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Probiotics and Fever Duration in Children With Upper Respiratory Tract Infections: A Randomized Clinical Trial
Silvia Bettocchi1, Anna Comotti2, Marina Elli3
1Pediatric Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Insights
This study found that a probiotic mixture significantly reduced fever duration in children with upper respiratory tract infections (URTIs). The probiotic adjuvant therapy offers a safe and effective option for managing pediatric URTI symptoms.
Area of Science:
- Pediatric Medicine
- Microbiology
- Immunology
Background:
- Upper respiratory tract infections (URTIs) are common in children, leading to frequent healthcare visits, particularly when accompanied by fever.
- Probiotics are being explored as complementary treatments for URTIs, but robust evidence in pediatric populations is limited.
Purpose of the Study:
- To assess the effectiveness of a specific probiotic mixture (Bifidobacterium breve M-16V, Bifidobacterium lactis HN019, Lactobacillus rhamnosus HN001) in reducing fever duration in children diagnosed with URTIs.
Main Methods:
- A randomized, double-blind, placebo-controlled clinical trial was conducted with children aged 28 days to 4 years presenting with fever (≥38.5 °C) and URTI.
- Participants received either the probiotic mixture or a placebo daily for 14 days, with fever duration as the primary outcome measure.
- Intention-to-treat analysis was employed, and participants, caregivers, and investigators were blinded to treatment allocation.
Main Results:
- The study enrolled 128 children, with 63 receiving probiotics and 65 receiving placebo.
- Children in the probiotic group experienced a shorter median fever duration (3 days) compared to the placebo group (5 days), representing a reduction of approximately 2 days.
- No significant differences in mild adverse events, such as constipation or abdominal pain, were observed between the groups.
Conclusions:
- The administration of this probiotic mixture effectively shortened fever duration in children with URTIs compared to placebo.
- The probiotic intervention demonstrated a favorable safety profile, suggesting its potential as an adjuvant therapy for pediatric URTIs.
Importance:
Upper respiratory tract infections (URTIs) are prevalent in children, prompting frequent health care consultations, especially among those with fever. Probiotics show potential as an adjuvant treatment for URTIs, but evidence in children is limited.
Objective:
To evaluate the efficacy of a probiotic mixture containing Bifidobacterium breve M-16V, Bifidobacterium lactis HN019, and Lactobacillus rhamnosus HN001 in shortening fever duration among children with URTIs.
Design, Setting, And Participants:
This randomized clinical trial was conducted between November 19, 2021, and June 20, 2023, at the pediatric emergency department of the Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy. Patients between 28 days and 4 years of age with a fever (≥38.5 °C) and URTI were eligible. Exclusion criteria included recent probiotic use, chronic autoimmune diseases, immunosuppressive treatment, and requirement for hospitalization. Randomization was computer generated and assigned participants to either the intervention (probiotics) or control (placebo) group. Participants, parents or caregivers, and investigators were masked to the group assignments. The primary analysis followed the intention-to-treat approach.
Interventions:
The probiotic group received daily single dose of 0.5 mL probiotic mixture containing Bifidobacterium breve M-16V, Bifidobacterium lactis HN019, and Lactobacillus rhamnosus HN001 for 14 days. The placebo group received daily single dose of 0.5 mL placebo for 14 days.
Main Outcomes And Measures:
The primary outcome was fever duration, defined as the number of days between the first and the last days with fever.
Results:
Of the 128 patients enrolled (69 males [54%]; mean [SD] age 2.5 [1.3] years), 65 (51%) were randomly assigned to receive placebo and 63 (49%) to receive probiotics. The median (IQR) fever duration was shorter in the probiotic group than the placebo group (median [IQR], 3 [2-4] days vs 5 [4-6] days; adjusted risk ratio, 0.64; 95% CI, 0.51-0.80). Few mild adverse events were reported and did not significantly differ between the probiotic and placebo groups, including constipation (6 [16%] and 6 [12%]; P = .80) and abdominal pain (3 [8%] and 2 [4%]; P = .65).
Conclusions And Relevance:
In this randomized clinical trial, administering a probiotic mixture reduced fever duration by 2 days compared with placebo, with no meaningful safety concerns. The probiotic mixture under investigation could be an effective adjuvant for shortening fever duration in children with URTIs.
Trial Registration:
ClinicalTrials.gov Identifier: NCT06052540.
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