Prebiotic and probiotic supplementation prevents rhinovirus infections in preterm infants: A randomized, placebo-controlled trial Oral probiotics influence oral and respiratory tract infections in pediatric population: a randomized double-blinded placebo-controlled pilot study. Probiotics and Child Care Absence Due to Infections: A Randomized Controlled Trial Efficacy of a polyvalent bacterial lysate in children with recurrent respiratory tract infections Disrupted Intestinal Microbiota and Intestinal Inflammation in Children with Cystic Fibrosis and Its Restoration with Lactobacillus GG: A Randomised Clinical Trial The effect of using an interactive booklet on childhood respiratory tract infections in consultations: Study protocol for a cluster randomised controlled trial in primary care Use of a polyvalent bacterial lysate in patients with recurrent respiratory tract infections: results of a prospective, placebo-controlled, randomized, double-blind study. More physician consultations and antibiotic prescriptions in families with high concern about infectious illness--adequate response to infection-prone child or self-fulfilling prophecy? Bifidobacterium animalis subsp. lactis BB-12 in reducing the risk of infections in early childhood Effectiveness of thymostimulin and study of lymphocyte-dependent antibacterial activity in children with recurrent respiratory infections. The prophylactic use of probiotics in the prevention of radiation therapy-induced diarrhea. Effects of probiotics on serum levels of Th1/Th2 cytokine and clinical outcomes in severe traumatic brain-injured patients: a prospective randomized pilot study Three-Year Study of Viral Etiology and Features of Febrile Respiratory Tract Infections in Japanese Pediatric Outpatients The use of the probiotic Lactobacillus rhamnosus GG and viral findings in the nasopharynx of children attending day care. Specific probiotics in reducing the risk of acute infections in infancy--a randomised, double-blind, placebo-controlled study. Feasibility cluster randomised controlled trial of a within-consultation intervention to reduce antibiotic prescribing for children presenting to primary care with acute respiratory tract infection and cough Effect of Probiotic Bacteria on Microbial Host Defense, Growth, and Immune Function in Human Immunodeficiency Virus Type-1 Infection
Background Simple and safe strategies for the prevention of viral respiratory tract infections ( RTIs )  are needed . Objective We hypothesized that early prebiotic or probiotic supplementation would reduce the risk of virus-associated RTIs during the first year of life in a cohort of preterm infants . Methods In this r and omized , double-blind , placebo-controlled trial ( Clinical Trials.gov no. NCT00167700 ) , 94 preterm infants ( gestational age , ≥32 + 0 and ≤36 + 6 weeks ; birth weight , > 1500 g ) treated at Turku University Hospital , Turku , Finl and , were allocated to receive oral prebiotics ( galacto-oligosaccharide and polydextrose mixture , 1:1 ) , a probiotic ( Lactobacillus rhamnosus GG , ATCC 53103 ) , or placebo ( microcrystalline cellulose ) between days 3 and 60 of life . The primary outcome was the incidence of clinical ly defined virus-associated RTI episodes confirmed from nasal swabs by using nucleic acid testing . Secondary outcomes were the severity and duration of RTIs . Results A significantly lower incidence of RTIs was detected in infants receiving prebiotics  ( rate ratio [ RR ] , 0.24 ; 95 % CI , 0.12 - 0.49 ; P < .001 ) or probiotics ( RR , 0.50 ; 95 % CI , 0.28 - 0.90 ; P = .022 ) compared with those receiving placebo . Also , the incidence of rhinovirus-induced episodes , which comprised 80 % of all RTI episodes , was found to be significantly lower in the prebiotic ( RR , 0.31 ; 95 % CI , 0.14 - 0.66 ; P = .003 ) and probiotic ( RR , 0.49 ; 95 % CI , 0.24 - 1.00 ; P = .051 ) groups compared with the placebo group . No differences emerged among the study groups in rhinovirus RNA load during infections , duration of rhinovirus RNA shedding , duration or severity of rhinovirus infections , or occurrence of rhinovirus RNA in asymptomatic infants . Conclusions Gut microbiota modification with specific prebiotics and probiotics might offer a novel and cost-effective means to reduce the risk of rhinovirus infections OBJECTIVE Acute oral and respiratory tract infections ( RTIs ) are highly present in the general population , and they represent one of the most impacting causes of morbidity and mortality every year . The aim of our study was to assess the clinical impact of oral probiotics on acute oral and respiratory tract infections affecting paediatric patients . PATIENTS AND METHODS This is a r and omized , double-blinded placebo-controlled clinical study , where probiotics have been compared with placebo in a double-blinded investigation . 