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

Abstract Reducing the use of antibiotics for upper respiratory tract infections is needed to limit the global threat of antibiotic resistance. We estimated the effectiveness of probiotics and xylitol for the management of pharyngitis.
PMID
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Authors

Mayor MeshTerms

Chewing Gum

Keywords
Journal Title cmaj : canadian medical association journal = journal de l'association medicale canadienne
Publication Year Start




 
PMID- 29255098
OWN - NLM
STAT- MEDLINE
DCOM- 20171227
LR  - 20171227
IS  - 1488-2329 (Electronic)
IS  - 0820-3946 (Linking)
VI  - 189
IP  - 50
DP  - 2017 Dec 18
TI  - Probiotic capsules and xylitol chewing gum to manage symptoms of pharyngitis: a
      randomized controlled factorial trial.
PG  - E1543-E1550
LID - 10.1503/cmaj.170599 [doi]
AB  - BACKGROUND: Reducing the use of antibiotics for upper respiratory tract
      infections is needed to limit the global threat of antibiotic resistance. We
      estimated the effectiveness of probiotics and xylitol for the management of
      pharyngitis. METHODS: In this parallel-group factorial randomized controlled
      trial, participants in primary care (aged 3 years or older) with pharyngitis
      underwent randomization by nurses who provided sequential intervention packs.
      Pack contents for 3 kinds of material and advice were previously determined by
      computer-generated random numbers: no chewing gum, xylitol-based chewing gum (15%
      xylitol; 5 pieces daily) and sorbitol gum (5 pieces daily). Half of each group
      were also randomly assigned to receive either probiotic capsules (containing 24 x
      10(9) colony-forming units of lactobacilli and bifidobacteria) or placebo. The
      primary outcome was mean self-reported severity of sore throat and difficulty
      swallowing (scale 0-6) in the first 3 days. We used multiple imputation to avoid 
      the assumption that data were missing completely at random. RESULTS: A total of
      1009 individuals consented, 934 completed the baseline assessment, and 689
      provided complete data for the primary outcome. Probiotics were not effective in 
      reducing the severity of symptoms: mean severity scores 2.75 with no probiotic
      and 2.78 with probiotic (adjusted difference -0.001, 95% confidence interval [CI]
      -0.24 to 0.24). Chewing gum was also ineffective: mean severity scores 2.73
      without gum, 2.72 with sorbitol gum (adjusted difference 0.07, 95% CI -0.23 to
      0.37) and 2.73 with xylitol gum (adjusted difference 0.01, 95% CI -0.29 to 0.30).
      None of the secondary outcomes differed significantly between groups, and no
      harms were reported. INTERPRETATION: Neither probiotics nor advice to chew
      xylitol-based chewing gum was effective for managing pharyngitis. Trial
      registration: ISRCTN, no. ISRCTN51472596.
CI  - (c) 2017 Joule Inc. or its licensors.
FAU - Little, Paul
AU  - Little P
AD  - Primary Care Group (Little, Stuart, Wingrove, Mullee, Thomas, Johnson, Leydon,
      Williamson, Moore); Health Economic Analyses Team (Yao, Zhu), Primary Care and
      Population Sciences Unit, University of Southampton; Patient and Public
      Involvement Collaborator (Richards-Hall), Southampton, UK [email protected]
FAU - Stuart, Beth
AU  - Stuart B
AD  - Primary Care Group (Little, Stuart, Wingrove, Mullee, Thomas, Johnson, Leydon,
      Williamson, Moore); Health Economic Analyses Team (Yao, Zhu), Primary Care and
      Population Sciences Unit, University of Southampton; Patient and Public
      Involvement Collaborator (Richards-Hall), Southampton, UK.
FAU - Wingrove, Zoe
AU  - Wingrove Z
AD  - Primary Care Group (Little, Stuart, Wingrove, Mullee, Thomas, Johnson, Leydon,
      Williamson, Moore); Health Economic Analyses Team (Yao, Zhu), Primary Care and
      Population Sciences Unit, University of Southampton; Patient and Public
      Involvement Collaborator (Richards-Hall), Southampton, UK.
FAU - Mullee, Mark
AU  - Mullee M
