023 · Systematic review
Saccharomyces fungemia and vulnerable-host risk.
Invasive Saccharomyces infection: a comprehensive review.
PMID 16267727 · 2005 · Comprehensive review
Invasive Saccharomyces infection reports.
Saccharomyces boulardii CNCM I-745: A Non-bacterial Microorganism Used as Probiotic Agent in Supporting Treatment of Selected Diseases.
PMID 32472262 · 2020 · Narrative review
CNCM I-745 preparation and probiotic context.

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