Systematic review and meta-analysis of Saccharomyces boulardii in adult patients

Table 1 Examples of commercially available probiotics containing “Saccharomyces boulardii”

Product name	Probiotic strain	Manufacturer	Stable at room temp1	Facility certified	Strain confirmed	Colony forming unit (cfu) per mg capsule or mL	Original strain-specific studies	Degree of clinical evidence2
Single strain
Florastor® (US) Perenterol® (Germany) Reflor® (Turkey) Ultra-Levure® (Asia)3	S. boulardii lyo	Biocodex (France)	Yes	EU GMP	Microsatellite sequency poly-morphism [28,29]	5 × 109/250 mg	Multiple[37-62]	A
SB+MOS	S. boulardii	Jarrow Formulas (Los Angeles, CA) and Gnosis (Italy)	No	EU GMP	Not stated	1.5 × 109	One study[63]	C
Saccharomyces boulardii	S. boulardii	Kirkman (Oregon)	No	GMP	DNA finger-print	3 × 109/150 mg	None	F
Saccharomyces boulardii	S. boulardii	Allergy Research Group (CA)/NutriCology (CA)	No	GMP	DNA finger-print	3 × 109/150 mg	None	F
Saccharomyces boulardii	S. boulardii	Klaire Labs (Reno Nevada)	No	GMP ISO 9001	Ribotyping	3 × 109/150 mg	None	F
In mixtures of probiotics
Protecflor® (Canada) Erce Flora® (Belgium)	S. cerevisiae boulardii CNCM I-1077) + L. rhamnosus + L. acidophilus + Bifido. strain	Institut Rosell-Lallemand (Quebec, Canada)	Not stated	Canadian GMP	Not stated	109/2 mL	Two studies [64,65]	D
MitoMix®	S. boulardii and Pediococcus acidilactici	Imagilin Technology (Maryland)	Yes	Not stated	Not stated	2.3 × 109/capsule	One study[66]	D
Primal Defense™	S. boulardii with 13 other strains4	Garden of Life (FL)	Yes	Not stated	No (only certified “organic”)	Total 1 × 109 per 410 mg	None	F
Pro-Bio Defense™	S. boulardii + 7 other strains5	Kirkman (OR)	No	GMP	DNA finger-print	Total: 2 × 1010/cap, no data on SB cfu	None	F
ABX Support™	S. boulardii + L. rhamnosus + Bifido. bifidum + Bifido. breve	Klaire Labs (NEV)	No	GMP ISO 9001	Ribotyping	5 × 109/300 mg	None	F
Kombucha fermented tea	S. boulardii + L. bacterium + blue-green algae	Millennium Products, Inc.	No	No	Not stated	1 × 109 per 16 oz.	None	F

¹Products not stable at room temperature require refrigeration, probably heat-dried. Products stable at room temperature are typically packaged in blister packs and are lyophilized;

²Degree of evidence: A = at least two randomized, controlled clinical trials in patients; B = one randomized controlled clinical trial in patients, C = case reports, uncontrolled randomized trials or open safety/kinetic studies in patients or volunteers, D = in vivo animal model or in vitro studies only, E = expert opinion only, F = no direct evidence;

³A few examples, Biocodex has over 40 brand names worldwide;

⁴Other strains in Primal Defense include: 11 strains of Lactobacilli (L. acidophilus, L. bulgaricus, L. lactis, L. plantarum, L. casei, L. lactis, L. leichmannii, L. brevis, L. caucasicus, L. fermenti, L. helveticus and 1 strain each: Bifidobacterium bifidum, Bacillus subtilis, Bacillus lichenformis);

⁵Other strains in Pro-Bio Defense include: 5 strains of Lactobacilli (L. plantarum, L. rhamnosus, L. acidophilus, L. casei, L. bulgaricus) and Bifidobacterium lactis and Streptococcus thermophilus. GMP: Good manufacturing practices.