{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T06:00:41Z","timestamp":1785477641541,"version":"3.56.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004775","name":"Natural Science Foundation of Gansu Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004775","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"\n Objective<\/jats:title>\n This study aimed to evaluate the comparative efficacy and safety of various probiotic regimens for treating Respiratory tract infections (RTIs) in otherwise healthy children.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Six Chinese and English databases were searched for randomized controlled trials of probiotics for the RTIs in children published from inception to November 15th, 2025. Pairwise meta-analysis and network meta-analysis were used to assess the efficacy and safety.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Eight RCTs enrolling 1,158 children aged 0.69 to 6.4 years from Ukraine, China, Malaysia, India, and Italy were included.\n Bifidobacterium<\/jats:italic>\n significantly shortened duration of cough,\n Lactobacillus<\/jats:italic>\n reduced duration of illness,\n Lactobacillus<\/jats:italic>\n +\n Bifidobacterium<\/jats:italic>\n reduced both duration of cough and antibiotic use, and the four-strain combination (\n Lactobacillus<\/jats:italic>\n +\n Bifidobacterium<\/jats:italic>\n +\n Enterococcus<\/jats:italic>\n +\n Bacillus<\/jats:italic>\n ) reduced durations of fever and cough. Low-certainty evidence suggested superior efficacy of the\n Lactobacillus<\/jats:italic>\n +\n Bifidobacterium<\/jats:italic>\n over both\n Bifidobacterium<\/jats:italic>\n and the four-strain combination for reducing duration of cough, and over\n Lactobacillus<\/jats:italic>\n for shortening antibiotic use. Stratified analyses revealed strain-specific effects across RTI subtypes:\n Bifidobacterium<\/jats:italic>\n shortened cough in LRTI [\u22121.12 days, (\u22121.82, \u22120.42)];\n Lactobacillus<\/jats:italic>\n reduced illness duration in both URTI [\u22121.31 days, (\u22122.19, \u22120.43)] and LRTI [\u22121.36 days, (\u22122.29, \u22120.43)], and shortened antibiotic use in URTI [\u22121.70 days, (\u22122.40, \u22121.00)];\n Lactobacillus<\/jats:italic>\n +\n Bifidobacterium<\/jats:italic>\n shortened fever in URTI [\u22122.00 days, (\u22122.57, \u22121.43)], cough in LRTI [\u22121.25 days, (\u22121.84, \u22120.66)], and both fever \u22127.10 days, (\u22128.54, \u22125.66)] and antibiotic use [\u221210.50 days, (\u221213.22, \u22127.78)] in RRTI; the four-strain combination reduced fever [\u22121.54 days, (\u22122.40, \u22120.68)] and cough [\u22122.51 days, (\u22123.89, \u22121.13)] in RRTI. One RCT reported comparable incidence of gastrointestinal adverse events between probiotic and control groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Moderate- to high-certainty evidence supports\n Bifidobacterium<\/jats:italic>\n for reducing cough duration and\n Lactobacillus<\/jats:italic>\n for shortening illness duration in children with RTIs. While\n Lactobacillus<\/jats:italic>\n +\n Bifidobacterium<\/jats:italic>\n demonstrated large-magnitude reductions in cough duration and antibiotic use, these findings derive from low- to moderate-certainty evidence and require verification through rigorously designed randomized clinical trials. Strain-specific effects varied across RTI subtypes, suggesting the need for tailored probiotic selection. Future research should prioritize validating multi-strain efficacy, establish optimal dosing protocols, and evaluate long-term safety profiles to enable evidence-based guideline development.\n <\/jats:p>\n <\/jats:sec>\n \n Systematic review registration<\/jats:title>\n \n https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251074234<\/jats:ext-link>\n , identifier CRD420251074234.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fnut.2026.1902533","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T05:38:39Z","timestamp":1785476319000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative efficacy and safety of probiotic for respiratory tract infections in children: a network meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Feiyang","family":"Na","sequence":"first","affiliation":[{"name":"Department of Pediatric, Gansu Provincial Maternal and Child-care 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