Efficacy of vitamin C for the prevention and treatment of upper respiratory tract infection. A meta-analysis in children

Abstract

Purpose

Upper respiratory tract infection (URTI) is a common infection in children, generally caused by viral respiratory infection. Vitamin C is currently proposed as prophylaxis for URTI. The purpose of this study was to assess the effectiveness of vitamin C administration in children for the prevention and reduced duration of URTI through a systematic literature review.

Methods

Review of the literature conducted between October 2017 and January 2018 in the main medical databases (CENTRAL, Medline and Embase) and by a gray literature approach. The selection criteria were: double-blind randomized controlled trials (RCTs) comparing vitamin C use to placebo in children aged 3 months to 18 years without chronic infection. Efficacy was assessed in terms of incidence, duration and severity of symptoms of URTI. A meta-analysis was conducted where possible.

Results

Eight RCTs, including 3135 children aged 3 months to 18 years, were selected. Quantitative analysis showed no difference between vitamin C administration and placebo (odds ratio = 0.75, 95% CI [0.54–1.03], p = 0.07, I2 = 74%). Vitamin C administration was found to decrease the duration of URTI by 1.6 days (standardized mean differences = −0.30 [−0.53; −0.08], p = 0.009, I2 = 70%). Children under 6 years of age benefit from more effective vitamin C supplementation associated with echinacea. No serious adverse events were reported.

Conclusions

Although no preventive effects were found, vitamin C intake reduced the duration of URTI. Considering the frequency of URTI, the inappropriate prescription of antibiotics, and the safe nature of vitamin C, its supplementation is justified, especially in children under 6 years of age and those who present a high frequency of URTI. There is a sound rationale for further trials with greater statistical power among children of this age.

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Abbreviations

URTI:

Upper respiratory tract infection

CG:

Control group

CI:

Confidence interval

IG:

Intervention group

RCT:

Randomized controlled trial

RR:

Relative risk

SMD:

Standardized mean difference

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Acknowledgements

The authors thank Mrs. Nathalie Pinol-Domenech, documentarian at Clermont Auvergne University Campus Health Library. We also thank Mr. Constantini for providing clarifications and additional data for this study.

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Authors

Contributions

BA, AC and PV conceptualized and designed the study, selected studies and planned the analysis. BA, PV, BP and AC contributed to the development of the selection criteria, the assessment strategy for the risk of bias and the data extraction criteria; BP provided statistical expertise. AC, BA and PV drafted the manuscript and HVR and EM participated in its improvement. All authors read, provided feedback and approved the final manuscript as submitted.

Corresponding author

Correspondence to Philippe Vorilhon.

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Vorilhon, P., Arpajou, B., Vaillant Roussel, H. et al. Efficacy of vitamin C for the prevention and treatment of upper respiratory tract infection. A meta-analysis in children. Eur J Clin Pharmacol 75, 303–311 (2019). https://doi.org/10.1007/s00228-018-2601-7

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Keywords

  • Upper respiratory tract infection
  • Vitamin C
  • Infants
  • Adolescents
  • Systematic review