Comparison of Clinical Efficacy of Saccharomyces Boulardii with Yogurt in Children with Acute Watery Diarrhea

Silwana  Taroni; Said Ali shah; Wahid  Nawaz; Yusra  Zia; Shakeel  Ahmed; Andleeb Tariq

doi:10.51253/pafmj.v76i4.13049

Authors

Silwana Taroni Department of Paediatrics, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Said Ali shah Department of Paediatrics, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Wahid Nawaz Department of Paediatrics, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Yusra Zia Department of Paediatrics, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Shakeel Ahmed Department of Paediatrics, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Andleeb Tariq Department of Paediatrics, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i4.13049

Keywords:

Acute Disease, Diarrhea, Probiotics; Saccharomyces boulardii, Yogurt

Abstract

Objective: To compare the clinical efficacy of Saccharomyces Boulardii versus yogurt in the treatment of acute watery diarrhea in children aged 6–24 months.

Study Design: Quasi-experimental Study.

Place and Duration of Study: Department of Paediatrics, Combined Military Hospital (CMH) Rawalpindi, Pakistan from Jan to May 2024.

Methodology: Fifty children with acute watery diarrhea were randomly allocated to receive either S. boulardii 250 mg twice daily (Group-A, n = 25) or plain yogurt 200 mL twice daily (Group-B, n = 25), in addition to standard oral rehydration and zinc. Primary outcomes were stool frequency at 48 h and time to recovery (≤3 formed stools in 24 h).

Results: Baseline characteristics were comparable between groups. Group-A showed significantly shorter duration of diarrhea (median 3.0 vs. 4.0 days), vomiting (1.0 vs. 3.0 days) and hospital stay (3.0 vs. 4.0 days) compared to Group-B (p=0.001 for all). Although recovery at 48 hours was higher in the Group-A (64.0% vs. 40.0%), the difference was not statistically significant (p=0.089). No significant difference was observed in recovery at 72 hours (p=0.747).

Conclusion: Saccharomyces Boulardii shortened the clinical course of acute watery diarrhea more effectively than yogurt, nearly doubling the 48-hour recovery rate without added adverse effects. Its routine use may therefore be considered in this age group.

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References

Hartman RM, Cohen AL, Antoni S, Mwenda J, Weldegebriel G, Biey J, et al. Risk factors for mortality among children younger than age 5 years with severe diarrhea in low-and middle-income countries: findings from the World Health Organization-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks. Clin Infect Dis 2023; 76(3): e1047-e1053.

https://doi.org/10.1093/cid/ciac561

2. Baloch DGM. An overview of diarrheagenic Escherichia coli among infants in Pakistan. Pak-Euro J Med Life Sci 2021; 4(Special Is): S11-S24.

https://doi.org/10.31580/pjmls.v4iSpecial%20Is.1865

3. Lucero YC, Velarde JJ, O’Ryan ML. Microorganisms responsible for neonatal diarrhea. Remington and Klein's Infectious Diseases of the Fetus and Newborn Infant: Elsevier; 2025. p. 310-347. e14. https://doi.org/10.1016/B978-0-323-79525-8.00021-4

4. Tiwari R, Tickell KD, Yoshioka E, Otieno J, Shah A, Richardson BA, et al. Lactoferrin and lysozyme to promote nutritional, clinical and enteric recovery: a protocol for a factorial, blinded, placebo-controlled randomised trial among children with diarrhoea and malnutrition (the Boresha Afya trial). BMJ Open 2024; 14(8): e079448.

https://doi.org/10.1136/bmjopen-2023-079448

5. Pokhrel N, Chaudhary S, Bhatta M, Rai B, Baral R. A descriptive study on use of adjunctive therapies in children with acute diarrhea. Int J Surg Glob Health 2025; 8(3): e00559.

