gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2026-36-3-74-89gastro-j-2048Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESШтамм-специфичная эффективность Saccharomyces boulardii CNCM I-745 в профилактике антибиотик-ассоциированной диареи: систематический обзор и метаанализStrain-Specific Efficacy of Saccharomyces boulardii CNCM I-745 in the Prevention of Antibiotic-Associated Diarrhea: A Systematic Review and Meta-AnalysisИвашкинВ. Т.IvashkinV. I.

Ивашкин Владимир Трофимович — доктор медицинских наук, профессор, академик РАН, заведующий кафедрой пропедевтики внутренних болезней, гастроэнтерологии и гепатологии Института клинической медицины им. Н.В. Склифосовского, директор клиники пропедевтики внутренних болезней, гастроэнтерологии и гепатологии им. В.Х. Василенко; главный внештатный специалист гастроэнтеролог Министерства здравоохранения Российской Федерации

119435, г. Москва, ул. Погодинская, 1, стр. 1

Vladimir T. Ivashkin — Dr. Sci. (Med.), Professor, Academician of the Russian Academy of Sciences, Head of the Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology of the N.V. Sklifosovsky Institute of Clinical Medicine, Director of the V.Kh. VasilenkoClinic of Internal Diseases Propedeutics, Gastroenterology and Hepatology; Chief Gastroenterologist of the Ministry of Health of the Russian Federation

119435, Moscow, Pogodinskaya str., 1, build. 1

ivashkin_v_t@staff.sechenov.ruhttps://orcid.org/0000-0001-9257-0171ГореловА. В.GorelovA. V.

Горелов Александр Васильевич — доктор медицинских наук, академик РАН, профессор кафедры детских болезней Клинического института детского здоровья им. Н.Ф. Филатова; заведующий кафедрой инфекционных болезней и эпидемиологии

111123, г. Москва, ул. Новогиреевская, 3а

Aleksandr V. Gorelov — Dr. Sci. (Med.), Academician of the Russian Academy of Sciences, Professor of the Department of Pediatrics, N.F. Filatov Clinical Institute of Children’s Health; Head of the Department of Infectious Diseases and Epidemiology

111123, Moscow, Novogireevskaya str., 3a

gorelov_a_v@staff.sechenov.ruhttps://orcid.org/0009-0000-4358-7823ХурматуллинаА. Р.KhurmatullinaA. R.

Хурматуллина Алсу Расимовна — студентка Института клинической медицины им. Н.В. Склифосовского; лаборант кафедры фармакологии

119435, г. Москва, ул. Погодинская, 1, стр. 1

Alsu R. Khurmatullina — Student of the N.V. Sklifosovsky Institute of Clinical Medicine; Laboratory Assistant of the Department of Pharmacology

119435, Moscow, Pogodinskaya str., 1, build. 1

alsu0308@rambler.ruhttps://orcid.org/0000-0002-4007-7112АндреевД. Н.AndreevD. N.

Андреев Дмитрий Николаевич* — кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней и гастроэнтерологии

127006, г. Москва, ул. Долгоруковская, 4

Dmitry N. Andreev* — Cand. Sci. (Med.), Associate Professor of the Department of Propaedeutics of Internal Diseases and Gastroenterology

127006, Moscow, Dolgorukovskaya str., 4

dna-mit8@mail.ruhttps://orcid.org/0000-0001-5232-7337УсенкоД. В.UsenkoD. V.

Усенко Денис Валериевич — доктор медицинских наук, доцент, ведущий научный сотрудник клинического отдела инфекционной патологии

111123, г. Москва, ул. Новогиреевская, 3а

Denis V. Usenko — Dr. Sci. (Med.), Docent, Leading Researcher of the Clinical Infection Division

111123, Moscow, Novogireevskaya str., 3a

dusenko@rambler.ruhttps://orcid.org/0000-0002-7923-9916ЗаборовскийА. В.ZaborovskiyА. V.

Заборовский Андрей Владимирович — доктор медицинских наук, заведующий кафедрой фармакологии

127006, г. Москва, ул. Долгоруковская, 4

Andrey V. Zaborovskiy — Dr. Sci. (Med.), Head of the Department of Pharmacology

127006, Moscow, Dolgorukovskaya str., 4

azabor@mail.ruhttps://orcid.org/0000-0003-1312-120XПолуэктоваЕ. А.PoluektovaE. A.

