Orally ingested probiotics, prebiotics, and synbiotics as countermeasures for respiratory tract infections in nonelderly adults: a systematic review and meta-analysis

Coleman, Julie L; Hatch-McChesney, Adrienne; Small, Stephanie D; Allen, Jillian T; Sullo, Elaine; Agans, Richard T; Fagnant, Heather S; Bukhari, Asma S; Karl, J Philip

doi:10.1093/advances/nmac086

Cited by 19Probiotics and Fermented FoodsMicrobial Metabolites in Food BiotechnologyGut microbiota and health

Orally ingested probiotics, prebiotics, and synbiotics as countermeasures for respiratory tract infections in nonelderly adults: a systematic review and meta-analysis

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Coleman, Julie L, Hatch-McChesney, Adrienne, Small, Stephanie D, Allen, Jillian T, Sullo, Elaine, Agans, Richard T, Fagnant, Heather S, Bukhari, Asma S +1 more·2022·Advances in Nutrition

DOI 10.1093/advances/nmac086PMC PMC9776651

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Abstract

The impact of gut microbiota-targeted interventions on the incidence, duration, and severity of respiratory tract infections (RTIs) in nonelderly adults, and factors moderating any such effects, are unclear. This systematic review and meta-analysis aimed to determine the effects of orally ingested probiotics, prebiotics, and synbiotics compared with placebo on RTI incidence, duration, and severity in nonelderly adults, and to identify potential sources of heterogeneity. Studies were identified by searching CENTRAL, PubMed, Scopus, and Web of Science up to December 2021. English-language, peer-reviewed publications of randomized, placebo-controlled studies that tested an orally ingested probiotic, prebiotic, or synbiotic intervention of any dose for ≥1 wk in adults aged 18-65 y were included. Results were synthesized using intention-to-treat and per-protocol random-effects meta-analysis. Heterogeneity was explored by subgroup meta-analysis and meta-regression. Risk of bias was assessed using the Cochrane risk-of-bias assessment tool for randomized trials version 2 (RoB2). Forty-two manuscripts reporting effects of probiotics (n = 38), prebiotics (n = 2), synbiotics (n = 1) or multiple -biotic types (n = 1) were identified (n = 9179 subjects). Probiotics reduced the risk of experiencing ≥1 RTI (relative risk = 0.91; 95% CI: 0.84, 0.98; P = 0.01), and total days (rate ratio = 0.77; 95% CI: 0.71, 0.83; P < 0.001), duration (Hedges' g = -0.23; 95% CI: -0.39, -0.08; P = 0.004), and severity (Hedges' g = -0.16; 95% CI: -0.29, -0.03; P = 0.02) of RTIs. Effects were relatively consistent across different strain combinations, doses, and durations, although reductions in RTI duration were larger with fermented dairy as the delivery matrix, and beneficial effects of probiotics were not observed in physically active populations. Overall risk of bias was rated as "some concerns" for most studies. In conclusion, orally ingested probiotics, relative to placebo, modestly reduce the incidence, duration, and severity of RTIs in nonelderly adults. Physical activity and delivery matrix may moderate some of these effects. Whether prebiotic and synbiotic interventions confer similar protection remains unclear due to few relevant studies. This trial was registered at https://www.crd.york.ac.uk/prospero/ as CRD42020220213.

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Many systematic reviews and meta-analyses of RCTs suggest beneficial effects of flavonoids and probiotics, while the effects of vitamins A, C, D, E, and zinc remain controversial.
“In recent years, many systematic reviews and meta-analyses of randomized controlled trials (RCTs) have explored the effectiveness of oral nutrient supplements in preventing RTIs,4,8, 9, 10, 11, 12, 13, 14, 15, 16 suggesting beneficial effects of flavonoids and probiotics, while the effects of vitamins A, C, D, E, and zinc remain controversial.”
From Comparative effectiveness of oral nutritional supplements in preventing respiratory tract infections among adults: a systematic review and network meta-analysis (2025) · cites this paper as [12]
Fewer systematic reviews have focused on the adult population.
“However, fewer systematic reviews have focused on the adult population.”
From Comparative effectiveness of oral nutritional supplements in preventing respiratory tract infections among adults: a systematic review and network meta-analysis (2025) · cites this paper as [12]

