BACKGROUND: Probiotics are live micro-organisms that may give a beneficial physiological effect when administered in adequate amounts. Some trials show that probiotic strains can prevent respiratory infections. Even though our previously published review showed the benefits of probiotics for acute upper respiratory tract infections (URTIs), several new studies have been published. This is an update of a review first published in 2011 and updated in 2015.
OBJECTIVES: To assess the effectiveness and safety of probiotics (any specified strain or dose), compared with placebo or no treatment, in the prevention of acute URTIs in people of all ages, at risk of acute URTIs.
SEARCH METHODS: We searched CENTRAL (2022, Issue 6), MEDLINE (1950 to May week 2, 2022), Embase (1974 to 10 May 2022), Web of Science (1900 to 10 May 2022), the Chinese Biomedical Literature Database, which includes the China Biological Medicine Database (from 1978 to 10 May 2022), the Chinese Medicine Popular Science Literature Database (from 2000 to 10 May 2022), and the Master's Degree Dissertation of Beijing Union Medical College Database (from 1981 to 10 May 2022). We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov for completed and ongoing trials on 10 May 2022.
SELECTION CRITERIA: We included individual randomised controlled trials (RCTs) and cluster-RCTs comparing probiotics with placebo or no treatment to prevent acute URTIs. The participants were children, adults, or the elderly in the community, care facilities, schools, or hospitals. Our main outcomes were the number of participants diagnosed with URTIs (at least one event and at least three events), the incidence rate (number of cases/person year) of acute URTIs, and the mean duration of an episode of URTIs. Our secondary outcomes were the number of participants who were absent from childcare centre, school, or work due to acute URTIs; the number of participants who used prescribed antibiotics for acute URTIs; and the number of participants who experienced at least one adverse event from probiotics. We excluded studies if they did not specify acute respiratory infections as 'upper'; studies with more than 50% of participants vaccinated against influenza or other acute URTIs within the last 12 months; and studies with significantly different proportions of vaccinated participants between the probiotics arm and the placebo or no treatment arm.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the eligibility of trials and extracted data using standard Cochrane methodological procedures. We analysed both intention-to-treat and per-protocol data and used a random-effects model. We expressed results as risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, both with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach.
MAIN RESULTS: We included 23 individual RCTs and one cluster-RCT. As one of the individual RCTs did not report outcomes in a usable way, we could only meta-analyse data from 23 trials, involving a total of 6950 participants including children (aged from one month to 11 years old), adults (mean age 37.3), and older people (mean age 84.6 years). One trial reported 22.5% flu-vaccine participants within the last 12 months, and 25.4% flu-vaccine participants during the intervention. Probiotics were more likely to be given with milk-based food in children; administered in powder form in adults; and given with milk-based food or in capsules in the elderly. Most of the studies used one or two strains (e.g. Lactobacillus plantarum HEAL9, Lactobacillus paracasei (8700:2 or N1115)) and 109 or 1011 colony-forming units (CFU)/day of probiotics for more than three months. We found that probiotics may reduce the number of participants diagnosed with URTIs (at least one event) (RR 0.76, 95% CI 0.67 to 0.87; P < 0.001; 16 studies, 4798 participants; low-certainty evidence); likely reduce the number of participants diagnosed with URTIs (at least three events) (RR 0.59, 95% CI 0.38 to 0.91; P = 0.02; 4 studies, 763 participants; moderate-certainty evidence); may reduce the incidence rate (number of cases/person year) of URTIs (rate ratio 0.82, 95% CI 0.73 to 0.92, P = 0.001; 12 studies, 4364 participants; low-certainty evidence); may reduce the mean duration of an episode of acute URTIs (MD -1.22 days, 95% CI -2.12 to -0.33; P = 0.007; 6 studies, 2406 participants; low-certainty evidence); likely reduce the number of participants who used prescribed antibiotics for acute URTIs (RR 0.58, 95% CI 0.42 to 0.81; P = 0.001; 6 studies, 1548 participants; moderate-certainty evidence); and may not increase the number of participants who experienced at least one adverse event (RR 1.02, 95% CI 0.90 to 1.15; P = 0.79; 8 studies, 2456 participants; low-certainty evidence). Evidence showing a decrease in the number of people absent from childcare centre, school, or work due to acute URTIs with probiotics is very uncertain (RR 0.14, 95% CI 0.03 to 0.59; 1 study, 80 participants; very low-certainty evidence). Adverse events from probiotics were minor, and most commonly gastrointestinal symptoms, such as vomiting, flatulence, diarrhoea, and bowel pain. AUTHORS' CONCLUSIONS: Overall, we found that probiotics were better than placebo or no treatment in preventing acute URTIs.