AD  - Primary Care Group (Little, Stuart, Wingrove, Mullee, Thomas, Johnson, Leydon,
      Williamson, Moore); Health Economic Analyses Team (Yao, Zhu), Primary Care and
      Population Sciences Unit, University of Southampton; Patient and Public
      Involvement Collaborator (Richards-Hall), Southampton, UK.
FAU - Thomas, Tammy
AU  - Thomas T
AD  - Primary Care Group (Little, Stuart, Wingrove, Mullee, Thomas, Johnson, Leydon,
      Williamson, Moore); Health Economic Analyses Team (Yao, Zhu), Primary Care and
      Population Sciences Unit, University of Southampton; Patient and Public
      Involvement Collaborator (Richards-Hall), Southampton, UK.
FAU - Johnson, Sophie
AU  - Johnson S
AD  - Primary Care Group (Little, Stuart, Wingrove, Mullee, Thomas, Johnson, Leydon,
      Williamson, Moore); Health Economic Analyses Team (Yao, Zhu), Primary Care and
      Population Sciences Unit, University of Southampton; Patient and Public
      Involvement Collaborator (Richards-Hall), Southampton, UK.
FAU - Leydon, Gerry
AU  - Leydon G
AD  - Primary Care Group (Little, Stuart, Wingrove, Mullee, Thomas, Johnson, Leydon,
      Williamson, Moore); Health Economic Analyses Team (Yao, Zhu), Primary Care and
      Population Sciences Unit, University of Southampton; Patient and Public
      Involvement Collaborator (Richards-Hall), Southampton, UK.
FAU - Richards-Hall, Samantha
AU  - Richards-Hall S
AD  - Primary Care Group (Little, Stuart, Wingrove, Mullee, Thomas, Johnson, Leydon,
      Williamson, Moore); Health Economic Analyses Team (Yao, Zhu), Primary Care and
      Population Sciences Unit, University of Southampton; Patient and Public
      Involvement Collaborator (Richards-Hall), Southampton, UK.
FAU - Williamson, Ian
AU  - Williamson I
AD  - Primary Care Group (Little, Stuart, Wingrove, Mullee, Thomas, Johnson, Leydon,
      Williamson, Moore); Health Economic Analyses Team (Yao, Zhu), Primary Care and
      Population Sciences Unit, University of Southampton; Patient and Public
      Involvement Collaborator (Richards-Hall), Southampton, UK.
FAU - Yao, Lily
AU  - Yao L
AD  - Primary Care Group (Little, Stuart, Wingrove, Mullee, Thomas, Johnson, Leydon,
      Williamson, Moore); Health Economic Analyses Team (Yao, Zhu), Primary Care and
      Population Sciences Unit, University of Southampton; Patient and Public
      Involvement Collaborator (Richards-Hall), Southampton, UK.
FAU - Zhu, Shihua
AU  - Zhu S
AD  - Primary Care Group (Little, Stuart, Wingrove, Mullee, Thomas, Johnson, Leydon,
      Williamson, Moore); Health Economic Analyses Team (Yao, Zhu), Primary Care and
      Population Sciences Unit, University of Southampton; Patient and Public
      Involvement Collaborator (Richards-Hall), Southampton, UK.
FAU - Moore, Michael
AU  - Moore M
AD  - Primary Care Group (Little, Stuart, Wingrove, Mullee, Thomas, Johnson, Leydon,
      Williamson, Moore); Health Economic Analyses Team (Yao, Zhu), Primary Care and
      Population Sciences Unit, University of Southampton; Patient and Public
      Involvement Collaborator (Richards-Hall), Southampton, UK.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - Canada
TA  - CMAJ
JT  - CMAJ : Canadian Medical Association journal = journal de l'Association medicale
      canadienne
JID - 9711805
RN  - 0 (Anti-Infective Agents, Local)
RN  - 0 (Chewing Gum)
RN  - VCQ006KQ1E (Xylitol)
SB  - AIM
SB  - IM
MH  - Anti-Infective Agents, Local/*therapeutic use
MH  - Bifidobacterium bifidum
MH  - *Chewing Gum
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - Lactobacillus acidophilus
MH  - Male
MH  - Pharyngitis/*drug therapy/prevention & control
MH  - Probiotics/*therapeutic use
MH  - Treatment Outcome
MH  - Xylitol/*therapeutic use
COIS- Competing interests: None declared.
EDAT- 2017/12/20 06:00
MHDA- 2017/12/20 06:00
CRDT- 2017/12/20 06:00
PHST- 2017/08/22 00:00 [accepted]
PHST- 2017/12/20 06:00 [entrez]
PHST- 2017/12/20 06:00 [pubmed]
PHST- 2017/12/20 06:00 [medline]
AID - 189/50/E1543 [pii]
AID - 10.1503/cmaj.170599 [doi]
PST - ppublish
SO  - CMAJ. 2017 Dec 18;189(50):E1543-E1550. doi: 10.1503/cmaj.170599.