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Li, L., Hong, K., Sun, Q., Xiao, H., Lai, L., Ming, M., & Li, C. (2020) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2020/8734140 · Cited by 34 · see citing works
The Effects of Prebiotics, Synbiotics, and Short-Chain Fatty Acids on Respiratory Tract Infections and Immune Function: A Systematic Review and Meta-Analysis
Williams, L. M., Stoodley, I. L., Berthon, B. S., & Wood, L. G. (2021) · Advances in Nutrition · doi:10.1093/advances/nmab114 · Cited by 34 · see citing works
Human rhinovirus in experimental infection after peroral Lactobacillus rhamnosus GG consumption, a pilot study
Tapiovaara, L. K., Kumpu, M., Mäkivuokko, H., Waris, M. E., Korpela, R., Pitkäranta, A., & Winther, B. (2016) · International Forum of Allergy & Rhinology · doi:10.1002/alr.21748 · Cited by 32 · see citing works
A novel role of probiotics in improving host defence of elite rugby union athlete: A double blind randomised controlled trial
Pumpa, K. L., McKune, A. J., & Harnett, J. (2019) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2019.03.013 · Cited by 28 · see citing works
Supplementation of Probiotics and Its Effects on Physically Active Individuals and Athletes: Systematic Review
Möller, G. B., Goulart, M. J. V. D. C., Nicoletto, B. B., Alves, F. D., & Schneider, C. D. (2019) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2018-0227 · Cited by 27 · see citing works
Fewer Community-Acquired Colds with Daily Consumption of Lactiplantibacillus plantarum HEAL9 and Lacticaseibacillus paracasei 8700:2. A Randomized, Placebo-Controlled Clinical Trial
Ahrén, I. L., Hillman, M., Nordström, E. A., Larsson, N., & Niskanen, T. M. (2020) · Journal of Nutrition · doi:10.1093/jn/nxaa353 · Cited by 26 · see citing works
Evaluation of Probiotics for Warfighter Health and Performance
Agans, R., Giles, G. E., Goodson, M. S., Karl, J. P., Leyh, S. M., Mumy, K. L., Racicot, K., & Soares, J. W. (2020) · Frontiers in Nutrition · doi:10.3389/fnut.2020.00070 · Cited by 26 · see citing works
Self-citation
Einfluß eines bakteriellen Immunstimulans (humane Enterococcus faecalis-Bakterien) auf die Rezidivhäufigkeit bei Patienten mit chronischer Bronchitis
Habermann, W., Zimmermann, K., Skarabis, H., Kunze, R., & Rusch, V. (2011) · Arzneimittelforschung · doi:10.1055/s-0031-1300140 · Cited by 25 · see citing works
Probiotic Supplementation and Respiratory Infection and Immune Function in Athletes: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Łagowska, K., & Bajerska, J. (2021) · Journal of Athletic Training · doi:10.4085/592-20 · Cited by 24 · see citing works
Gut Microbiota-targeted Interventions for Reducing the Incidence, Duration, and Severity of Respiratory Tract Infections in Healthy Non-elderly Adults
Karl, J. P. (2020) · Military Medicine · doi:10.1093/milmed/usaa261 · Cited by 23 · see citing works
Self-citation
Lactobacillus gasseri SBT2055 Stimulates Immunoglobulin Production and Innate Immunity after Influenza Vaccination in Healthy Adult Volunteers: a Randomized, Double-blind, Placebo-controlled, Parallel-group Study
Nishihira, J., Moriya, T., Sakai, F., Kabuki, T., Kawasaki, Y., & Nishimura, M. (2016) · Functional Foods in Health and Disease · doi:10.31989/ffhd.v6i9.284 · Cited by 23 · see citing works
Probiotics and respiratory and gastrointestinal tract infections in Finnish military conscripts – a randomised placebo-controlled double-blinded study
Kalima, K., Lehtoranta, L., He, L., Pitkäniemi, J. M., Lundell, R. V., Julkunen, I., Roivainen, M., Närkiö, M., Mäkelä, M. J., Siitonen, S., et al. (2016) · Beneficial Microbes · doi:10.3920/bm2015.0172 · Cited by 16 · see citing works
The effect of probiotics on prevention of upper respiratory tract infections in the paediatric community – a systematic review
Emre, İ. E., Eroğlu, Y., Kara, A., Dinleyici, E. Ç., & Özen, M. (2020) · Beneficial Microbes · doi:10.3920/bm2019.0119 · Cited by 15 · see citing works
Effects of a Lactobacilli Probiotic on Reducing Duration of URTI and Fever, and Use of URTI-Associated Medicine: A Re-Analysis of a Randomized, Placebo-Controlled Study
Altadill, T., Espadaler, J., & Liong, M. (2021) · Microorganisms · doi:10.3390/microorganisms9030528 · Cited by 13 · see citing works
Oral Chinese Herbal Medicine as Prophylactic Treatment for Episodic Migraine in Adults: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials
Lyu, S., Zhang, C. S., Guo, X., Zhang, A. L., Sun, J., Lu, C., Xue, C. C., & Luo, X. (2020) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2020/5181587 · Cited by 10 · see citing works
Effects of the regular intake of the probiotic Lactobacillus reuteri (DSM 17938) on respiratory and gastrointestinal infections in a workplace setting: a double-blind randomized placebo-controlled trial
Schröder, C., Schmidt, S., Garbe, E., Röhmel, J., & Giersiepen, K. (2015) · BMC Nutrition · doi:10.1186/2055-0928-1-3 · Cited by 7 · see citing works