Wheezing, asthma, and respiratory infections (RTI) are among the most common causes of morbidity in children and their economic and social burden could be significantly reduced by specific prevention strategies. Epidemiological studies suggest that lower levels of some nutrients are associated with higher prevalence of these conditions, but the possible protective effect of early supplementation with these nutrients has not yet been established. Aim of our review is to synthetize the available scientific evidence on the role of supplementation with pre- and probiotics, vitamin D, fish and poly-unsaturated fatty acids (PUFA), vitamin A, C, and E, given during the first year of life, in the prevention of wheezing, asthma and RTI. We searched studies published on this topic in the PubMed database between January 2000 and September 2021. As for pre- and probiotics, most of the studies showed that an early supplementation had no protective effect toward the development of asthma and wheezing, while conflicting results were reported on their role in the reduction of RTI. As for vitamin D, the available data suggest that early and regular (on a daily or weekly base) supplementation of vitamin D during infancy could have a role in the prevention of RTI, while most studies showed no effect in the prevention of wheezing or asthma. Finally, early introduction of fish in the diet in most studies has proved protective toward wheezing and asthma development.
BACKGROUND: A 2017 meta-analysis of data from 25 randomised controlled trials (RCTs) of vitamin D supplementation for the prevention of acute respiratory infections (ARIs) revealed a protective effect of this intervention. We aimed to examine the link between vitamin D supplementation and prevention of ARIs in an updated meta-analysis.
METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and the ClinicalTrials.gov registry for studies listed from database inception to May 1, 2020. Double-blind RCTs of vitamin D3, vitamin D2, or 25-hydroxyvitamin D (25[OH]D) supplementation for any duration, with a placebo or low-dose vitamin D control, were eligible if they had been approved by a research ethics committee, and if ARI incidence was collected prospectively and prespecified as an efficacy outcome. Studies reporting results of long-term follow-up of primary RCTs were excluded. Aggregated study-level data, stratified by baseline 25(OH)D concentration and age, were obtained from study authors. Using the proportion of participants in each trial who had one or more ARIs, we did a random-effects meta-analysis to obtain pooled odds ratios (ORs) and 95% CIs to estimate the effect of vitamin D supplementation on the risk of having one or more ARIs (primary outcome) compared with placebo. Subgroup analyses were done to estimate whether the effects of vitamin D supplementation on the risk of ARI varied according to baseline 25(OH)D concentration (<25 nmol/L vs 25·0-49·9 nmol/L vs 50·0-74·9 nmol/L vs >75·0 nmol/L), vitamin D dose (daily equivalent of <400 international units [IU] vs 400-1000 IU vs 1001-2000 IU vs >2000 IU), dosing frequency (daily vs weekly vs once per month to once every 3 months), trial duration (≤12 months vs >12 months), age at enrolment (<1·00 years vs 1·00-15·99 years vs 16·00-64·99 years vs ≥65·00 years), and presence versus absence of airway disease (ie, asthma only, COPD only, or unrestricted). Risk of bias was assessed with the Cochrane Collaboration Risk of Bias Tool. The study was registered with PROSPERO, CRD42020190633.
