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

Abstract

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.

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Abbreviations

AOM:

acute otitis media

BB-12:

Bifidobacterium animalis subsp. lactis

CI:

confidence interval

CFU:

colony-forming units

LGG:

Lactobacillus rhamnosus GG

MD:

mean difference

RCTs:

randomized controlled trials

RR:

risk ratio

RTIs:

respiratory tract infections

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Acknowledgments

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.

Funding

No funding was secured for this study.

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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.

Corresponding author

Correspondence to Iva Hojsak.

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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.

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Not applicable for this manuscript.

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Communicated by Mario Bianchetti

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Laursen, R.P., Hojsak, I. Probiotics for respiratory tract infections in children attending day care centers—a systematic review. Eur J Pediatr 177, 979–994 (2018). https://doi.org/10.1007/s00431-018-3167-1

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Keywords

  • Children
  • Meta-analysis
  • RCT
  • Respiratory infections
  • Acute otitis media