Flagged first, then by citations

2 of the 81 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

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Sorted by citations

Is There Evidence to Support Probiotic Use for Healthy People?
Merenstein, D. J., Tancredi, D. J., Karl, J. P., Krist, A. H., Lenoir‐Wijnkoop, I., Reid, G., Roos, S., Szajewska, H., & Sanders, M. E. (2024) · Advances in Nutrition · doi:10.1016/j.advnut.2024.100265 · Cited by 51 · see citing works
Self-citation
Probiotic cultivated meat: bacterial-based scaffolds and products to improve cultivated meat
Kolodkin‐Gal, I., Dash, O., & Rak, R. (2023) · Trends in biotechnology · doi:10.1016/j.tibtech.2023.09.002 · Cited by 29 · see citing works
Antibacterial and Immunostimulatory Activity of Potential Probiotic Lactic Acid Bacteria Isolated from Ethiopian Fermented Dairy Products
Gizachew, S., Van Beeck, W., Spacova, I., Dekeukeleire, M., Alemu, A., Woldemedhin, W. M., Mariam, S. H., Lebeer, S., & Engidawork, E. (2023) · Fermentation · doi:10.3390/fermentation9030258 · Cited by 26 · see citing works
The Improvement and Related Mechanism of Microecologics on the Sports Performance and Post-Exercise Recovery of Athletes: A Narrative Review
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The role of dairy food intake for improving health among black Americans across the life continuum: A summary of the evidence
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Clinical Efficacy of Probiotics for Relieving Cold Symptoms in Healthy Individuals: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial
Lungaro, L., Malfa, P., Manza, F., Negrelli, M., Costanzini, A., Squarzanti, D. F., Re, M. L., Cariani, A., Ghisellini, S., Caputo, F., et al. (2025) · Nutrients · doi:10.3390/nu17091490 · Cited by 5 · see citing works
The interaction between genetic predicted gut microbiome abundance and particulate matter on the risk of incident asthma in adults
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“12,22 Synbiotics were defined as combinations of probiotics (single or multiple strains) and prebiotics (nondigestible carbohydrates fermented by gut microbiota).”
Influential
The effect of probiotic Bifidobacterium lactis Bl-04 on innate antiviral responses in vitro
Latvala, S., Lehtinen, M. J., Mäkelä, S. M., Nedveck, D. A., Zabel, B., Ahonen, I., Lehtoranta, L., Turner, R. B., & Liljavirta, J. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e29588 · Cited by 6 · see citing works
A review of dairy food intake for improving health among black geriatrics in the US
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Current advances in microbiome sciences within the US Department of Defense�part 1: microbiomes for human health and performance
Colston, S. M., Barbato, R. A., Goodson, M. S., Karl, J. P., Kokoska, R. J., Leary, D. D., Racicot, K., Varaljay, V. A., & Soares, J. W. (2023) · BMJ Military Health · doi:10.1136/military-2022-002307 · Cited by 3 · see citing works
Self-citation
Meeting report of the sixth annual tri-service microbiome consortium symposium
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Self-citation
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Additional file 1 of Meeting report of the sixth annual tri-service microbiome consortium symposium
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Self-citation
English language proficiency as a driver of safety, certification, and digital transformation in palm oil sector
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Randomized, Double-Blind, Placebo-Controlled Clinical Trial Assessing the Efficacy of Lacticaseibacillus rhamnosus CRL 1505 in Preventing Upper Respiratory Tract Infections in Healthy Adults
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Gut Microbiota-targeted Interventions for Reducing the Incidence, Duration, and Severity of Respiratory Tract Infections in Healthy Non-elderly Adults
Karl, J. P. (2020) · Military Medicine · doi:10.1093/milmed/usaa261 · Cited by 23 · see citing works
Self-citation
Orally Ingested Probiotic, Prebiotic, and Synbiotic Interventions as Countermeasures for Gastrointestinal Tract Infections in Nonelderly Adults: A Systematic Review and Meta-Analysis
Fagnant, H., Isidean, S., Wilson, L., Bukhari, A. S., Allen, J. T., Agans, R. T., Lee, D. M., Hatch-McChesney, A., Whitney, C., Sullo, E., et al. (2023) · Advances in Nutrition · doi:10.1016/j.advnut.2023.02.002 · Cited by 12 · see citing works
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Preventing Respiratory Tract Infections by Synbiotic Interventions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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Strain-Specific Effects of Early-Life Probiotic Supplementation on Respiratory Infections in Infants: A Systematic Review and Meta-Analysis
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The Effects of Prebiotics, Synbiotics, and Short-Chain Fatty Acids on Respiratory Tract Infections and Immune Function: A Systematic Review and Meta-Analysis
Williams, L. M., Stoodley, I. L., Berthon, B. S., & Wood, L. G. (2021) · Advances in Nutrition · doi:10.1093/advances/nmab114 · Cited by 34 · see citing works