FINDINGS: We identified 1528 articles, of which 46 RCTs (75 541 participants) were eligible. Data for the primary outcome were obtained for 48 488 (98·1%) of 49 419 participants (aged 0-95 years) in 43 studies. A significantly lower proportion of participants in the vitamin D supplementation group had one or more ARIs (14 332 [61·3%] of 23 364 participants) than in the placebo group (14 217 [62·3%] of 22 802 participants), with an OR of 0·92 (95% CI 0·86-0·99; 37 studies; I2=35·6%, pheterogeneity=0·018). No significant effect of vitamin D supplementation on the risk of having one or more ARIs was observed for any of the subgroups defined by baseline 25(OH)D concentration. However, protective effects of supplementation were observed in trials in which vitamin D was given in a daily dosing regimen (OR 0·78 [95% CI 0·65-0·94]; 19 studies; I2=53·5%, pheterogeneity=0·003), at daily dose equivalents of 400-1000 IU (0·70 [0·55-0·89]; ten studies; I2=31·2%, pheterogeneity=0·16), for a duration of 12 months or less (0·82 [0·72-0·93]; 29 studies; I2=38·1%, pheterogeneity=0·021), and to participants aged 1·00-15·99 years at enrolment (0·71 [0·57-0·90]; 15 studies; I2=46·0%, pheterogeneity=0·027). No significant interaction between allocation to the vitamin D supplementation group versus the placebo group and dose, dose frequency, study duration, or age was observed. In addition, no significant difference in the proportion of participants who had at least one serious adverse event in the vitamin supplementation group compared with the placebo group was observed (0·97 [0·86-1·07]; 36 studies; I2=0·0%, pheterogeneity=0·99). Risk of bias within individual studies was assessed as being low for all but three trials.
INTERPRETATION: Despite evidence of significant heterogeneity across trials, vitamin D supplementation was safe and overall reduced the risk of ARI compared with placebo, although the risk reduction was small. Protection was associated with administration of daily doses of 400-1000 IU for up to 12 months, and age at enrolment of 1·00-15·99 years. The relevance of these findings to COVID-19 is not known and requires further investigation.
FUNDING: None.
ObjectivesTo assess the overall effect of vitamin D supplementation on risk of acute respiratory infection (ARI), and to identify factors modifying this effect.
DesignWe conducted a systematic review and meta-analysis of data from randomised controlled trials (RCTs) of vitamin D for ARI prevention using a random effects model. Pre-specified sub-group analyses were done to determine whether effects of vitamin D on risk of ARI varied according to baseline 25-hydroxyvitamin D (25[OH]D) concentration or dosing regimen.
Data SourcesMEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, ClinicalTrials.gov and the International Standard RCT Number (ISRCTN) registry from inception to May 2020.
Eligibility Criteria for Selecting StudiesDouble-blind RCTs of supplementation with vitamin D or calcidiol, of any duration, were eligible if they were approved by a Research Ethics Committee and if ARI incidence was collected prospectively and pre-specified as an efficacy outcome.
ResultsWe identified 40 eligible RCTs (total 30,956 participants, aged 0 to 95 years). Data were obtained for 29,841 (96.5%) of 30,909 participants in 39 studies. For the primary comparison of vitamin D supplementation vs. placebo, the intervention reduced risk of ARI overall (Odds Ratio [OR] 0.89, 95% CI 0.81 to 0.98; P for heterogeneity 0.009). No statistically significant effect of vitamin D was seen for any of the sub-groups defined by baseline 25(OH)D concentration. However, protective effects were seen for trials in which vitamin D was given using a daily dosing regimen (OR 0.75, 95% CI 0.61 to 0.93); at daily dose equivalents of 400-1000 IU (OR 0.70, 95% CI 0.55 to 0.89); and for a duration of [≤]12 months (OR 0.82, 95% CI 0.72 to 0.94). Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (OR 0.94, 95% CI 0.81 to 1.08). Risk of bias within individual studies was assessed as being low for all but two trials. A funnel plot showed asymmetry, suggesting that small trials showing non-protective effects of vitamin D may have been omitted from the meta-analysis.
