Saccharomyces boulardii, the Probiotic Yeast

Most probiotics on a store shelf are bacteria. Saccharomyces boulardii is a yeast, a close relative of the yeast used in baking and brewing, and that one difference shapes both its appeal and its risks. It is tested mostly in people taking antibiotics, because those drugs are built to kill bacteria and yeast is not a bacterium. Being a live yeast, it has also caused rare bloodstream infections in very ill hospital patients. This page goes through the trials condition by condition, with the numbers. For how this yeast compares with other strains, see Probiotic Strains and Selection and the Probiotics Benefits hub.

Table of Contents

  1. A Yeast Among Bacteria
  2. From Lychee and Mangosteen to a Medicine Cabinet
  3. Antibiotic-Associated Diarrhea
  4. Clostridioides difficile
  5. Traveler's Diarrhea
  6. Acute Diarrhea in Children
  7. Helicobacter pylori Treatment Side Effects
  8. Irritable Bowel Syndrome
  9. Bloodstream Infections and Other Safety Findings
  10. What the Trials Gave
  11. What Is Not Known
  12. Key Research Papers
  13. Connections
  14. Featured Videos

A Yeast Among Bacteria

Bacteria and yeasts are very different kinds of cell. Antibacterial antibiotics work by hitting structures that bacteria have and yeasts lack, such as the bacterial cell wall and bacterial ribosomes. A Lactobacillus capsule taken during an antibiotic course is itself a target. A yeast is not, which is why trials could give Saccharomyces boulardii at the same time as the antibiotic rather than around it. The 2005 trial in children gave both together for the whole course, and the 1994 Clostridioides difficile trial combined the yeast with vancomycin or metronidazole.

A 2020 review of the yeast's biology lists other differences reported in the laboratory and in pharmacokinetic studies:

The best-studied mechanism involves a protein the yeast releases. Work in rats and in human colon tissue identified a 54-kilodalton protease, an enzyme that cuts other proteins, which digests Clostridioides difficile toxins A and B and the receptor toxin A binds to. In human colon tissue held in laboratory chambers, drops in the tissue's barrier function caused by toxin A and toxin B were reversed by 60% and 68% when the toxins were first exposed to this protease. That is a laboratory result and does not by itself show what happens in a patient. The 2020 review also describes gut-barrier, immune and competitive effects, drawn largely from animal and cell work.

Back to Table of Contents

From Lychee and Mangosteen to a Medicine Cabinet

As reported in a 2017 genome paper, the French scientist Henri Boulard first isolated the yeast from lychee and mangosteen fruit in 1923. A 2007 genetic study gives the shorter version: a yeast isolated from fruit in Indochina and used as a remedy for diarrhea since 1950. The details of that early story come down through later papers as background, not from original records read for this page.

The name is also a matter of history. The organism was first described as its own species. Genetic work then showed its genome to be so similar to Saccharomyces cerevisiae that the 2007 authors described the two as belonging to one species, and the name Saccharomyces cerevisiae variety boulardii appears in the literature. This has a practical side: in one hospital study described below, routine laboratory methods could not tell the probiotic from ordinary Saccharomyces cerevisiae in blood cultures.

The genetic features that set it apart are still being worked out:

In other words, the reason this one strain behaves as a probiotic is not fully explained by its genes so far. Some papers name the strain as CNCM I-745, a culture collection number and not a brand, while others name only the species.

Back to Table of Contents

Antibiotic-Associated Diarrhea

This is the use with the most trials. A 2015 meta-analysis pooled 21 randomized trials with 4,780 participants:

A risk ratio of 0.47 means the risk in the yeast group was a little under half the risk in the comparison group. An earlier meta-analysis limited to adults reached almost the same figure (risk ratio 0.47, 95% confidence interval 0.35–0.63).

Individual trials show how the numbers look in practice:

The wider probiotic picture points the same way. A 2019 Cochrane review of all probiotics in children (33 studies, 6,352 children) found diarrhea in 8% versus 19% (risk ratio 0.45), with larger effects at 5 billion or more colony-forming units a day. It rated the certainty of that evidence as moderate, and 20 of the 33 studies as high risk of bias. An evidence guide published in 2018 graded this yeast among the probiotics with strong evidence for preventing antibiotic-associated diarrhea; the guide was funded by an educational grant from a probiotic maker, and its authors disclose ties to the industry.

Back to Table of Contents

Clostridioides difficile

Clostridioides difficile is a toxin-producing bacterium that can overgrow after antibiotics, causing diarrhea and sometimes severe colitis. Evidence for the yeast here is weaker and less consistent than for antibiotic-associated diarrhea generally. See the Clostridioides difficile Infection page for the disease itself.

