Saccharomyces boulardii CNCM I-745 and smectite treatment for pediatric acute gastroenteritis in China: a systematic review and meta-analysis

TL;DR

This study finds that adding the probiotic Saccharomyces boulardii to smectite improves treatment outcomes for children with acute gastroenteritis in China.

Contribution

A meta-analysis of Chinese trials reveals that S. boulardii CNCM I-745 combined with smectite is more effective than smectite alone for pediatric acute gastroenteritis.

Findings

S. boulardii CNCM I-745 improved cure rates by 45% compared to smectite alone.

The probiotic reduced the duration of gastroenteritis by approximately 1.5 days.

It also improved total effectiveness ratings and reduced adverse events.

Abstract

Pediatric acute gastroenteritis (PAGE) is a common cause of morbidity and mortality, especially among children under 5 years of age. Standard treatments typically include rehydration therapy, dietary modifications, antimicrobials, and adjunctive treatments with smectite or specific probiotics. The efficacy of adding Saccharomyces boulardii to standard treatments, including regimens that already incorporate smectites, remains not well known. Most trials evaluating this combination have been published in Chinese, which has limited global awareness of this type of treatment.

This study aimed to meta-analytically examine whether the addition of S. boulardii CNCM I-745 to smectite is more effective in treating PAGE than smectite alone.

Systematic searches were conducted in PubMed, Google Scholar, China National Knowledge Infrastructure, and the China Biology Medicine database up to 20 February 2025 receiving smectites. Eligible studies were randomized controlled trials conducted in China that compared S. boulardii CNCM I-745 with controls in children with PAGE receiving smectites, with no language restrictions. Data were independently extracted using standardized forms, including outcomes related to PAGE (cured, duration of PAGE, length of hospitalization, and immune markers) and potential confounding variables (dose, disease etiology).

Of 57 included trials (5,767 participants), S. boulardii CNCM I-745 significantly improved the cure rate (RR = 1.45, 95% CI 1.38, 1.53), reduced the duration of PAGE (SMD = −1.54 days, 95% CI −1.79, −1.29), improved the total effectiveness rating (RR = 1.21, 95% CI 1.18, 1.24), and reduced adverse events (RR = 0.64, 95% CI 0.43, 0.97).

S. boulardii CNCM I-745 significantly improved cure rates, reduced the duration of PAGE, decreased stool frequency and vomiting, and shortened hospitalization duration, while being well-tolerated.

http://www.crd.york.ac.uk/PROSPERO, PROSPERO #CRD42024567537.

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