ConclusionsVitamin D supplementation was safe and reduced risk of ARI, despite evidence of significant heterogeneity across trials. The overall effect size may have been over-estimated due to publication bias. Protection was associated with administration of daily doses of 400-1000 IU vitamin D for up to 12 months. The relevance of these findings to COVID-19 is not known and requires investigation.
Systematic Review RegistrationCRD42020190633
O_TEXTBOXSummary Box
What is already known on this subject?O_LIA previous individual participant data meta-analysis from 10,933 participants in 25 randomised controlled trials (RCTs) of vitamin D supplementation for the prevention of acute respiratory infection (ARI) demonstrated an overall protective effect (number needed to treat to prevent one ARI [NNT]=33).Sub-group analysis revealed most benefit in those with the lowest vitamin D status at baseline and not receiving bolus doses.
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What this study addsO_LIWe updated this meta-analysis with trial-level data from an additional 14 placebo-controlled RCTs published since December 2015 (i.e. new total of 39 studies with 29,841 participants).
C_LIO_LIAn overall protective effect of vitamin D supplementation against ARI was seen (NNT=36).
C_LIO_LIA funnel plot revealed evidence of publication bias, which could have led to an over-estimate of the protective effect.
C_LIO_LINo statistically significant effect of vitamin D was seen for any of the sub-groups defined by baseline 25(OH)D concentration.
C_LIO_LIStrongest protective effects were associated with administration of daily doses of 400-1000 IU vitamin D for [≤]12 months (NNT=8).
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C_TEXTBOX
CONTEXTO: Otite média aguda (AOM) é a infecção bacteriana mais comum entre crianças pequenas nos Estados Unidos. Há limitações e preocupações com o tratamento com antibióticos e cirurgia e medidas preventivas tão eficazes são atraentes. Uma medida preventiva potencial é o xilitol, um substituto de açúcar natural que reduz o risco de decaimento dental. O xilitol pode reduzir a adesão de Streptococcus pneumoniae (S pneumoniae) e Haemophilus influenzae (H influenzae) às células nasofaríngeas in vitro. Esta é uma atualização de uma revisão publicada pela primeira vez em 2011. OBJETIVOS: Avaliar a eficácia e segurança do xilitol para prevenir AOM em crianças com idade até 12 anos. MÉTODOS DE PESQUISA: Pesquisamos CENTRAL (até o número 12, 2015), MEDLINE (1950 a janeiro de 2016), Embase (1974 a janeiro de 2016), CINAHL (1981 a janeiro de 2016), LILACS (1982 a janeiro de 2016), Web of Science ( 2011 a janeiro de 2016) e International Pharmaceutical Abstracts (2000 a janeiro de 2016). CRITÉRIOS DE SELECÇÃO: Ensaios controlados randomizados (RCTs) ou quasi-RCTs de crianças com idade igual ou menor de 12 anos, onde o suplemento de xilitol foi comparado com placebo ou nenhum tratamento para prevenir a OMA. COLETA E ANÁLISE DE DADOS: dois autores de revisão selecionaram, independentemente, os resultados dos resultados de pesquisa, avaliaram e classificaram a qualidade do estudo e extraíram os dados relevantes para serem incluídos na revisão. Nós nos contatamos com autores de teste para solicitar dados faltantes. Observamos dados sobre quaisquer eventos adversos de xilitol. Nós extraímos dados sobre resultados relevantes e estimamos o tamanho do efeito calculando a relação de risco (RR), diferença de risco (RD) e intervalos de confiança de 95% (IC) associados. PRINCIPAIS RESULTADOS: Identificamos cinco ensaios clínicos que envolveram 3405 crianças para inclusão. Para esta atualização de 2016, identificamos um novo