Probiotic capsules and xylitol chewing gum to manage symptoms of pharyngitis: a randomized controlled factorial trial

Little, Paul; Stuart, Beth; Wingrove, Zoe; Mullee, Mark; Thomas, Tammy; Johnson, Sophie; Leydon, Geraldine; Richards-Hall, Samantha; Williamson, Ian; Yao, Lily; Zhu, Shihua; Moore, Michael

doi:10.1503/cmaj.170599

Cited by 9 publications

(4 citation statements)

References 35 publications

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“…Examples in addition to our trial include large trials that failed to show any benefit of probiotics to prevent antibiotic-associated diarrhea and Clostridium difficile infection in adults 40 and necrotizing enterocolitis in preterm infants 41 or to reduce pharyngitis symptoms in children and adults. 42 Furthermore, recent studies show that responsiveness to probiotics may follow highly individualized patterns and that their effect, including negative outcomes, may vary according to indigenous microbiota and gene-expression profiles. 43,44 These examples highlight the importance of conducting high-quality studies to systematically assess the efficacy and safety of probiotics.…”

Section: Discussionmentioning

confidence: 99%

Lactobacillus rhamnosus GG versus Placebo for Acute Gastroenteritis in Children

et al. 2018

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BACKGROUND Acute gastroenteritis develops in millions of children in the United States every year, and treatment with probiotics is common. However, data to support the use of probiotics in this population are limited. METHODS We conducted a prospective, randomized, double-blind trial involving children 3 months to 4 years of age with acute gastroenteritis who presented to one of 10 U.S. pediatric emergency departments. Participants received a 5-day course of Lactobacillus rhamnosus GG at a dose of 1×1010 colony-forming units twice daily or matching placebo. Follow-up surveys were conducted daily for 5 days and again 14 days after enrollment and 1 month after enrollment. The primary outcome was moderate-to-severe gastroenteritis, which was defined as an illness episode with a total score on the modified Vesikari scale of 9 or higher (scores range from 0 to 20, with higher scores indicating more severe disease), within 14 days after enrollment. Secondary outcomes included the duration and frequency of diarrhea and vomiting, the duration of day-care absenteeism, and the rate of household transmission (defined as the development of symptoms of gastroenteritis in previously asymptomatic household contacts). RESULTS Among the 971 participants, 943 (97.1%) completed the trial. The median age was 1.4 years (interquartile range, 0.9 to 2.3), and 513 participants (52.9%) were male. The modified Vesikari scale score for the 14-day period after enrollment was 9 or higher in 55 of 468 participants (11.8%) in the L. rhamnosus GG group and in 60 of 475 participants (12.6%) in the placebo group (relative risk, 0.96; 95% confidence interval, 0.68 to 1.35; P = 0.83). There were no significant differences between the L. rhamnosus GG group and the placebo group in the duration of diarrhea (median, 49.7 hours in the L. rhamnosus GG group and 50.9 hours in the placebo group; P = 0.26), duration of vomiting (median, 0 hours in both groups; P = 0.17), or day-care absenteeism (median, 2 days in both groups; P = 0.67) or in the rate of household transmission (10.6% and 14.1% in the two groups, respectively; P = 0.16). CONCLUSIONS Among preschool children with acute gastroenteritis, those who received a 5-day course of L. rhamnosus GG did not have better outcomes than those who received placebo. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others; ClinicalTrials.gov number, NCT01773967.)

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Section: Discussionmentioning

confidence: 99%

Lactobacillus rhamnosus GG versus Placebo for Acute Gastroenteritis in Children

et al. 2018

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“…Despite some anti-pathogenic effects by xylitol on some potential pathogens of the upper respiratory tract, the consumption of 5 pieces of 15% xylitol-containing chewing gum by 106 pharyngitis patients for three months was not found to be associated with a reduction in pharyngitis and did not perform better in reducing symptoms; difficulty in swallowing and sore throat as compared to no chewing gum control subjects ( n = 110). Data were collected by questionnaire [53]. Inhalation of xylitol aerosol has been suggested to reduce salt concentration in airway surface liquid (ASL); increased salt concentrations are associated with reduced antimicrobial activity of ASL and may partially explain the pathogenesis of cystic fibrosis [51].…”

