Probiotics for respiratory tract infections in children attending day care centers—a systematic review
- 754 Downloads
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.
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.
KeywordsChildren Meta-analysis RCT Respiratory infections Acute otitis media
acute otitis media
Bifidobacterium animalis subsp. lactis
Lactobacillus rhamnosus GG
randomized controlled trials
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.
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.
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.
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.
Not applicable for this manuscript.
- 1.Amaral MA, Guedes GHBF, Epifanio M, Wagner MB, Jones MH, Mattiello R (2017) Network meta-analysis of probiotics to prevent respiratory infections in children and adolescents: network of probiotics to prevent respiratory infections. Pediatr Pulmonol 52:833–843. https://doi.org/10.1002/ppul.23643 CrossRefPubMedGoogle Scholar
- 2.Cáceres P, Montes S, Vega N et al (2010) Effects of Lactobacillus rhamnosus HN001 on acute respiratory infections and intestinal secretory IgA in children. J Pediatr Infect Dis 5:353–362Google Scholar
- 4.Gutierrez-Castrellon P, Lopez-Velazquez G, Diaz-Garcia L, Jimenez-Gutierrez C, Mancilla-Ramirez J, Estevez-Jimenez J, Parra M (2014) Diarrhea in preschool children and Lactobacillus reuteri: a randomized controlled trial. Pediatrics 133:e904–e909. https://doi.org/10.1542/peds.2013-0652 CrossRefPubMedGoogle Scholar
- 5.Hao Q, Dong BR, Wu T (2015) Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev 2:CD006895Google Scholar
- 6.Hatakka K, Savilahti E, Pönkä A, Meurman JH, Poussa T, Näse L, Saxelin M, Korpela R (2001) Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial. BMJ 322:1327. https://doi.org/10.1136/bmj.322.7298.1327 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, Morelli L, Canani RB, Flint HJ, Salminen S, Calder PC, Sanders ME (2014) Expert consensus document: the International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 11:506–514. https://doi.org/10.1038/nrgastro.2014.66 CrossRefPubMedGoogle Scholar
- 10.Hojsak I, Snovak N, Abdović S, Szajewska H, Mišak Z, Kolaček S (2010) Lactobacillus GG in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centers: a randomized, double-blind, placebo-controlled trial. Clin Nutr 29:312–316. https://doi.org/10.1016/j.clnu.2009.09.008 CrossRefPubMedGoogle Scholar
- 11.Hojsak I, Močić Pavić A, Kos T, Dumančić J, Kolaček S (2016) Bifidobacterium animalis subsp. lactis in prevention of common infections in healthy children attending day care centers—randomized, double blind, placebo-controlled study. Clin Nutr 35:587–591. https://doi.org/10.1016/j.clnu.2015.05.004 CrossRefPubMedGoogle Scholar
- 13.King S, Glanville J, Sanders ME, Fitzgerald A, Varley D (2014) Effectiveness of probiotics on the duration of illness in healthy children and adults who develop common acute respiratory infectious conditions: a systematic review and meta-analysis. Br J Nutr 112:41–54. https://doi.org/10.1017/S0007114514000075 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Kukkonen K, Savilahti E, Haahtela T, Juntunen-Backman K, Korpela R, Poussa T, Tuure T, Kuitunen M (2008) Long-term safety and impact on infection rates of postnatal probiotic and prebiotic (synbiotic) treatment: randomized, double-blind, placebo-controlled trial. Pediatrics 122:8–12. https://doi.org/10.1542/peds.2007-1192 CrossRefPubMedGoogle Scholar
- 16.Kumpu M, Kekkonen RA, Kautiainen H, Järvenpää S, Kristo A, Huovinen P, Pitkäranta A, Korpela R, Hatakka K (2012) Milk containing probiotic Lactobacillus rhamnosus GG and respiratory illness in children: a randomized, double-blind, placebo-controlled trial. Eur J Clin Nutr 66:1020–1023. https://doi.org/10.1038/ejcn.2012.62 CrossRefPubMedGoogle Scholar
- 20.Merenstein D, Murphy M, Fokar A, Hernandez RK, Park H, Nsouli H, Sanders ME, Davis BA, Niborski V, Tondu F, Shara NM (2010) Use of a fermented dairy probiotic drink containing Lactobacillus casei (DN-114 001) to decrease the rate of illness in kids: the DRINK study. A patient-oriented, double-blind, cluster-randomized, placebo-controlled, clinical trial. Eur J Clin Nutr 64:669–677CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, O'Brien KL, Roca A, Wright PF, Bruce N, Chandran A, Theodoratou E, Sutanto A, Sedyaningsih ER, Ngama M, Munywoki PK, Kartasasmita C, Simões EAF, Rudan I, Weber MW, Campbell H (2010) Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet 375:1545–1555. https://doi.org/10.1016/S0140-6736(10)60206-1 CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Prodeus A, Niborski V, Schrezenmeir J, Gorelov A, Shcherbina A, Rumyantsev A (2016) Fermented milk consumption and common infections in children attending day-care centers: a randomized trial. J Pediatr Gastroenterol Nutr 63:534–543. https://doi.org/10.1097/MPG.0000000000001248 CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Schünemann H, Brozek J, Guyatt G, Oxman A (2013) Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. Updated October 2013. The GRADE Working GroupGoogle Scholar
- 35.Wang Y, Li X, Ge T, Xiao Y, Liao Y, Cui Y, Zhang Y, Ho W, Yu G, Zhang T (2016) Probiotics for prevention and treatment of respiratory tract infections in children: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 95:e4509. https://doi.org/10.1097/MD.0000000000004509 CrossRefGoogle Scholar
- 39.Zutavern A, Rzehak P, Brockow I, Schaaf B, Bollrath C, von Berg A, Link E, Kraemer U, Borte M, Herbarth O, Wichmann HE, Heinrich J, for the LISA Study Group (2007) Day care in relation to respiratory-tract and gastrointestinal infections in a German birth cohort study. Acta Paediatr 96:1494–1499. https://doi.org/10.1111/j.1651-2227.2007.00412.x CrossRefPubMedGoogle Scholar