teste para inclusão. Este teste foi sistematicamente revisado, mas devido a várias fontes de heterogeneidade, não foi incluído na meta-análise. Os quatro ensaios restantes foram de qualidade metodológica adequada. Em três ECRs que envolveram um total de 1826 crianças finlandesas saudáveis que freqüentavam creche, há evidências de qualidade moderada de que o xilitol (de qualquer forma) pode reduzir o risco de OMA de 30% para cerca de 22% em comparação com o grupo controle (RR 0,75, 95 % IC 0,65 a 0,88). Entre os motivos do abandono escolar, não houve diferenças significativas no desconforto abdominal e na erupção cutânea entre o xilitol e os grupos controle. O Xilitol não foi efetivo na redução de AOM entre crianças saudáveis durante uma infecção respiratória (RR 1,13, IC 95% 0,83 a 1,53, evidência de qualidade moderada) ou entre crianças saudáveis propensas a otite (RR 0,90, IC 95%: 0,67 a 1,21; baixa qualidade Evidência). CONCLUSÕES DOS AUTORES: Há evidências de qualidade moderada que demonstram que a administração profilática de xilitol entre crianças saudáveis que freqüentam creches pode reduzir a ocorrência de OMA. Não há evidências inconclusivas sobre a eficácia do xilitol na prevenção da OMA entre crianças com infecção respiratória ou entre crianças propensas a otite. A meta-análise foi limitada porque os dados vieram de um pequeno número de estudos, e a maioria era do mesmo grupo de pesquisa.
JUSTIFICATIVA E OBJETIVOS: A maioria dos osteopatas são treinados em cuidados pediátricos e tratamento manipulativo osteopático (OMT) está disponível para muitas doenças pediátricas. O objetivo desta revisão sistemática foi avaliar criticamente a eficácia da OMT para o tratamento de condições pediátricos.
MÉTODOS: Onze bancos de dados foram pesquisados em seus respectivos inícios de novembro 2012. Apenas ensaios clínicos randomizados (ECR) foram incluídas, se eles testaram OMT contra qualquer tipo de controle em pacientes pediátricos. Qualidade do estudo foi criticamente avaliado utilizando os critérios de Cochrane.
RESULTADOS: Dezessete estudos preencheram os critérios de inclusão. Cinco ensaios clínicos randomizados foram de alta qualidade metodológica. Destes, preferido um OMT, enquanto que 4 revelou nenhum efeito em comparação com diversas intervenções de controlo. Repetições por pesquisadores independentes estavam disponíveis para apenas duas condições, e ambos não conseguiram confirmar as conclusões dos estudos anteriores. Sete ensaios clínicos randomizados sugerem que OMT leva a uma redução significativamente maior nos sintomas de asma, obstrução nasolacrimal congênita (pós-tratamento), ganho de peso diário e tempo de permanência hospitalar, disfunções miccionais, cólica infantil, otite média, ou assimetria postural em comparação com várias controle intervenções. Sete ensaios clínicos randomizados indicaram que a OMT não teve efeito sobre os sintomas da asma, paralisia cerebral, escoliose idiopática, apnéia obstrutiva, otite média, ou desordens temporomandibulares em comparação com várias intervenções de controle. Três ensaios clínicos randomizados não realizar comparações entre os grupos. A maioria dos ensaios clínicos randomizados incluídos não informou as taxas de incidência de efeitos adversos.
CONCLUSÕES: A evidência da eficácia do OMT para as condições pediátricos ainda não foi provado devido à escassez e baixa qualidade metodológica dos estudos primários.
OBJETIVO: revisar sistematicamente a eficácia da administração de Lactobacillus rhamnosus GG (LGG) para a prevenção de infecções respiratórias em crianças.
PROJETO: Revisão Sistemática e Meta-análise.
FONTES DE DADOS: bases de dados eletrônicas e registros de prova.