Preventing a first case. In the 2015 meta-analysis specific to this yeast, the reduction reached significance only in children (2 trials, 579 children, risk ratio 0.25, 95% confidence interval 0.08–0.73). In adults it did not (9 trials, 1,441 adults, risk ratio 0.8, 95% confidence interval 0.47–1.34).

All probiotics together. The 2025 Cochrane review covers 47 studies with 15,260 people, across many probiotic strains and not this yeast alone. In 38 trials (13,179 participants), the disease occurred in 1.6% of those on probiotics and 3.2% of controls (risk ratio 0.50, 95% confidence interval 0.38–0.64). The reviewers rated this low-certainty evidence and describe a small absolute benefit: about 65 people taking probiotics for one case prevented. Length of hospital stay likely did not change. They noted company affiliations or funding in 28 of the studies, and they frame the finding for people on antibiotics who are not immunocompromised. The 2017 edition had reported that the effect was concentrated in trials where the baseline risk was above 5% (3.1% versus 11.6%, risk ratio 0.30), in an analysis planned after the fact.

Preventing a recurrence. Two older trials tested the yeast alongside standard antibiotics in people who already had the disease:

These two trials are decades old and used the antibiotic regimens of their time, so how they apply alongside later treatments is an open question.

Back to Table of Contents

Traveler's Diarrhea

Rates of traveler's diarrhea range from 5% to 50% depending on the destination. The main source is a 2007 meta-analysis of 12 randomized trials across several probiotics. Probiotics as a group modestly lowered the risk (risk ratio 0.85, 95% confidence interval 0.79–0.91), about a 15% reduction. The author reported significant efficacy for Saccharomyces boulardii and for a mixture of Lactobacillus acidophilus and Bifidobacterium bifidum. No serious adverse reactions were reported in the 12 trials.

This is a smaller effect than the one seen with antibiotics, and the search behind it ended in 2005. The 2010 review of adult trials, by the same author, also supported this use. A pooled risk for this yeast alone, with a dose attached, does not appear in the abstracts read for this page.

Back to Table of Contents

Acute Diarrhea in Children

Here the headline numbers and the quality of the trials pull in different directions, and the reviews reach different conclusions.

Put together: smaller, less rigorous trials report about a day saved, and the most rigorous trials of probiotics as a class do not confirm it.

Back to Table of Contents

Helicobacter pylori Treatment Side Effects

Eradicating Helicobacter pylori takes a multi-drug course, and side effects such as abdominal pain and diarrhea are common. The yeast is studied as an add-on. The parent article gives the headline results of a 2025 meta-analysis; the details below show where the benefit does and does not appear.

The pattern is a clearer effect on side effects than on eradication. A risk ratio of 1.11 on eradication is a small gain on an already common outcome, while the fall in diarrhea is large. The 2023 analysis looked at standard triple therapy in children, so its results may not carry over to other regimens. For the drug regimens themselves, see Triple and Quadruple Antibiotic Therapy.

Back to Table of Contents

Irritable Bowel Syndrome

The evidence here is thin. Both trials read for this page are small, and in both, symptoms also improved on placebo while quality-of-life scores favored the yeast.

The 2010 review of adult trials listed irritable bowel syndrome among uses that show promise but need more supporting evidence. For other options studied in this condition, see Peppermint, Probiotics and Herbals for Irritable Bowel Syndrome.

Back to Table of Contents

Bloodstream Infections and Other Safety Findings

The trials above reported few side effects, and several report no serious ones. The 2020 biology review states that no fungemia, meaning yeast in the bloodstream, was reported in clinical trials. Fungemia does appear in hospital reports, and the setting is consistent: very ill patients, often in intensive care, often with a central venous catheter or tube or intravenous feeding.

How often. One large hospital study looked at 46,729 adult patients from 2016 to 2019, at a facility using the yeast to try to prevent Clostridioides difficile. Of 16,404 people given the yeast, 18 (0.11%) had Saccharomyces cerevisiae in the blood, or 1.70 cases per 10,000 patient-days. Intensive care raised the odds about sixfold (odds ratio 6.55), and the rate was 0.26 cases per 1,000 central-line days. The authors concluded that the risk did not appear greater than that of any hospital-acquired bloodstream infection. It is one retrospective study from one setting, and its laboratory could not separate the two yeasts.

Who. A 2023 systematic review found 108 analyzable Saccharomyces fungemia cases published from 2005 to 2022; 73 (67.6%) had received this probiotic. Risk factors tied to the probiotic cases were intensive care stays, intravenous or tube feeding, diarrheal illness, and diabetes. All-cause death across the 108 patients was 36.1%, with no significant difference between those who had taken the probiotic and those who had not. These were very sick people, so that figure reflects their illness as well as the infection.

