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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Upper respiratory tract infection
Randomized controlled trial
Standardized mean difference
Monto AS (2002) Epidemiology of viral respiratory infections. Am J Med 112(Suppl 6A):4S–12S
Parkin PC, Taylor CY, Petric M et al (2002) Controlled study of respiratory viruses and wheezing. Arch Dis Child 87:221–222
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
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
Anderson TW (1977) Large scale studies with vitamin C. Acta Vitaminol Enzymol 31:43–50
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
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
Dykes MH, Meier P (1975) Ascorbic acid and the common cold. Evaluation of its efficacy and toxicity. JAMA 231:1073–1079
Chalmers TC (1975) Effects of ascorbic acid on the common cold. An evaluation of the evidence. Am J Med 58:532–536
Karlowski TR, Chalmers TC, Frenkel LD et al (1975) Ascorbic acid for the common cold. A prophylactic and therapeutic trial. JAMA 231:1038–1042
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
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
Cochrane handbook for systematic reviews of interventions | Cochrane Training. http://training.cochrane.org/handbook. Accessed 18 Jan 2018
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
Wilson CW, Loh HS, Foster FG (1973) Common cold symptomatology and vitamin C. Eur J Clin Pharmacol 6:196–202
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
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
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
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
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
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
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
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
Miller JZ, Nance WE, Norton JA et al (1977) Therapeutic effect of vitamin C. A co-twin control study. JAMA 237:248–251
Ritzel G (1961) Critical evaluation of vitamin C as a prophylactic and therapeutic agent in colds. Helv Med Acta 28:63–68
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
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
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
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
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
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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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
- Upper respiratory tract infection
- Vitamin C
- Systematic review