Saccharomyces boulardii CNCM I-745 for Prevention of Antibiotic-Associated Diarrhea and Clostridioides difficile in China: Systematic Review and Meta-Analysis

Probiotics are commonly used for patients receiving antibiotics to prevent antibiotic-associated diarrhea (AAD). Randomized, controlled trials (RCTs) conducted in China are often not included in probiotic reviews and meta-analyses due to the difficulties in accessing Chinese journals and translating the Chinese language. Our aim is to evaluate the efficacy and safety of S. boulardii CNCM I-745 in AAD prevention trials done in China. A literature search was conducted using PubMed, Google Scholar and Chinese databases (CNKI, CMB) (from inception to June 2023) for RCTs assessing S. boulardii CNCM I-745 for the prevention of AAD and Clostridioides difficile infections (CDI). Inclusion criteria: RCT done in China, new prescription of antibiotic, randomized to S. boulardii and control groups. Random-effect or fixed-effects models were used depending upon the degree of heterogeneity and the risk of bias for each study was determined. This review was registered with Prospero (PROSPERO CRD 429831). The literature search found 361 articles, which were screened and 46 (8,201 participants) were included in the analysis. S. boulardii CNCM I-745 significantly reduced the incidence of AAD (RR=0.43, 95% C.I. 0.40,0.48, P < 0.0001) and CDI (RR=0.30, 95% C.I. 0.10, 0.87, P = 0.03). S. boulardii CNCM I-745 had similar degrees of efficacy for both the prevention of AAD in trials done in China and for trials done in other countries. Saccharomyces boulardii CNCM I-745 was well tolerated and effective in trials in China for both the prevention of AAD and CDI.