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



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.


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.


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.


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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Standardized mean difference


  1. 1.

    Monto AS (2002) Epidemiology of viral respiratory infections. Am J Med 112(Suppl 6A):4S–12S

    Article  PubMed  Google Scholar 

  2. 2.

    Parkin PC, Taylor CY, Petric M et al (2002) Controlled study of respiratory viruses and wheezing. Arch Dis Child 87:221–222

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. 3.

    InVS | BEH n°01 (6 janvier 2009) Observatoire Hivern@le – KhiObs : surveillance épidémiologique des pathologies hivernales de la sphère ORL chez l’enfant en France. Les recours pour asthme dans les services des urgences d’Île-de-France, 2006–2007. Epidémiologie de la cryptosporidiose humaine en France en 2006 et 2007 : données du réseau Cryptosporidies Anofel. http://invs.santepubliquefrance.fr/beh/2009/01/index.htm. Accessed 3 Jan 2018

  4. 4.

    Manzella JP, Roberts NJ (1979) Human macrophage and lymphocyte responses to mitogen stimulation after exposure to influenza virus, ascorbic acid, and hyperthermia. J Immunol 123:1940–1944

    CAS  PubMed  Google Scholar 

  5. 5.

    Anderson TW (1977) Large scale studies with vitamin C. Acta Vitaminol Enzymol 31:43–50

    CAS  PubMed  Google Scholar 

  6. 6.

    Anderson TW, Suranyi G, Beaton GH (1974) The effect on winter illness of large doses of vitamin C. Can Med Assoc J 111:31–36

    CAS  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Anderson TW, Beaton GH, Corey P, Spero L (1975) Winter illness and vitamin C: the effect of relatively low doses. Can Med Assoc J 112:823–826

    CAS  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Dykes MH, Meier P (1975) Ascorbic acid and the common cold. Evaluation of its efficacy and toxicity. JAMA 231:1073–1079

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Chalmers TC (1975) Effects of ascorbic acid on the common cold. An evaluation of the evidence. Am J Med 58:532–536

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Karlowski TR, Chalmers TC, Frenkel LD et al (1975) Ascorbic acid for the common cold. A prophylactic and therapeutic trial. JAMA 231:1038–1042

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Hemilä H, Chalker E (2013) Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev:CD000980. https://doi.org/10.1002/14651858.CD000980.pub4

  12. 12.

    Shamseer L, Moher D, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 350:g7647

    Article  PubMed  Google Scholar 

  13. 13.

    Cochrane handbook for systematic reviews of interventions | Cochrane Training. http://training.cochrane.org/handbook. Accessed 18 Jan 2018

  14. 14.

    Murad MH, Montori VM, Ioannidis JPA et al (2014) How to read a systematic review and meta-analysis and apply the results to patient care: users’ guides to the medical literature. JAMA 312:171–179. https://doi.org/10.1001/jama.2014.5559

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Wilson CW, Loh HS, Foster FG (1973) Common cold symptomatology and vitamin C. Eur J Clin Pharmacol 6:196–202

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Garaiova I, Muchová J, Nagyová Z et al (2015) Probiotics and vitamin C for the prevention of respiratory tract infections in children attending preschool: a randomised controlled pilot study. Eur J Clin Nutr 69:373–379. https://doi.org/10.1038/ejcn.2014.174

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Constantini NW, Dubnov-Raz G, Eyal B-B et al (2011) The effect of vitamin C on upper respiratory infections in adolescent swimmers: a randomized trial. Eur J Pediatr 170:59–63. https://doi.org/10.1007/s00431-010-1270-z

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Cohen HA, Varsano I, Kahan E et al (2004) Effectiveness of an herbal preparation containing echinacea, propolis, and vitamin C in preventing respiratory tract infections in children: a randomized, double-blind, placebo-controlled, multicenter study. Arch Pediatr Adolesc Med 158:217–221. https://doi.org/10.1001/archpedi.158.3.217

    Article  PubMed  Google Scholar 

  19. 19.

    Bancalari A, Seguel C, Neira F et al (1984) Prophylactic value of vitamin C in acute respiratory tract infections in schoolchildren. Rev Med Chil 112:871–876

    CAS  PubMed  Google Scholar 

  20. 20.

    Ludvigsson J, Hansson LO, Tibbling G (1977) Vitamin C as a preventive medicine against common colds in children. Scand J Infect Dis 9:91–98

    Article  CAS  PubMed  Google Scholar 

  21. 21.

    Coulehan JL, Reisinger KS, Rogers KD, Bradley DW (1974) Vitamin C prophylaxis in a boarding school. N Engl J Med 290:6–10. https://doi.org/10.1056/NEJM197401032900102

    Article  CAS  PubMed  Google Scholar 

  22. 22.

    Coulehan JL, Eberhard S, Kapner L et al (1976) Vitamin C and acute illness in Navajo school children. N Engl J Med 295:973–977. https://doi.org/10.1056/NEJM197610282951802

    Article  CAS  PubMed  Google Scholar 

  23. 23.

    Miller JZ, Nance WE, Kang K (1978) A co-twin control study of the effects of vitamin C. Prog Clin Biol Res 24(Pt C):151–156

    PubMed  Google Scholar 

  24. 24.

    Miller JZ, Nance WE, Norton JA et al (1977) Therapeutic effect of vitamin C. A co-twin control study. JAMA 237:248–251

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Ritzel G (1961) Critical evaluation of vitamin C as a prophylactic and therapeutic agent in colds. Helv Med Acta 28:63–68

    CAS  PubMed  Google Scholar 

  26. 26.

    Karsch-Völk M, Barrett B, Kiefer D et al (2014) Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev:CD000530. https://doi.org/10.1002/14651858.CD000530.pub3

  27. 27.

    Hao Q, Dong BR, Wu T (2015) Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev:CD006895. https://doi.org/10.1002/14651858.CD006895.pub3

  28. 28.

    Quick M (2015) Cochrane commentary: probiotics for prevention of acute upper respiratory infection. Explore N Y N 11:418–420. https://doi.org/10.1016/j.explore.2015.07.012

    Article  Google Scholar 

  29. 29.

    Kenealy T, Arroll B (2013) Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Syst Rev 6:CD000247. https://doi.org/10.1002/14651858.CD000247.pub3

    Article  Google Scholar 

  30. 30.

    Grüber C, Keil T, Kulig M et al (2008) History of respiratory infections in the first 12 yr among children from a birth cohort. Pediatr Allergy Immunol Off Publ Eur Soc Pediatr Allergy Immunol 19:505–512. https://doi.org/10.1111/j.1399-3038.2007.00688.x

    Article  Google Scholar 

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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.

Author information




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.

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