RESULTADOS: Quatro ECRs envolvendo 1.805 participantes preencheram os critérios de inclusão. Comparado com placebo, a administração LGG foi associado com uma redução na incidência de otite média aguda (quatro ECR, n = 1,805, RR 0.76, 95% CI 0,64-0,91, o modelo de efeitos fixos, NNT 17, IC 95% 11-46), a redução do risco de infecções respiratórias superiores (um RCT, n = 281, RR 0,62, 95% CI 0,50-0,78, NNT 4, 3-8 CI 95%) e tratamentos com antibióticos (quatro ECR, n = 1,805, RR 0,80, 95% CI 0,71-0,91, modelo de efeitos fixos). Não houve diferença significativa entre a LGG e os grupos de controlo do risco de infecções respiratórias em geral e a incidência de infecções respiratórias inferiores. No entanto, a análise de subgrupo de dois estudos sobre crianças com mais de um ano apresentaram redução significativa do risco de infecções respiratórias em geral (dois ECRs, n 794, RR = 0,73, 95% CI 0,57-0,92, o modelo de efeitos aleatórios, o NNT 8, 95% Cl 5-14). Os efeitos adversos foram semelhantes nos dois grupos. Nenhum evento adverso sério foi relatado.
CONCLUSÃO: A administração de Lactobacillus rhamnosus GG em comparação com o placebo tem o potencial de reduzir a incidência da otite média aguda, as infecções respiratórias e uso de antibióticos em crianças.
OBJETIVO: Avaliar as evidências de qualquer tipo de homeopatia preventivo ou terapêutico para doenças intervenção testes da infância e adolescência.
MÉTODOS: pesquisas bibliográficas sistemáticas foram realizadas até janeiro de 2006 em MEDLINE, EMBASE, AMED, CINAHL, Central Cochrane, Biblioteca Homeopática britânico, ClinicalTrials.gov, e no Reino Unido National Research Register. Bibliografias foram verificados para outras publicações relevantes. Os estudos foram selecionados de acordo com inclusão pré-definidos e critérios de exclusão. Todos os duplo-cegos, controlados com placebo ensaios clínicos randomizados de qualquer intervenção homeopática para prevenir ou tratar doenças da infância e adolescência foram incluídos. Segundo a classificação da Organização Mundial de Saúde, a faixa etária definida para a inclusão foi 0 a 19 anos. Seleção do estudo, a extração de dados e avaliação da qualidade metodológica foram realizadas independentemente por 2 revisores.
RESULTADOS: Um total de 326 artigos foram identificados, 91 dos quais foram recuperados para avaliação detalhada. Dezasseis ensaios que avaliam 9 diferentes condições foram incluídos no estudo. Com a exceção de atenção e hiperatividade e diarréia aguda na infância (cada testada em 3 ensaios), nenhuma condição foi avaliada em mais de 2 duplo-cegos de ensaios clínicos randomizados. A prova de atenção e hiperatividade e diarréia infantil aguda é mista, apresentando resultados positivos e negativos para as respectivas medidas de resultados principais. Para vegetação adenóide, asma e infecções do trato respiratório superior cada uma, 2 ensaios estão disponíveis, que sugerem que não há diferença em comparação com placebo. Para 4 condições, apenas ensaios individuais estão disponíveis.
CONCLUSÃO: A evidência de rigorosos ensaios clínicos de qualquer tipo de homeopatia terapêutica ou preventiva intervenção testes para doenças da infância e adolescência não é convincente o suficiente para recomendações em qualquer condição.
JUSTIFICATIVA: A otite média aguda (OMA) é uma doença espontaneamente remissão de que a dor é o sintoma mais angustiante. Antibióticos são conhecidos por ter menos benefícios do que inicialmente se supunha. Alívio da dor tópica pode ser uma intervenção satisfatória para quem sofre de OMA e incentivar os médicos a prescrever antibióticos a menos.
OBJETIVOS: Avaliar a eficácia da analgesia tópica para OMA em adultos e crianças.
