Prophylactic Saccharomyces boulardii versus nystatin for the prevention of fungal colonization and invasive fungal infection in premature infants

Eur J Pediatr. 2013 Oct;172(10):1321-6. doi: 10.1007/s00431-013-2041-4. Epub 2013 May 24.


Aim: This study aims to compare the efficacy of orally administered Saccharomyces boulardii versus nystatin in prevention of fungal colonization and invasive fungal infections in very low birth weight infants.

Method: A prospective, randomized comparative study was conducted in preterm infants with a gestational age of ≤ 32 weeks and birth weight of ≤ 1,500 g. They were randomized into two groups, to receive S. boulardii or nystatin. Skin and stool cultures were performed for colonization and blood cultures for invasive infections, weekly.

Results: A total of 181 infants were enrolled (S. boulardii group, n = 91; nystatin group, n = 90). Fungal colonization of the skin (15.4 vs 18.9 %, p = 0.532) and the stool (32.2 vs 27 %, p = 0.441) were not different between the probiotic and nystatin groups. Two patients had Candida-positive blood culture in the nystatin group whereas none in the probiotic group. Feeding intolerance, clinical sepsis, and number of sepsis attacks were significantly lower in the probiotics group than in the nystatin group.

Conclusion: Prophylactic S. boulardii supplementation is as effective as nystatin in reducing fungal colonization and invasive fungal infection, more effective in reducing the incidence of clinical sepsis and number of sepsis attacks and has favorable effect on feeding intolerance.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Antifungal Agents / therapeutic use*
  • Feces / microbiology
  • Female
  • Fungi / isolation & purification
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / microbiology
  • Infant, Premature, Diseases / prevention & control*
  • Infant, Very Low Birth Weight
  • Male
  • Mycoses / microbiology
  • Mycoses / prevention & control*
  • Nystatin / therapeutic use*
  • Probiotics / therapeutic use*
  • Prospective Studies
  • Saccharomyces / physiology*
  • Skin / microbiology
  • Treatment Outcome


  • Antifungal Agents
  • Nystatin