https://doi.org/10.1097/GH9.0000000000000559

6. Hadjimbei E, Botsaris G, Chrysostomou S. Beneficial effects of yoghurts and probiotic fermented milks and their functional food potential. Foods 2022; 11(17): 2691.

https://doi.org/10.3390/foods11172691

7. Vergara SC, Leiva MJ, Mestre MV, Vazquez F, Nally MC, Maturano YP. Non-saccharomyces yeast probiotics: revealing relevance and potential. FEMS Yeast Res 2023; 23: foad041.

https://doi.org/10.1093/femsyr/foad041

8. Souza HFd, Carosia MF, Pinheiro C, Carvalho MVd, Oliveira CAFd, Kamimura ES. On probiotic yeasts in food development: Saccharomyces boulardii, a trend. Food Sci Tech 2021; 42: e92321. https://doi.org/10.1590/fst.92321

9. Steyer A, Mičetić-Turk D, Fijan S. The efficacy of probiotics as antiviral agents for the treatment of rotavirus gastrointestinal infections in children: an updated overview of literature. Microorganisms 2022; 10(12): 2392.

https://doi.org/10.3390/microorganisms10122392

10. Kazemi S, Homayouni-Rad A, Samadi KH, Sarabi-aghdam V, Zeynolabedini P, Agha B, et al. Selection of appropriate probiotic yeasts for use in dairy products: a narrative review. Food Prod Process Nutr 2025; 7(1): 13.

https://doi.org/10.1186/s43014-024-00293-x

11. Eren M, Dinleyici EC, Vandenplas Y. Clinical efficacy comparison of Saccharomyces Boulardii and yogurt fluid in acute non-bloody diarrhea in children: a randomized, controlled, open-label study. Am J Trop Med Hyg 2010; 82(3): 488-491. https://doi.org/10.4269/ajtmh.2010.09-0529

12. Nordin E, Hellström PM, Brunius C, Landberg R. Modest conformity between self-reporting of Bristol stool form and fecal consistency measured by stool water content in irritable bowel syndrome and a FODMAP and gluten trial. Am J Gastroenterol 2022; 117(10): 1668-16674.

https://doi.org/10.14309/ajg.0000000000001942

13. Zhao Y, Yang Y, Aruna, Xiao J, Song J, Huang T, et al. Saccharomyces Boulardii combined with quadruple therapy for Helicobacter pylori eradication decreased the duration and severity of diarrhea: a multi-center prospective randomized controlled trial. Front Med 2021; 8: 776955.

https://doi.org/10.3389/fmed.2021.776955

14. Yachha SK, Sarma MS, Mohan N, Wadhwa N, Vr NK, Srinivasan R, et al. Indian Academy of Pediatrics Consensus Guidelines for probiotic use in childhood diarrhea. Indian Pediatr 2022; 59(7): 543-551.

https://doi.org/10.1007/s13312-022-2557-7

15. Munir M, Shah SA, Zaman S, Goheer L, Bushra S, Khan SA. Efficacy Of Saccharomyces Boulardii in the Management of Acute Watery Diarrhea. Pak Armed Forces Med J 2021(2): 686.

16. Tabassum S, Hanif HH, Riaz S, Ahmed N, Ahsan M. Saccharomyces Boulardii Vs. Yogurt Fluid for Acute Diarrhoea: A Clinical Efficacy Comparison. Pak J Med Health Sci 2022; 16(11): 436. https://doi.org/10.53350/pjmhs20221611436

17. Pannerchelvan S, Rios-Solis L, Wasoh H, Sobri MZM, Wong FWF, Mohamed MS, et al. Functional yogurt: a comprehensive review of its nutritional composition and health benefits. Food Funct 2024; 15(22): 10927-10955. https://doi.org/10.1039/D4FO03671A

18. McFarland LV. Efficacy of single-strain probiotics versus multi-strain mixtures: systematic review of strain and disease specificity. Dig Dis Sci 2021; 66: 694-704.

https://doi.org/10.1007/s10620-020-06244-z