40 subjects with a recent clinical history reporting oral and respiratory tract infections were r and omly selected and assigned to control ( n=20 ) or the probiotics ( n=20 ) group . During the 3 months before the starting , all subjects were assessed with several salivary examinations . RESULTS We found significant differences in the incidence of oral and respiratory tract infections between control and probiotic group , with a marked reduction of oral and respiratory tract infections episodes in the probiotic group . Salivary examinations gave similar results in both the groups , however , despite the salivary flow , viscosity and buffering were similar , on the contrary , pH values were found to be more alkaline in patients of probiotic group . CONCLUSIONS This study showed the main positive effects related to a supplementation with probiotics in order to prevent or reduce the incidence of infections onset in oral and respiratory tracts without any drugs-related adverse effects This is a r and omized , placebo-controlled study in which we examine the effect of probiotics ( BB-12 and LGG ) on child care absenteeism and infections in infants . OBJECTIVES : The risk of infections is higher in children attending child care compared with children cared for at home . This study examined the effect of a combination of probiotics on absence from child care because of respiratory and gastrointestinal infections in healthy infants aged 8 to 14 months at the time of enrollment in child care . METHODS : The ProbiComp study was a r and omized , double-blind , placebo-controlled study . A total of 290 infants were r and omly allocated to receive a placebo or a combination of Bifidobacterium animalis subsp lactis and Lactobacillus rhamnosus in a dose of 109 colony-forming units of each daily for a 6-month intervention period . Absence from child care , occurrence of infant symptoms of illness , and doctor visits were registered by the parents using daily and weekly Web-based question naires . RESULTS : Median absence from child care was 11 days ( interquartile range : 6–16 ) . Intention-to-treat analysis showed no difference between the probiotics and placebo groups ( P = .19 ) . Additionally , there was no difference in any of the secondary outcomes between groups ; the number of children with doctor-diagnosed upper or lower respiratory tract infections , the number of doctor visits , antibiotic treatments , occurrence and duration of diarrhea , and days with common cold symptoms , fever , vomiting , or caregivers ’ absence from work . CONCLUSIONS : A daily administration of a combination of B animalis subsp lactis and L rhamnosus for 6 months did not reduce the number of days absent from child care in healthy infants at the time of enrollment in child care Respiratory tract infections ( RTIs ) are the most frequent infections in humans , particularly in children . In addition to intervention , increasing interest is focusing on immunomodulatory therapy for recurrent RTIs , which indicate a reduced defense capacity of the respiratory mucosa . LW 50020 , an oral immunomodulator that contains the antigens of seven bacteria common in RTIs , has reduced the number , duration , and severity of RTIs in children and adults . This 56-week placebocontrolled , double-blind study in 188 children investigated whether the efficacy of the st and ard schedule ( immunization cycle + one booster cycle ) would be enhanced by additional booster cycles . Efficacy and safety over the long term were also assessed . The rate of infection was reduced by 50 % with the st and ard schedule and could not be further decreased by two consecutive booster cycles . With both schedules , this reduction was sustained during a 28-week treatmentfree observation period that followed the 28-week treatment period . The number of adverse drug reactions was low , and all were transient , expected , and nonserious . These results confirm that LW 50020 is an effective and safe strategy for RTIs Background & Aims Intestinal inflammation is a hallmark of cystic fibrosis ( CF ) . Administration of probiotics can reduce intestinal inflammation and the incidence of pulmonary exacerbations . We investigated the composition of intestinal microbiota in children with CF and analyzed its relationship with intestinal inflammation . We also investigated the microflora structure before and after Lactobacillus GG ( LGG ) administration in children with CF with and without antibiotic treatment .  