Métodos de pesquisa: Para essa atualização segundo buscamos o Cadastro Central Cochrane de Ensaios Controlados (CENTRAL) (The Cochrane Library 2011, edição 1), Ovídio MEDLINE (de 2008 a fevereiro Semana 1 2011), Ovídio MEDLINE (em processo & Outros Não indexados Citações 10 de fevereiro de 2011), Ovídio EMBASE (2008 a 2011 Semana 05), EBSCO CINAHL (2008 a 4 de Fevereiro de 2011) e Ovídio AMED (2008 a abril de 2011).
CRITÉRIOS DE SELEÇÃO: duplo-cego randomizado ensaios randomizados (ECR) ou quase-ECRs comparando uma preparação ótica com um efeito analgésico (excluindo antibióticos) versus placebo ou uma preparação de ótica com um efeito analgésico (excluindo antibióticos) versus qualquer outra preparação ótica com um analgésico efeito, em adultos ou crianças com menos de cuidados primários com OMA sem perfuração.
COLETA DE DADOS E ANÁLISE: Três autores da revisão independente de estudos selecionados, a qualidade dos estudos avaliados e dados extraídos. Tentativas de obter informação adicional dos autores dos estudos dos estudos incluídos foram infrutíferas.
PRINCIPAIS RESULTADOS: Cinco ensaios clínicos, incluindo 391 crianças com idades entre três e 18 anos corresponde aos nossos critérios. Dois estudos (117 crianças) em comparação orelha gotas anestésicas versus placebo imediatamente ao diagnóstico. Todas as crianças receberam alguma forma de alívio da dor oral. Em todos os cinco estudos, ficou claro que a dor de ouvido diminui rapidamente para a maioria dos doentes. No entanto, houve uma diferença estatisticamente significativa na proporção de crianças que atingiram uma redução de 50% na dor em favor de anestésico cai 10 minutos após a instilação (razão de risco (RR) 2,13, intervalo de confiança de 95% (IC) 1,19-3,80) e 30 minutos após instilação (RR de 1,43, IC de 95% 1,12-1,81) no AOM dia foi diagnosticado, mas não aos 20 minutos (RR 1,24, IC de 95% 0,88-1,74). Três ensaios (274 crianças) em comparação anestésico ouvido cai com naturopathic orelha gotas de ervas. Gotas Naturopathic foram favorecidos 15 e 30 minutos após a instilação, um a três dias após o diagnóstico, mas as diferenças não foram estatisticamente significativas. Apenas um ensaio olhou para reações adversas e não o acharam. No geral, os resultados desta análise são baseadas em evidências julgamento que é de baixo risco ou pouco clara de preconceito.
Conclusão dos autores: Evidências de cinco ECRs, apenas dois dos quais abordou a questão mais relevante de eficácia primário, fornece evidências limitadas de que gotas de ouvido são eficazes 30 minutos após a administração em crianças mais velhas com OMA. Subsiste a incerteza quanto à magnitude do efeito e mais alta qualidade são necessários estudos.
Probiotics are live micro-organisms that may give a beneficial physiological effect when administered in adequate amounts. Some trials show that probiotic strains can prevent respiratory infections. Even though our previously published review showed the benefits of probiotics for acute upper respiratory tract infections (URTIs), several new studies have been published. This is an update of a review first published in 2011 and updated in 2015.
OBJECTIVES:
To assess the effectiveness and safety of probiotics (any specified strain or dose), compared with placebo or no treatment, in the prevention of acute URTIs in people of all ages, at risk of acute URTIs.
SEARCH METHODS:
We searched CENTRAL (2022, Issue 6), MEDLINE (1950 to May week 2, 2022), Embase (1974 to 10 May 2022), Web of Science (1900 to 10 May 2022), the Chinese Biomedical Literature Database, which includes the China Biological Medicine Database (from 1978 to 10 May 2022), the Chinese Medicine Popular Science Literature Database (from 2000 to 10 May 2022), and the Master's Degree Dissertation of Beijing Union Medical College Database (from 1981 to 10 May 2022). We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov for completed and ongoing trials on 10 May 2022.