Authors: Coleman, J. L., Hatch-McChesney, A., Small, S. D., Allen, J. T., Sullo, E., Agans, R. T., Fagnant, H. S., Bukhari, A. S., & Karl, J. P.
Affiliations: U.S. Army Research Institute of Environmental Medicine (US)
George Washington University (US)
Naval Medical Research Unit DAYTON (US)
Corresponding author: Karl, J Philip
ORCID: Small, Stephanie D
Sullo, Elaine
Agans, Richard T
Fagnant, Heather S
Bukhari, Asma S
Karl, J Philip
Venue: Advances in Nutrition
Publisher: Elsevier BV
Published: 2022-11
Volume: 13
Issue: 6
Pages: 2277-2295
ISSN: 2156-5376 (ISSN-L)
2161-8313
DOI: 10.1093/advances/nmac086
PMC: PMC9776651
OpenAlex: W4290973973
Cited by: 19
References: 81
Citations by year: 2026: 5 · 2025: 4 · 2024: 5 · 2023: 5
FWCI: 0.32
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
Locations: Advances in Nutrition (publishedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
OSTI OAI (U.S. Department of Energy Office of Scientific and Technical Information) (submittedVersion)
Funders: U.S. Army Research Institute of Environmental Medicine
Second Decade Society
U.S. Department of Energy
Oak Ridge Institute for Science and Education
U.S. Army Medical Research and Development Command
Topics: Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
Health Sciences › Nursing › Nutrition and Dietetics › Microbial Metabolites in Food Biotechnology
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Keywords: probiotics, prebiotics, synbiotics, respiratory infections, gut microbiota, non-elderly adults, infection incidence, infection duration, infection severity, fermented dairy, physical activity, risk of bias, subgroup heterogeneity, placebo effect
MeSH terms: Adult, Humans, Respiratory Tract Infections, Probiotics, PubMed, Prebiotics, Synbiotics

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Orally ingested probiotics, prebiotics, and synbiotics as countermeasures for respiratory tract infections in nonelderly adults: a systematic review and meta-analysis

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