Methods The intestinal microbiota were analyzed by denaturing gradient gel electrophoresis ( DGGE ) , real-time polymerase chain reaction ( RT-PCR ) , and fluorescence in situ hybridization ( FISH ) . Intestinal inflammation was assessed by measuring fecal calprotectin ( CLP ) and rectal nitric oxide ( rNO ) production in children with CF as compared with healthy controls . We then carried out a small double-blind r and omized clinical trial with LGG . Results Twenty-two children with CF children were enrolled in the study ( median age , 7 years ; range , 2–9 years ) . Fecal CLP and rNO levels were higher in children with CF than in healthy controls ( 184±146 µg/g vs. 52±46 µg/g ; 18±15 vs. 2.6±1.2 µmol/L NO2 − , respectively ; P<0.01 ) . Compared with healthy controls , children with CF had significantly different intestinal microbial core structures . The levels of Eubacterium rectale , Bacteroides uniformis , Bacteroides vulgatus , Bifidobacterium adolescentis , Bifidobacterium catenulatum , and Faecalibacterium prausnitzii were reduced in children with CF . A similar but more extreme pattern was observed in children with CF who were  taking antibiotics . LGG administration reduced fecal CLP and partially restored intestinal microbiota . There was a significant correlation between reduced microbial richness and intestinal inflammation . Conclusions CF causes qualitative and quantitative changes in intestinal microbiota , which may represent a novel therapeutic target in the treatment of CF . Administration of probiotics restored gut microbiota , supporting the efficacy of probiotics in reducing intestinal inflammation and pulmonary exacerbations . Trial Registration Clinical Trials.gov NCT Background Respiratory tract infections in children result in more primary care consultations than any other acute condition , and are the most common reason for prescribing antibiotics ( which are largely unnecessary ) . About a fifth of children consult again for the same illness episode . Providing parents with written information on respiratory tract infections may result in a reduction in re-consultation rates and antibiotic prescribing for these illnesses . Asking clinicians to provide and discuss the information during the consultation may enhance effectiveness . This paper outlines the protocol for a study design ed to evaluate the use of a booklet on respiratory tract infections in children within primary care consultations . Methods / Design This will be a cluster r and omised controlled trial . General practice s will be r and omised to provide parents consulting because their child has an acute respiratory tract infection with either an interactive booklet , or usual care . The booklet provides information on the expected duration of their child 's illness , the likely benefits of various treatment options , signs and symptoms that should prompt re-consultation , and symptomatic treatment advice . It has been design ed for use within the consultation and aims to enhance communication through the use of specific prompts . Clinicians r and omised to using the interactive booklet will receive online training in its use . Outcomes will be assessed via a telephone interview with the parent two weeks after first consulting . The primary outcome will be the proportion of children who re-consult for the same illness episode . Secondary outcomes include : antibiotic use , parental satisfaction and enablement , and illness costs . Consultation rates for respiratory tract infections for the subsequent year will be assessed by a review of practice notes . Discussion Previous studies in adults and children have shown that educational interventions can result in reductions in re-consultation rates and use of antibiotics for respiratory tract infections . This will be the first study to determine whether providing parents with a booklet on respiratory tract infections in children , and discussing it with them during the consultation , reduces re-consultations and antibiotic use for the same illness without reducing satisfaction with care . Trial registration Current Controlled Trials IS RCT Respiratory tract infections ( RTIs ) are the most common infections in humans , and it is difficult to effectively treat patients with increased susceptibility to these ailments . LW 50020 ( Luivac ; Paspat oral ) , an oral immunomodulator consisting of the antigens of seven bacteria commonly involved in RTIs , has been developed for the induction of specific and nonspecific immune responses of the mucosa-associated lymphoid tissue . In this placebo-controlled study , the efficacy and safety of the tablet formulation of LW 50020 were evaluated in children and adults with recurrent RTIs . Tablets were taken once daily during two periods of 4 weeks each , interrupted by a treatment-free interval of 4 weeks . The main endpoint of the study , a clinical severity score that evaluated treatment benefits , was significantly lower in the second study period in patients treated with the bacterial lysate compared to patients given