SELECTION CRITERIA:
We included individual randomised controlled trials (RCTs) and cluster-RCTs comparing probiotics with placebo or no treatment to prevent acute URTIs. The participants were children, adults, or the elderly in the community, care facilities, schools, or hospitals. Our main outcomes were the number of participants diagnosed with URTIs (at least one event and at least three events), the incidence rate (number of cases/person year) of acute URTIs, and the mean duration of an episode of URTIs. Our secondary outcomes were the number of participants who were absent from childcare centre, school, or work due to acute URTIs; the number of participants who used prescribed antibiotics for acute URTIs; and the number of participants who experienced at least one adverse event from probiotics. We excluded studies if they did not specify acute respiratory infections as 'upper'; studies with more than 50% of participants vaccinated against influenza or other acute URTIs within the last 12 months; and studies with significantly different proportions of vaccinated participants between the probiotics arm and the placebo or no treatment arm.
DATA COLLECTION AND ANALYSIS:
Two review authors independently assessed the eligibility of trials and extracted data using standard Cochrane methodological procedures. We analysed both intention-to-treat and per-protocol data and used a random-effects model. We expressed results as risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, both with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach.
MAIN RESULTS:
We included 23 individual RCTs and one cluster-RCT. As one of the individual RCTs did not report outcomes in a usable way, we could only meta-analyse data from 23 trials, involving a total of 6950 participants including children (aged from one month to 11 years old), adults (mean age 37.3), and older people (mean age 84.6 years). One trial reported 22.5% flu-vaccine participants within the last 12 months, and 25.4% flu-vaccine participants during the intervention. Probiotics were more likely to be given with milk-based food in children; administered in powder form in adults; and given with milk-based food or in capsules in the elderly. Most of the studies used one or two strains (e.g. Lactobacillus plantarum HEAL9, Lactobacillus paracasei (8700:2 or N1115)) and 109 or 1011 colony-forming units (CFU)/day of probiotics for more than three months. We found that probiotics may reduce the number of participants diagnosed with URTIs (at least one event) (RR 0.76, 95% CI 0.67 to 0.87; P < 0.001; 16 studies, 4798 participants; low-certainty evidence); likely reduce the number of participants diagnosed with URTIs (at least three events) (RR 0.59, 95% CI 0.38 to 0.91; P = 0.02; 4 studies, 763 participants; moderate-certainty evidence); may reduce the incidence rate (number of cases/person year) of URTIs (rate ratio 0.82, 95% CI 0.73 to 0.92, P = 0.001; 12 studies, 4364 participants; low-certainty evidence); may reduce the mean duration of an episode of acute URTIs (MD -1.22 days, 95% CI -2.12 to -0.33; P = 0.007; 6 studies, 2406 participants; low-certainty evidence); likely reduce the number of participants who used prescribed antibiotics for acute URTIs (RR 0.58, 95% CI 0.42 to 0.81; P = 0.001; 6 studies, 1548 participants; moderate-certainty evidence); and may not increase the number of participants who experienced at least one adverse event (RR 1.02, 95% CI 0.90 to 1.15; P = 0.79; 8 studies, 2456 participants; low-certainty evidence). Evidence showing a decrease in the number of people absent from childcare centre, school, or work due to acute URTIs with probiotics is very uncertain (RR 0.14, 95% CI 0.03 to 0.59; 1 study, 80 participants; very low-certainty evidence). Adverse events from probiotics were minor, and most commonly gastrointestinal symptoms, such as vomiting, flatulence, diarrhoea, and bowel pain.
AUTHORS' CONCLUSIONS:
Overall, we found that probiotics were better than placebo or no treatment in preventing acute URTIs.
