SYSTEMATIC REVIEW article
Front. Pediatr.
Sec. Pediatric Gastroenterology, Hepatology and Nutrition
This article is part of the Research TopicStrain-Specific Probiotics: Enhancing Children's Health Through Targeted Clinical ResearchView all 21 articles
Saccharomyces boulardii CNCM I-745 and smectite treatment for pediatric acute diarrhea in China: Systematic review and meta-analysis
Provisionally accepted
Tong Li1
Lynne Vernice McFarland2,3*- 1The First Affiliated Hospital of Dalian Medical University, Dalian, China
- 2Public Health Reserves Corps, Seattle, United States
- 3McFarland Consulting, Seattle, United States
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Introduction: Pediatric acute gastroenteritis (PAGE) is a common cause of morbidity and mortality, especially in children under five years old. Standard treatments may include rehydration, diet changes, antimicrobials and adjunctive treatments with smectite or specific probiotics. The efficacy of adding Saccharomyces boulardii to standard treatments including smectites is not well known globally most trials are published in Chinese, which has limited global awareness of this type of treatment. Aim: To meta-analytically examine if the addition of S. boulardii CNCM I-745 to smectite versus smectite alone will effectively treat PAGE. Methods: Systematic searches using databases (PubMed, Google Scholar, China National Knowledge Infrastructure and China Biology Medicine disc to February 20, 2025. Inclusion criteria were randomized, controlled trials in China comparing S. boulardii CNCM I-745 to controls for children with PAGE with no language restrictions. Independent extraction of variables assessing PAGE (cured, duration of PAGE, hospitalization, and immune markers) and potential confounding variables (dose, etiology) using standardized forms. Results: Of 57 included trials (5,767 participants), S. boulardii CNCM I-745 significantly improved the cure rate (RR=1.45, 95% C.I. 1.38, 1.53), reduced the duration of PAGE (SMD= -1.54 days, 95% C.I. -1.79, -1.29), improved the total effectiveness rating (RR=1.21, 95% C.I. 1.18, 1.24) and reduced adverse events (RR=0.64, 95% C.I. 0.43, 0.97). Conclusion: S. boulardii CNCM I-745 significantly improved cure rates, significantly reduced the duration of PAGE, reduced stool frequency and vomiting and decreased days of hospitalization, while being well-tolerated. Registered: The review was registered with PROSPERO #CRD42024567537
Keywords: Acute pediatric diarrhea, clinical trials, Meta-analysis, probiotic, smectite
Received: 16 Nov 2025; Accepted: 22 Jan 2026.
Copyright: © 2026 Li and McFarland. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lynne Vernice McFarland
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