Полуэктова Елена Александровна — доктор медицинских наук, профессор кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии Института клинической медицины им. Н.В. Склифосовского, врач-гастроэнтеролог отделения хронических заболеваний кишечника и поджелудочной железы Клиники пропедевтики внутренних болезней, гастроэнтерологии и гепатологии им. В.Х. Василенко, руководитель Координационно-аналитического центра по микробиоте

119435, г. Москва, ул. Погодинская, 1, стр. 1

Elena A. Poluektova — Dr. Sci. (Med.), Professor of the De- partment of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology of the N.V. Sklifosovsky Institute of Clinical Medicine, Gastroenterologist of the Department of Chronic Intestinal and Pancreatic Diseases of the V.Kh. Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology, Head of the Microbiota Reference Center of the Ministry of Health of the Russian Federation

119435, Moscow, Pogodinskaya str., 1, build. 1

 

poluektova_e_a@staff.sechenov.ruhttps://orcid.org/0000-0003-3362-2968ТрухмановА. С.TrukhmanovA. S.

Трухманов Александр Сергеевич — доктор медицинских наук, профессор кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии Института клинической медицины им. Н.В. Склифосовского

119435, г. Москва, ул. Погодинская, 1, стр. 1

Alexander S. Trukhmanov — Dr. Sci. (Med.), Professor of the Department of Internal Disease Propaedeutics, Gastroenterology and Hepatology, N.V. Sklifosovsky Institute of Clinical Medicine

119435, Moscow, Pogodinskaya str., 1, build. 1

trukhmanov_a_s@staff.sechenov.ruhttps://orcid.org/0000-0003-4456-8725ЛапинаТ. Л.LapinaT. L.

Лапина Татьяна Львовна — кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии Института клинической медицины им. Н.В. Склифосовского

119435, г. Москва, ул. Погодинская, 1, стр. 1

Tatiana L. Lapina — Cand. Sci. (Med.), Associate Professor at the Department of Propaedeutics of Internal Diseases of the N.V. Sklifosovsky Institute of Clinical Medicine

119435, Moscow, Pogodinskaya str., 1, build. 1

lapina_t_l@staff.sechenov.ruhttps://orcid.org/0000-0001-7513-1636МасленниковР. В.MaslennikovR. V.

Масленников Роман Вячеславович — кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии Института клинической медицины им. Н.В. Склифосовского, эксперт Координационно-аналитического центра по обеспечению химической и биологической безопасности

119435, г. Москва, ул. Погодинская, 1, стр. 1

Roman V. Maslennikov — Cand. Sci. (Med.), Associate Professor of the Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology of the N.V. Skli- fosovsky Institute of Clinical Medicine, Expert of the Micro- biota Reference Center of the Ministry of Health of the Russian Federation

119435, Moscow, Pogodinskaya str., 1, build. 1

maslennikov_r_v@staff.sechenov.ruhttps://orcid.org/0000-0003-3362-2968МаевИ. В.MaevI. V.

Маев Игорь Вениаминович — доктор медицинских наук, профессор, академик РАН, заведующий кафедрой пропедевтики внутренних болезней и гастроэнтерологии

119435, Moscow, Pogodinskaya str., 1, build. 1

Igor V. Maev — Dr. Sci. (Med)., Professor, Academician of the Russian Academy of Medical Sciences, Head of the Department of Propaedeutics of Internal Diseases and Gastroenterology

127006, Moscow, Dolgorukovskaya str., 4.

maev_iv@rosunimed.ruФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет); ФГБОУ ВО «Российский университет медицины» Министерства здравоохранения Российской Федерации; ФБУН «Центральный научно-исследовательский институт эпидемиологии» Федеральной службы по надзору в сфере защиты прав потребителей и благополучия человекаРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University); Russian University of Medicine; Central Research Institute of EpidemiologyRussian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет); ФГБОУ ВО «Российский университет медицины» Министерства здравоохранения Российской ФедерацииРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University); Russian University of MedicineRussian FederationФГБОУ ВО «Российский университет медицины» Министерства здравоохранения Российской ФедерацииРоссияRussian University of MedicineRussian FederationФБУН «Центральный научно-исследовательский институт эпидемиологии» Федеральной службы по надзору в сфере защиты прав потребителей и благополучия человекаРоссияCentral Research Institute of EpidemiologyRussian Federation2026300620263637489Copyright © Ивашкин В.Т., Горелов А.В., Хурматуллина А.Р., Андреев Д.Н., Усенко Д.В., Заборовский А.В., Полуэктова Е.А., Трухманов А.С., Лапина Т.Л., Масленников Р.В., Маев И.В., 20262026Ивашкин В.Т., Горелов А.В., Хурматуллина А.Р., Андреев Д.Н., Усенко Д.В., Заборовский А.В., Полуэктова Е.А., Трухманов А.С., Лапина Т.Л., Масленников Р.В., Маев И.В.Ivashkin V.I., Gorelov A.V., Khurmatullina A.R., Andreev D.N., Usenko D.V., Zaborovskiy А.V., Poluektova E.A., Trukhmanov A.S., Lapina T.L., Maslennikov R.V., Maev I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/2048Цель

Цель: проведение систематического обзора и метаанализа эффективности применения Saccharomyces boulardii CNCM I-745 в профилактике антибиотик-ассоциированной диареи (ААД) у взрослых и детей.