placebo . A comparison of the infection rates in the first and second study periods of patients treated with LW 50020 revealed a placebo-corrected reduction of 39 % in children and a placebo-corrected reduction of 44 % in adolescents and adults . The placebo-corrected duration of infections was shortened by 47 % in children and by 55 % in older patients . No serious drug-related side effects occurred . This study demonstrated that the oral bacterial immunomodulator LW 50020 is efficacious in treating patients with recurrent RTIs BACKGROUND Respiratory tract infections ( RTI ) in children is the most common cause of prescription of antibiotics . It is important to describe and analyse non-medical factors in order to develop more rational use of antibiotics . OBJECTIVES To compare families with high and low concern about infectious illness with regard to social variables , perception of infection proneness and beliefs in antibiotics  and to relate the concern for infectious illness to reported morbidity , physician consultations and antibiotic prescriptions for the 18-month-old child in the family . METHODS A prospect i ve , population -based survey was performed . During 1 month , all infectious symptoms , physician consultations and antibiotic treatments for 18-month-old children were noted . The 818 families also answered questions about their socio-economic situation , illness perception and concern about infectious illness . RESULTS High concern about infectious illness was associated with more frequent physicians consultations and more prescriptions of antibiotics . There was no significant difference in reported days with symptoms of RTI , but the parents more often experienced their children with RTI without fever as being ill . The variables of infection proneness in the child , inadequate beliefs in antibiotics and the factor of being the only child were important explanatory factors for concern about infectious illness . CONCLUSIONS High concern about infectious illness is an important determining factor for physician consultations and antibiotic prescription for small children . An adequate consultation , where the doctor deals with the parents ' worries and gives appropriate information about symptoms and disease , might contribute to less antibiotic prescribing with preserved parental satisfaction Background : Specific probiotic bacteria have proven to be effective in the prevention and treatment of infectious diseases in early life in at-risk population s. The impact of administration of Bifidobacterium animalis subsp . lactis BB-12 ( BB-12 ) on the risk of acute infectious diseases was studied in healthy children . Methods : In this double-blind , placebo-controlled study , 109 1-mo-old infants were assigned r and omly to a probiotic group receiving a BB-12–containing tablet ( n = 55 ) or a placebo ( n = 54 ) . Test tablets were administered to the infants twice a day ( daily dose of BB-12 10 billion colony-forming units ) until the age of 2 y with a novel slow-release pacifier or a spoon . Breastfeeding habits , pacifier use , dietary habits , medications , and all signs and symptoms of acute infections were registered in diaries by parents and in question naires by trained professionals . Results : The infants receiving BB-12 were reported to have experienced fewer respiratory tract infections ( RTIs ; 87 vs. 100 % ; risk ratio : 0.87 ; 95 % confidence interval : 0.76 , 1.00 ; P = 0.033 ) than the controls . No significant differences between the groups were observed in reported gastrointestinal symptoms , otitis media , or fever . The baseline characteristics of the two groups were similar , as was the duration of breastfeeding . Conclusion : Administration of BB-12 in early childhood may reduce RTIs Recurrent respiratory infections ( RRI ) consist of more relapsing acute respiratory infections than the ones expected for the age [ > 6 acute respiratory tract infections ( RTI ) per year if age is > 3 years , and > 8 acute RTI per year if age is < 3 years ] . Concerning the pathogenesis of RRI , several investigations report the important role of environmental factors , early socialization and immunological dysfunctions , such as lymphocyte sub population s alterations , IgG subclass deficiency and phagocytosis and /or opsonization deficit during acute infections . In this framework , we have studied the lymphocyte-dependent antibacterial activity ( ABA ) among 121 children affected by RRI . Results show a statistically significant alteration of this function in 38 children ( 31.4 % ) : 19 of them exhibited an absent ABA ( group 1 ) , while in the others same function was reduced ( group 2 ) . A bovine thymic extract , thymostimulin , was administered to both groups by intramuscular injections ( 1 mg/kg ) for a 3 month cycle . At the end of therapy we observed a statistical significant rise of ABA only in group 1 and among children aged > 3 years . Among the same patients , 33 children ( 86.8 % ) improved in terms of reduction of clinical score and better results were seen among children aged > 3 years . These data emphasize the beneficial role of thymostimulin in RRI-affected children , suggesting a transient immaturity of the immune system as one of the possible pathogenetic factor Cancer treatment regimens that include radiation therapy ( RT ) to the abdominal region for cervical , ovarian , prostate , sigmoid , or colorectal cancer potentially disturb the colonization resistance of the indigenous gut flora , causing RT-induced diarrhea , enteritis , and colitis in more than 80 % of patients with cancer . One approach for the prevention of RT-induced diarrhea is the use of probiotics . R and omized clinical trials have demonstrated efficacy of probiotic preparations VSL # 3 and Lactobacillus casei DN-114 001 in decreasing the incidence and grade of RT-induced diarrhea . Oncology nurses and advanced practice clinicians are in a position to interpret research findings related to RT-induced diarrhea , enteritis , and colitis and to apply evidence -based practice principles in patients with cancer receiving RT to promote positive outcomes Introduction Traumatic brain injury ( TBI ) is associated with a profound immunological dysfunction manifested by a severe shift from T-helper type 1 ( Th1 ) to T-helper type 2 ( Th2 ) response . This predisposes patients to infections , sepsis , and adverse outcomes . Probiotic bacteria have been shown to balance the Th1/Th2 cytokines in allergic murine models and patients . For the present study , we hypothesized that the enteral administration of probiotics would adjust the Th1/Th2 imbalance and improve clinical outcomes in TBI patients . Methods We design ed a prospect i ve , r and omized , single-blind study . Patients with severe TBI and Glasgow Coma Scale scores between 5 and 8 were included , result ing in 26 patients in the control group and 26 patients in the probiotic group .  All patients received enteral nutrition via a nasogastric tube within 24 to 48 hours following admission . In addition , the probiotic group received 109 bacteria of viable probiotics per day for 21 days . The associated serum levels of Th1/Th2 cytokines , Acute Physiology and Chronic Health Evaluation ( APACHE ) II and Sequential Organ Failure Assessment ( SOFA ) scores , nosocomial infections , length of ICU stay , and 28-day mortality rate were studied . Results The patients responded to viable probiotics , and showed a significantly higher increase in serum IL-12p70 and IFNγ levels while also experiencing a dramatic decrease in IL-4 and IL-10 concentrations . APACHE II and SOFA scores were not significantly affected by probiotic treatment . Patients in the probiotic group experienced a decreased incidence of nosocomial infections towards the end of the study . Shorter ICU stays were also observed among patients treated with probiotic therapy . However , the 28-day mortality rate was unaffected . Conclusions The present study showed that daily prophylactic administration of probiotics could attenuate the deviated Th1/Th2 response induced by severe TBI , and could result in a decreased nosocomial infection rate , especially in the late period . Trial registration ChiCTR-TRC-10000835 Background : For most febrile respiratory tract infections ( RTIs ) in children , the causative pathogen is never identified . We sought to identify the causative pathogen in individual cases of pediatric outpatient with RTIs and to determine whether particular clinical features of RTIs are associated with particular viruses . Methods : Over 3 years , we prospect ively collected nasopharyngeal aspirate specimens from individual pediatric out patients with an RTI accompanied by persistent fever ( > 3 days , ≥38.0 ° C ) and peak temperature ≥39.0 ° C . Two methods —(1 ) viral culture for respiratory viruses and ( 2 ) real-time polymerase chain reaction ( PCR ) assays identifying 9 different respiratory viruses and 2 respiratory bacteria — were used to test specimens . Results : For 495 specimens , viral culture and real-time PCR assays together identified at least 1 pathogen in 83.0 % and ≥1 viruses alone in 79.4 % . These 2 methods identified 138 children with respiratory syncytial virus , 66 with human metapneumovirus , 73 with parainfluenza viruses , 124 with adenovirus , 23 with rhinovirus , 38 with enterovirus , 11 with influenza type C virus , 15 with Mycoplasma pneumoniae and 3 with Chlamydophila pneumoniae ; the coinfection rate was 19.7 % among all infections . Among the patients with single-pathogen infections , the rate of lower RTI was 37.6 % for