Section: Nose Throat and Earmentioning

confidence: 99%

Xylitol’s Health Benefits beyond Dental Health: A Comprehensive Review

et al. 2019

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Xylitol has been widely documented to have dental health benefits, such as reducing the risk for dental caries. Here we report on other health benefits that have been investigated for xylitol. In skin, xylitol has been reported to improve barrier function and suppress the growth of potential skin pathogens. As a non-digestible carbohydrate, xylitol enters the colon where it is fermented by members of the colonic microbiota; species of the genus Anaerostipes have been reported to ferment xylitol and produce butyrate. The most common Lactobacillus and Bifidobacterium species do not appear to be able to grow on xylitol. The non-digestible but fermentable nature of xylitol also contributes to a constipation relieving effect and improved bone mineral density. Xylitol also modulates the immune system, which, together with its antimicrobial activity contribute to a reduced respiratory tract infection, sinusitis, and otitis media risk. As a low caloric sweetener, xylitol may contribute to weight management. It has been suggested that xylitol also increases satiety, but these results are not convincing yet. The benefit of xylitol on metabolic health, in addition to the benefit of the mere replacement of sucrose, remains to be determined in humans. Additional health benefits of xylitol have thus been reported and indicate further opportunities but need to be confirmed in human studies.

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“…Most medicines used in clinic to treat pharyngitis are antibiotics or a single component drug with limited targets, and the therapeutic effect is often unsatisfactory [10]. After a long period of treatment, the patient will become resistant to the drug, which will even cause severe toxic and side effects [11][12][13]. Thus, investigators in China and other Asian countries have endeavoured to seek alternative treatments for pharyngitis from TCM or natural herbs, some of which have shown promising effects in clinical studies.…”

Section: Introductionmentioning

confidence: 99%

Relieving Sore Throat Formula Exerts a Therapeutic Effect on Pharyngitis through Immunoregulation and NF-κB Pathway

Ding

Wei

et al. 2020

Mediators of Inflammation

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Relieving Sore Throat Formula (RSTF) is a formula approved by the China Food and Drug Administration and has been used for the treatment of pharyngitis in clinic for many years. However, the potential pharmacological mechanism still remains unknown. We combined multiple methods including bioinformatics data digging, network pharmacology analysis, and pathway analysis to predict the potential target of RSTF. We verified our in silico prediction results with an in vivo/vitro antibacterial effect test, mouse phagocytic index test, proliferation, transformation, and migration of mouse spleen lymphocytes. Alteration of NF-κB pathway was determined by Western blotting, immunofluorescence, and PCR. The in vivo experiments demonstrated that the RSTF could significantly relieve the symptoms of pharyngitis. A rat saliva secretion test showed that RSTF can effectively relieve the xerostomia symptom. A phenol red excretion test showed that RSTF has an eliminating phlegm effect. A hot plate method and granuloma experiment proved that RSTF also have analgesic and anti-inflammatory effects. In silico prediction demonstrates that 70 active compounds of RSTF were filtered out through ADME screening and 84 putative targets correlated with different diseases. Pathway enrichment analysis showed that the candidate targets were mostly related to the response to bacteria and immunity signalling pathways, which are known contributors to pharyngitis. Experimental results confirmed that RSTF exerted therapeutic effects on pharyngitis mainly by antibacterial effect and downregulation of NF-κB activities. It is demonstrated both in silico and in vivo/vitro that RSTF exerted therapeutic effects on pharyngitis mainly through an antibiotic effect and downregulation of NF-κB signalling pathway.

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Probiotic capsules and xylitol chewing gum to manage symptoms of pharyngitis: a randomized controlled factorial trial

Cited by 9 publications

References 35 publications

Lactobacillus rhamnosus GG versus Placebo for Acute Gastroenteritis in Children

Lactobacillus rhamnosus GG versus Placebo for Acute Gastroenteritis in Children

Xylitol’s Health Benefits beyond Dental Health: A Comprehensive Review

Relieving Sore Throat Formula Exerts a Therapeutic Effect on Pharyngitis through Immunoregulation and NF-κB Pathway

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