Southampton, UK—It’s the time of year when sore throat sufferers come to pharmacies looking for relief. Pharmacists now can tell them, based on a new study, that the use of probiotics and xylitol chewing gum doesn’t appear to help.

A report of a randomized controlled trial (RCT) published in CMAJ (Canadian Medical Association Journal) looked at whether those products could work as an alternative to antibiotics.

“Simple over-the-counter treatments could potentially limit the effects of both bacterial and viral infections and help patients to manage symptoms,” explained Paul Little, MBBS, BA, MD, of the Primary Care Group, University of Southampton in the UK. “This would enable self-management, potentially facilitate a quicker return to normal activities, and reduce the pressure to use antibiotics.”

Based on past research, the study team looked at whether probiotics and xylitol, a birch sugar that prevents bacterial growth, could help reduce recurrence of upper respiratory tract infections. Included in the RCT were 934 patients in the UK over a 4-year study period from June 2010 to 2014, with 689 providing complete data for the trial. 

Participants older than age 3 (or caregivers) were asked to use a symptom diary, recording the number of probiotic capsules and sticks of chewing gum used each day, as well as the severity of symptoms. 

Pack contents for three kinds of material and advice were previously determined by computer-generated random numbers: 
• No chewing gum, 
• Xylitol-based chewing gum (15% xylitol; five pieces daily) and 
• Sorbitol gum (five pieces daily). 

Half of each group also was randomly assigned to receive either probiotic capsules (containing 24 ? 109 colony-forming units of lactobacilli and bifidobacteria) or placebo. 
Mean self-reported severity of sore throat and difficulty swallowing (scale 0-6) in the first 3 days were measured as primary outcomes.

Results indicate that mean severity scores were 2.75 with no probiotic and 2.78 with probiotic (adjusted difference ?0.001, 95% confidence interval [CI] ?0.24 to 0.24). For chewing gum, mean severity scores were 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). 

Researchers point out that none of the secondary outcomes differed significantly between groups, and no adverse effects were reported.

“There is no reason for clinicians to advise patients to use either of these treatments for the symptomatic management of pharyngitis,” study authors conclude.

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