respiratory syncytial virus , 40.7 % for human metapneumovirus , 18.2 % for parainfluenza viruses and 2.2 % for adenovirus ( P < 0.01 ) . Conclusions : Viral culture and real-time PCR assays were used together to identify causative pathogens in 83 % of febrile outpatient children with RTI ; specific viruses were associated with particular clinical diagnoses Limited data are available on the effects of probiotics on the nasopharyngeal presence of respiratory viruses in children attending day care . In this sub study of a r and omized , double-blinded , placebo-controlled 28-week intervention study , nasopharyngeal swab sample s were collected , on visits to a physician due to symptoms of infection , from children receiving control milk ( N = 97 ) and children receiving the same milk supplemented with probiotic Lactobacillus rhamnosus GG ( N = 97 ) . The presence of 14 respiratory viruses was assessed by PCR methods , and viral findings were compared with symptom prevalences in the intervention groups . Rhinovirus was identified in 28.6 % of 315 swab sample s , followed by respiratory syncytial virus ( 12.4 % ) , parainfluenza virus 1 ( 12.1 % ) , enterovirus ( 8.9 % ) , influenza A(H1N1)pdm09 ( 7.9 % ) , human bocavirus 1 ( 3.8 % ) , parainfluenza virus 2 ( 3.2 % ) , adenovirus ( 2.9 % ) , and influenza A(H3N2 ) ( 0.6 % ) . The children in the probiotic group had less days with respiratory symptoms per month than the children in the control group ( 6.48 [ 95 % CI 6.28 - 6.68 ] vs. 7.19 [ 95 % CI 6.98 - 7.41 ] , P < 0.001 ) . Probiotic intervention did not reduce significantly the occurrence of the examined respiratory viruses , or have an effect on the number of respiratory symptoms observed at the time of a viral finding . Rhinovirus , respiratory syncytial virus , and parainfluenza virus 1 were the most common respiratory viruses in symptomatic children . Children receiving Lactobacillus rhamnosus GG had fewer days with respiratory symptoms than children in the control group , although probiotic intervention was not effective in reducing the amount of viral findings or the respiratory symptoms associated with viral findings A r and omised , double-blind , placebo-controlled study was conducted to determine whether probiotics might be effective in reducing the risk of infections in infancy . Infants requiring formula before the age of 2 months were recruited from community well-baby clinics . Infant formula supplemented with the probiotics Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb-12 or placebo was administered daily until the age of 12 months . Incidence of early infections ( before the age of 7 months ) and incidence of recurrent ( three or more ) infections during the first year of life were recorded as the main outcome measures of the study . During the first 7 months of life , seven out of thirty-two ( 22 % ) infants receiving probiotics and twenty out of forty ( 50 % ) infants receiving placebo experienced acute otitis media ( risk ratio ( RR ) 0.44 ( 95 % CI 0.21 , 0.90 ) ; P = 0.014 ) and antibiotics were prescribed for ten out of thirty-two ( 31 % ) infants receiving probiotics and twenty-four out of forty ( 60 % ) infants receiving placebo ( RR 0.52 ( 95 % CI 0.29 , 0.92 ) ; P = 0.015 ) . During the first year of life , nine out of thirty-two ( 28 % ) infants receiving probiotics and twenty-two out of forty ( 55 % ) infants receiving placebo encountered recurrent respiratory infections ( RR 0.51 ( 95 % CI 0.27 , 0.95 ) ; P = 0.022 ) . These data suggest that probiotics may offer a safe means of reducing the risk of early acute otitis media and antibiotic use and the risk of recurrent respiratory infections during the first year of life . Further clinical trials are warranted Objective To investigate recruitment and retention , data collection methods and the acceptability of a ‘ within-consultation ’ complex intervention design ed to reduce antibiotic prescribing . Design Primary care feasibility cluster r and omised controlled trial . Setting 32 general practice s in South West Engl and recruiting children from October 2014 to April 2015 . Participants Children ( aged 3 months to < 12 years ) with acute cough and respiratory tract infection ( RTI ) . Intervention A web-based clinician-focussed clinical rule to predict risk of future hospitalisation and a printed leaflet with individualised child health information for carers , safety-netting advice and a treatment decision record . Controls Usual practice , with clinicians recording data on symptoms , signs and treatment decisions . Results Of 542 children invited , 501 ( 92.4 % ) consented to participate , a month ahead of schedule . Antibiotic prescribing data were collected for all children , follow-up data for 495 ( 98.8 % ) and the National Health Service re source