Материалы и методы

Материалы и методы. Протокол данного систематического обзора и метаанализа был предварительно зарегистрирован в международной базе PROSPERO (CRD420261296647). В соответствии с рекомендациями PRISMA 2020 проведен систематический поиск публикаций в базах данных MEDLINE/PubMed, Embase, Cochrane Library, Scopus и РИНЦ с момента появления первых публикаций по 6 февраля 2026 г. Включались исследования, оценивающие эффективность S. boulardii CNCM I-745 (лекарственный препарат «Энтерол®») в первичной профилактике ААД и инфекции Clostridioides difficile у взрослых и детей.

Результаты

Результаты. В метаанализ было включено 29 исследований, соответствующих критериям включения. Применение S. boulardii CNCM I-745 было ассоциировано со статистически значимым снижением частоты ААД по сравнению с контролем в общем пуле исследований (отношение шансов [ОШ] 0,38; 95%-ный доверительный интервал [95% ДИ] 0,32–0,45). Анализ в подгруппах подтвердил эффективность пробиотика как у взрослых (20 исследований, n = 3937; ОШ 0,45; 95% ДИ 0,33–0,61), так и у детей, где эффект был еще более выраженным (7 исследований, n = 1608; ОШ 0,31; 95% ДИ 0,23–0,41). В анализе исследований, в которых S. boulardii CNCM I-745 применялся в составе схем эрадикации Helicobacter pylori, также было выявлено статистически значимое снижение риска ААД (13 исследований, n = 2333; ОШ 0,36; 95% ДИ 0,25–0,52). Дополнительный анализ продемонстрировал значимое снижение риска инфекции Clostridioides difficile на фоне приема S. boulardii CNCM I-745 (8 исследований, n = 18 426; ОШ 0,67; 95% ДИ 0,49–0,92).

Выводы

Выводы. Результаты настоящего метаанализа демонстрируют высокую эффективность S. boulardii CNCM I-745 в профилактике ААД у взрослых и детей, а также снижении риска инфекции Clostridioides difficile на фоне антибиотикотерапии с первого дня ее проведения.

Aim

Aim: to perform a systematic review and meta-analysis of the efficacy of Saccharomyces boulardii CNCM I-745 in the prevention of antibiotic-associated diarrhea (AAD) in adults and children.

Materials and methods

Materials and methods. The protocol for this systematic review and meta-analysis was prospectively registered in the international PROSPERO database (CRD420261296647). In accordance with the PRISMA 2020 guidelines, a systematic literature search was conducted in MEDLINE/PubMed, Embase, the Cochrane Library, Scopus, and RSCI (Russian Science Citation Index) from the time first publications appeared to February 6, 2026. Studies evaluating the efficacy of S. boulardii CNCM I-745 (Enterol®) in the primary prevention of AAD and Clostridioides difficile infection (CDI) in adults and children were included.

Results

Results. A total of 29 studies met the inclusion criteria and were included in the meta-analysis. The use of S. boulardii CNCM I-745 was associated with a statistically significant reduction in the incidence of AAD compared with control in the overall pooled analysis (OR 0.38; 95 % CI 0.32–0.45). Subgroup analysis confirmed the efficacy of the probiotic in both adults (20 studies, n = 3937; OR 0.45; 95 % CI 0.33–0.61) and children, in whom the effect was even more pronounced (7 studies, n = 1608; OR 0.31; 95 % CI 0.23–0.41). In the analysis of studies in which S. boulardii CNCM I-745 was used as part of Helicobacter pylori eradication regimens, a statistically significant reduction in AAD risk was also observed (13 studies, n = 2333; OR 0.36; 95 % CI 0.25–0.52). Additional analysis demonstrated a significant reduction in CDI risk with S. boulardii CNCM I-745 use (8 studies, n = 18,426; OR 0.67; 95 % CI 0.49–0.92).

Conclusions

Conclusions. The results of this meta-analysis demonstrate the high efficacy of S. boulardii CNCM I-745 in the prevention of AAD in adults and children, as well as in reducing the risk of CDI during antibiotic therapy from the very first

day of treatment

day of treatment.

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The authors declare that there are no conflicts of interest present.