Treatment of recurrent Clostridium difficile colitis with vancomycin and Saccharomyces boulardii.

Recurrence of Clostridium difficile-associated diarrhea and pseudomembranous colitis occurs in up to 20% of patients after standard therapy. In these patients, subsequent recurrences are even more frequent. Saccharomyces boulardii, a nonpathogenic yeast, was found to be effective in preventing clindamycin cecitis recurrence in an animal model. We performed an open trial of S. boulardii to evaluate its efficacy in treating recurrences of C. difficile-associated colitis in humans. Thirteen patients with recurring C. difficile cytotoxin-positive diarrhea (who had an average of 3.6 previous recurrences) were treated with 10 days of vancomycin and a 30-day course of S. boulardii. Eleven (85%) had no further recurrences. S. boulardii may have a role in treating recurrent C. difficile diarrhea and colitis.