How it may reach the blood. Case reports propose several routes:

A 2005 outbreak report is the clearest single example. Three intensive care patients developed fungemia in the second half of April 2003. The only risk factor identified was the probiotic, given by nasogastric tube, and only 2 of 41 comparison patients had received it. Strains from the capsules and the patients had identical DNA fingerprinting, and stopping the product in the unit ended the outbreak. A literature review in the same paper found another 57 cases. Overall, 60% were in intensive care, 71% were on tube or intravenous feeding, 26 had detected probiotic use, and 17 died.

Treatment of these infections. The 2020 review states that cases responded well to fluconazole or amphotericin B. A 2017 case of an 8-year-old in pediatric surgical intensive care did not respond to caspofungin and was treated with amphotericin B.

Preterm infants. In October 2023 the U.S. Food and Drug Administration stated that preterm infants given a probiotic product are at risk of invasive, potentially fatal infection from the bacteria or yeast in it, and that it has not approved any probiotic product for use as a drug or biological product in infants of any age. That statement concerns probiotic products broadly, not this yeast alone.

Everyday side effects. In the 2025 Cochrane review of all probiotics, adverse events were if anything slightly less common in the probiotic groups (10.9% versus 12.2%). The most common in both groups were abdominal cramping, nausea, fever, soft stools, flatulence and taste disturbance.

Decisions about medicines and supplements in hospital, especially around central lines and immune suppression, belong with the treating team.

Back to Table of Contents

What the Trials Gave

Doses varied by trial and condition. These are reports of what was given in each study, not a suggested amount.

The pooled analyses in the earlier sections combine trials with differing doses and durations, so no single best dose comes out of them.

