European Journal of Pediatrics

, Volume 177, Issue 7, pp 979–994 | Cite as

Probiotics for respiratory tract infections in children attending day care centers—a systematic review

  • Rikke Pilmann Laursen
  • Iva HojsakEmail author


Probiotics have been suggested to have a preventive effect on respiratory tract infections (RTIs), but limited evidence exist on strain-specific effects. The main aim of this systematic review and meta-analysis was to evaluate strain-specific probiotic effects on RTIs in children attending day care. We included 15 RCTs with 5121 children in day care settings (aged 3 months to 7 years), but due to high diversity in reported outcomes, different number of RCTs were available for evaluated outcomes. Twelve RCTs (n = 4527) reported results which could be compared in at least one outcome of the meta-analysis. Compared to placebo, Lactobacillus rhamnosus GG (LGG) significantly reduced duration of RTIs (three RCTs, n = 1295, mean difference − 0.78 days, 95% confidence interval (CI) − 1.46; − 0.09), whereas no effect was found on other evaluated outcomes. Based on the results from two studies (n = 343), Bifidobacterium animalis subsp. lactis BB-12 showed no effect on duration of RTIs or on absence from day care. Meta-analyses on other strains or their combination were not possible due to limited data and different outcome measures.

Conclusion: LGG is modestly effective in decreasing the duration of RTIs. More RCTs investigating specific probiotic strains or their combinations in prevention of RTIs are needed.

What is known:

Previously published systematic reviews have suggested that probiotics may have a preventive effect on respiratory infections, but limited data exist on strain specific effects.

What is new:

This systematic review showed that use of Lactobacillus rhamnosus GG modestly reduces the duration of respiratory tract infections.


Children Meta-analysis RCT Respiratory infections Acute otitis media 



acute otitis media


Bifidobacterium animalis subsp. lactis


confidence interval


colony-forming units


Lactobacillus rhamnosus GG


mean difference


randomized controlled trials


risk ratio


respiratory tract infections



Authors would like to thank Professor Gutierrez-Castrellon and Doctor Niborski for responding to the e-mail and sending us additional data; Doctor Weizman, Professor Kloster Smerud, and Professor Merenstein for responding to the e-mail; Doctor Magdalena Krbot Skorić for critical review of the meta-analysis.

Authors’ contributions

Concept and design of the study RPL, IH; literature search RPL, IH; analysis of the data IH; interpretation of the data RPL, IH; drafting of the manuscript RPL; critical analysis of the manuscript RPL, IH; final approval of the manuscript RPL, IH.

Funding information

No funding was secured for this study.

Compliance with ethical standards

Conflicts of interest

Iva Hojsak has participated as a clinical investigator for Biogaia and Chr Hansen and speaker for Biogaia, Medisadria, Nutricia, and Pharmas. Rikke Pilmann Laursen declared no potential conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Not applicable for this manuscript.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenCopenhagenDenmark
  2. 2.Children’s Hospital Zagreb, School of MedicineUniversity of ZagrebZagrebCroatia
  3. 3.School of MedicineUniversity J.J. StrossmayerOsijekCroatia
  4. 4.Referral Center for Pediatric Gastroenterology and NutritionChildren’s Hospital ZagrebZagrebCroatia

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