Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Saccharomyces cerevisiae, particularly the variant Saccharomyces boulardii, has been studied as a probiotic adjunct or alternative to antibiotics, primarily in the context of gastrointestinal disorders such as antibiotic-associated diarrhea (AAD), Clostridioides difficile infection, and traveler’s diarrhea. Randomized controlled trials and meta-analyses have demonstrated that S. boulardii can reduce the risk of AAD and may help restore gut flora balance disrupted by antibiotic use. The mechanism involves competitive inhibition of pathogenic bacteria, modulation of host immune responses, and enhancement of intestinal barrier function. However, S. cerevisiae is not an antibiotic and does not act as a direct substitute for antibiotics in treating bacterial infections. Instead, its role is supportive: it may help prevent or mitigate some adverse effects of antibiotics or, in some cases, reduce the need for antibiotics in mild self-limiting gastrointestinal infections.

There is no strong evidence supporting the use of S. cerevisiae as a replacement for antibiotics in treating systemic or severe bacterial infections. Its use is primarily adjunctive. Regulatory bodies such as the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) and various clinical guidelines acknowledge the probiotic’s benefit in specific settings, but not as a direct alternative to antibiotics. Overall, the evidence base is moderate, with consistent findings for prevention of antibiotic-associated side effects but limited or no evidence for direct antimicrobial efficacy.

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