In vivo effectiveness and safety of probiotics on prophylaxis and treatment of oral candidiasis: a systematic review and meta-analysis
2019
To systematically review and assess the in vivo effectiveness and safety of
probioticsfor prophylaxis and treating oral candidiasis. A literature search for studies published in English until August 1, 2018 was conducted in the following databases: PubMed, EMBASE, Cochrane Library, and Web of Science. Randomized controlled clinical trials and experimental mouse animal model studies comparing
probiotics(at any dosage and in any form) with control groups (placebo, blank control or other agents) and reporting outcomes of the prophylactic and therapeutic effects were considered for inclusion. A descriptive study and, potentially, a meta-analysis were planned. Six randomized controlled clinical trials and 5 controlled experiments of mouse animal models were included in the systematic review. Four randomized controlled clinical trials comparing a
probioticsgroup with a placebo/blank control group in 480 elderly and denture wearers were included in the meta-analysis. The overall combined odds ratio of the (random effects) meta-analysis was 0.24 (95% CI =0.09–0.63, P < 0.01). The overall combined odds ratio of the (fixed effects) sensitivity analysis was 0.39 (95% CI =0.25–0.60, P < 0.01) by excluding a study with the smallest sample size. These analyses showed that there was a statistically significant difference in the effect of
probioticscompared with the control groups in elderly and denture wearers. The remaining 2 studies compared
probioticswith other agents in a population aged 18–75 years and children aged 6–14 years respectively, and were analyzed descriptively. Meta-analysis and descriptive analyses indicated that
probioticswere potentially effective in reducing morbidity, improving clinical symptoms and reducing oral Candida counts in oral candidiasis. The biases of the included studies were low or uncertain. The relatively common complaints reported were
gastrointestinal discomfortand unpleasant taste, and no severe adverse events were reported.
Probioticswere superior to the placebo and blank control in preventing and treating oral candidiasis in the elderly and denture wearers. Although
probioticsshowed a favorable effect in treating oral candidiasis, more evidence is required to warrant their effectiveness when compared with conventional antifungal treatments. Moreover, data on the safety of
probioticsare still insufficient, and further research is needed.
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