use data for 494 ( 98.6 % ) . The overall antibiotic prescribing rates for children ’s RTIs were 25 % and 15.8 % ( p=0.018 ) in intervention and control groups , respectively . We found evidence of postr and omisation differential recruitment : the number of children recruited to the intervention arm was higher ( 292 vs 209 ) ; over half were recruited by prescribing nurses compared with less than a third in the control arm ; children in the intervention arm were younger ( median age 2 vs 3 years controls , p=0.03 ) and appeared to be more unwell than those in the control arm with higher respiratory rates ( p<0.0001 ) , wheeze prevalence ( p=0.007 ) and global illness severity scores assessed by carers ( p=0.045 ) and clinicians ( p=0.01 ) . Interviews with clinicians confirmed preferential recruitment of less unwell children to the trial , more so in the control arm . Conclusion Differential recruitment may explain the paradoxical antibiotic prescribing rates . Future cluster level studies should consider design s which remove the need for individual consent postr and omisation and embed the intervention within electronic primary care records . Trial registration number IS RCT N 23547970 UKCRN study ID The hypothesis that probiotic administration protects the gut surface and could delay progression of Human Immunodeficiency Virus type1 ( HIV-1 ) infection to the Acquired Immunodeficiency Syndrome ( AIDS ) was proposed in 1995 . Over the last five years , new studies have clarified the significance of HIV-1 infection of the gut associated lymphoid tissue ( GALT ) for subsequent alterations in the microflora and breakdown of the gut mucosal barrier leading to pathogenesis and development of AIDS . Current studies show that loss of gut CD4 + Th17 cells , which differentiate in response to normal microflora , occurs early in HIV-1 disease . Microbial translocation and suppression of the T regulatory ( Treg ) cell response is associated with chronic immune activation and inflammation . Combinations of probiotic bacteria which upregulate Treg activation have shown promise in suppressing pro inflammatory immune response in models of autoimmunity including inflammatory bowel disease and provide a rationale for use of probiotics in HIV-1/AIDS . Disturbance of the microbiota early in HIV-1 infection leads to greater dominance of potential pathogens , reducing levels of bifidobacteria and lactobacillus species and increasing mucosal inflammation . The interaction of chronic or recurrent infections , and immune activation contributes to nutritional deficiencies that have lasting consequences especially in the HIV-1 infected child . While effective anti-retroviral therapy ( ART ) has enhanced survival , wasting is still an independent predictor of survival and a major presenting symptom . Congenital exposure to HIV-1 is a risk factor for growth delay in both infected and non-infected infants . Nutritional intervention after 6 months of age appears to be largely ineffective . A meta analysis of r and omized , controlled clinical trials of infant formulae supplemented with Bifidobacterium lactis showed that weight gain was significantly greater in infants who received B. lactis compared to formula alone . Pilot studies have shown that probiotic bacteria given as a supplement have improved growth and protected against loss of CD4 + T cells . The recognition that normal bacterial flora prime neonatal immune response and that abnormal flora have a profound impact on metabolism has generated insight into potential mechanisms of gut dysfunction in many setting s including HIV-1 infection . As discussed here , current and emerging studies support the concept that probiotic bacteria can provide specific benefit in HIV-1 infection . Probiotic bacteria have proven active against bacterial vaginosis in HIV-1 positive women and have enhanced growth in infants with congenital HIV-1 infection . Probiotic bacteria may stabilize CD4 + T cell numbers in HIV-1 infected children and are likely to have protective effects against inflammation and chronic immune activation of the gastrointestinal immune system
Conclusion : Based on the available data and taking into account the safety profile of RCTs , probiotic consumption appears to be a feasible way to decrease the incidence of RTIs in children
Background : Respiratory tract infections ( RTIs ) represent one of the main health problems in children .
Probiotics are viable bacteria that colonize the intestine and affect the host intestinal microbial balance .
Accumulating evidence suggests that probiotic consumption may decrease the incidence of or modify RTIs .
The authors systematic ally review ed data from r and omized controlled trials ( RCTs ) to investigate the effect of probiotic consumption on  RTIs in children .