Back to Table of Contents

What Is Not Known

Back to Table of Contents

Key Research Papers

  1. Szajewska H, Kołodziej M. Systematic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Aliment Pharmacol Ther. 2015;42(7):793-801. PubMed PMID: 26216624
  2. McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol. 2010;16(18):2202-22. PubMed PMID: 20458757
  3. 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. 2005;21(5):583-90. PubMed PMID: 15740542
  4. Can M, Beşirbellioglu BA, Avci IY, Beker CM, Pahsa A. Prophylactic Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea: a prospective study. Med Sci Monit. 2006;12(4):PI19-22. PubMed PMID: 16572062
  5. Kovacevic P, Mrdja V, Kovacevic T, Mrdja J, Soldatovic I, Rajkovaca Z. Saccharomyces boulardii for the Prevention of Antibiotic-Associated Diarrhea in Hospitalized Patients Receiving Antibiotics: A Single-Center, Randomized, Double-Blind, Placebo-Controlled Trial. Antibiotics (Basel). 2026;15(9):868. PubMed PMID: 42792018
  6. Guo Q, Goldenberg JZ, Humphrey C, El Dib R, Johnston BC. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev. 2019;4(4):CD004827. PubMed PMID: 31039287
  7. Sniffen JC, McFarland LV, Evans CT, Goldstein EJC. Choosing an appropriate probiotic product for your patient: An evidence-based practical guide. PLoS One. 2018;13(12):e0209205. PubMed PMID: 30586435
  8. Esmaeilinezhad Z, Ghosh NR, Walsh CM, Steen JP, Burgman AM, Mertz D, Johnston BC. Probiotics for the prevention of Clostridioides difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev. 2025;9(9):CD006095. PubMed PMID: 40931979
  9. Goldenberg JZ, Yap C, Lytvyn L, Lo CK, Beardsley J, Mertz D, Johnston BC. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev. 2017;12(12):CD006095. PubMed PMID: 29257353
  10. McFarland LV, Surawicz CM, Greenberg RN, Fekety R, Elmer GW, Moyer KA, Melcher SA, Bowen KE, Cox JL, Noorani Z, et al. A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA. 1994;271(24):1913-8. PubMed PMID: 8201735
  11. Surawicz CM, McFarland LV, Greenberg RN, Rubin M, Fekety R, Mulligan ME, Garcia RJ, Brandmarker S, Bowen K, Borjal D, Elmer GW. The search for a better treatment for recurrent Clostridium difficile disease: use of high-dose vancomycin combined with Saccharomyces boulardii. Clin Infect Dis. 2000;31(4):1012-7. PubMed PMID: 11049785
  12. 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. 1999;67(1):302-7. PubMed PMID: 9864230
  13. McFarland LV. Meta-analysis of probiotics for the prevention of traveler's diarrhea. Travel Med Infect Dis. 2007;5(2):97-105. PubMed PMID: 17298915
  14. Szajewska H, Kołodziej M, Zalewski BM. Systematic review with meta-analysis: Saccharomyces boulardii for treating acute gastroenteritis in children-a 2020 update. Aliment Pharmacol Ther. 2020;51(7):678-688. PubMed PMID: 32056266
  15. McFarland LV, Li T. Efficacy and safety of Saccharomyces boulardii CNCM I-745 for the treatment of pediatric acute diarrhea in China: a systematic review and meta-analysis. Front Cell Infect Microbiol. 2025;15:1587792. PubMed PMID: 40535538
  16. Collinson S, Deans A, Padua-Zamora A, Gregorio GV, Li C, Dans LF, Allen SJ. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 2020;12(12):CD003048. PubMed PMID: 33295643
  17. Li M, Xie Y. Efficacy and safety of Saccharomyces boulardii as an adjuvant therapy for the eradication of Helicobacter pylori: a meta-analysis. Front Cell Infect Microbiol. 2025;15:1441185. PubMed PMID: 40012609
  18. Liu LH, Han B, Tao J, Zhang K, Wang XK, Wang WY. The effect of Saccharomyces boulardii supplementation on Helicobacter pylori eradication in children: a systematic review and meta-analysis of Randomized controlled trials. BMC Infect Dis. 2023;23(1):878. PubMed PMID: 38102568
  19. Choi CH, Jo SY, Park HJ, Chang SK, Byeon JS, Myung SJ. A randomized, double-blind, placebo-controlled multicenter trial of saccharomyces boulardii in irritable bowel syndrome: effect on quality of life. J Clin Gastroenterol. 2011;45(8):679-83. PubMed PMID: 21301358
  20. Abbas Z, Yakoob J, Jafri W, Ahmad Z, Azam Z, Usman MW, Shamim S, Islam M. Cytokine and clinical response to Saccharomyces boulardii therapy in diarrhea-dominant irritable bowel syndrome: a randomized trial. Eur J Gastroenterol Hepatol. 2014;26(6):630-9. PubMed PMID: 24722560
  21. Vinayagamoorthy K, Pentapati KC, Prakash H. Epidemiology of Saccharomyces fungemia: A systematic review. Med Mycol. 2023;61(2):myad014. PubMed PMID: 36806741
  22. Wombwell E, Bransteitter B, Gillen LR. Incidence of Saccharomyces cerevisiae fungemia in hospitalised patients administered Saccharomyces boulardii probiotic. Mycoses. 2021;64(12):1521-1526. PubMed PMID: 34585799
  23. Muñoz P, Bouza E, Cuenca-Estrella M, Eiros JM, Pérez MJ, Sánchez-Somolinos M, Rincón C, Hortal J, Peláez T. Saccharomyces cerevisiae fungemia: an emerging infectious disease. Clin Infect Dis. 2005;40(11):1625-34. PubMed PMID: 15889360
  24. Lherm T, Monet C, Nougière B, Soulier M, Larbi D, Le Gall C, Caen D, Malbrunot C. Seven cases of fungemia with Saccharomyces boulardii in critically ill patients. Intensive Care Med. 2002;28(6):797-801. PubMed PMID: 12107689
  25. Hennequin C, Kauffmann-Lacroix C, Jobert A, Viard JP, Ricour C, Jacquemin JL, Berche P. Possible role of catheters in Saccharomyces boulardii fungemia. Eur J Clin Microbiol Infect Dis. 2000;19(1):16-20. PubMed PMID: 10706174
  26. Atıcı S, Soysal A, Karadeniz Cerit K, Yılmaz Ş, Aksu B, Kıyan G, Bakır M. Catheter-related Saccharomyces cerevisiae Fungemia Following Saccharomyces boulardii Probiotic Treatment: In a child in intensive care unit and review of the literature. Med Mycol Case Rep. 2017;15:33-35. PubMed PMID: 28280685
  27. Edwards-Ingram L, Gitsham P, Burton N, Warhurst G, Clarke I, Hoyle D, Oliver SG, Stateva L. Genotypic and physiological characterization of Saccharomyces boulardii, the probiotic strain of Saccharomyces cerevisiae. Appl Environ Microbiol. 2007;73(8):2458-67. PubMed PMID: 17293506
  28. Khatri I, Tomar R, Ganesan K, Prasad GS, Subramanian S. Complete genome sequence and comparative genomics of the probiotic yeast Saccharomyces boulardii. Sci Rep. 2017;7(1):371. PubMed PMID: 28336969
  29. Pais P, Almeida V, Yılmaz M, Teixeira MC. Saccharomyces boulardii: What Makes It Tick as Successful Probiotic? J Fungi (Basel). 2020;6(2):78. PubMed PMID: 32512834

PubMed Topic Searches

  1. PubMed: Saccharomyces boulardii randomized trials
  2. PubMed: Saccharomyces boulardii and antibiotic-associated diarrhea
  3. PubMed: Saccharomyces boulardii and Clostridioides difficile
  4. PubMed: Saccharomyces boulardii fungemia

Back to Table of Contents

Connections

Back to Table of Contents