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Behaviour of Saccharomyces boulardii in recurrent Clostridium difficile disease patients

1999; Wiley; Volume: 13; Issue: 12 Linguagem: Inglês

10.1046/j.1365-2036.1999.00666.x

1365-2036

Elmer, McFarland, Surawicz, Danko, Greenberg,

Gut microbiota and health

Background: Despite recent interest in therapeutic microorganisms taken orally, little is known about the pharmacodynamics of these agents in a target population of patients with disease. The present study reports the stool concentrations of Saccharomyces boulardii in a patient population with Clostridium difficile disease (CDD) and correlates stool concentrations with efficacy. Methods: Patients with recurrent CDD all received a 10‐day standard antibiotic regimen together with 28 days of S. boulardii or placebo. Stool samples were collected from patients at various time points and assayed for S. boulardii . Results: The mean concentration of S. boulardii of patients who recurred was 2.5 × 10 4 CFU/g compared to 1 × 10 6 CFU/g in patients that did not recur ( P =0.02). Patients with low yeast concentrations in their stools (<10 4 /g) recurred more often (14/15, 93%) compared with patients with higher levels (19/35, 54%, P =0.007). Clearance of S. boulardii was rapid; only 4% had positive stools 3 days after stopping dosing. Conclusions: After chronic dosing of S. boulardii , patients with low stool concentrations had a higher likelihood of recurrence of CDD. Stool concentrations were also lower during periods of diarrhoea. These results show the importance of characterizing the dynamics of a therapeutic microorganism in patients with disease, as kinetic studies in healthy volunteers may not give a true reflection of the disturbed microecology in the disease state.