Journal of Pediatric Perspectives

Journal of Pediatric Perspectives

Effect of Probiotic on Clinical Outcomes in Children with Pneumonia: A Randomized Double-Blind Trial

Document Type : original article

Authors
1 Department of Pediatrics, Ghaem Hospital, Mashhad University of Medical Science, Mashhad, Iran.
2 Department of Pediatrics, Mashhad University of Medical Science, Mashhad, Iran.
3 Bojnord University of Medical Science, Bojnord, Iran.
Abstract
Background: Pneumonia remains a major cause of morbidity and mortality among children worldwide. Evidence suggests that probiotics may modulate immune responses and potentially improve respiratory infections. This study aimed to evaluate the effect of probiotic supplementation on clinical outcomes in children aged 3 months to 12 years hospitalized with pneumonia.
Methods: In this double-blind randomized clinical trial, 108 children diagnosed with pneumonia were allocated into two groups: 54 received a daily 1‑gram sachet of Protexin probiotic (containing 1×10⁹ CFU), and 54 received a placebo matched in appearance. Clinical signs and symptoms, including fever, lethargy, tachypnea, cough, retraction, wheezing, rales, hypoxia, and length of hospital stay, were monitored at baseline and at scheduled follow-up intervals. Data analysis was performed using SPSS; t‑tests were applied for normally distributed quantitative variables and Mann–Whitney tests for non‑normal variables, with a significance level of P<0.05.
Results: No significant differences were found between the probiotic and placebo groups regarding gender, age, baseline symptoms, or length of hospital stay (P>0.05 for all). However, the frequency of fever at 36 and 60 hours after admission was significantly lower in the probiotic group (P=0.037, P=0.034), and lethargy at 36 hours after admission was significantly less common compared to the placebo group (P=0.009).
Conclusions: While most clinical parameters did not differ between groups, probiotic supplementation was associated with a significant reduction in fever and lethargy during hospitalization. Probiotics may serve as a beneficial adjunct therapy in pediatric pneumonia, although further studies with larger sample sizes and detailed clinical endpoints are recommended.
Keywords
Subjects

1. Leung DT, Chisti MJ, Pavia AT. Prevention and control of childhood pneumonia and diarrhea. Pediatric Clinics of North America. 2016 Feb;63(1):67.
2. Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, editors. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia: Elsevier; 2024. P. 2642-43.
3. Wyllie R, Hyams JS, Kay M. Pediatric gastrointestinal and liver disease E-Book. Elsevier Health Sciences; 2020 Sep 24.
4. Liu Y, Chen Y, Liao H, Sun S, Zhang X, Xie L, et al. Research progress on the application of Lacticaseibacillus rhamnosus GG in pediatric respiratory diseases. Frontiers in Nutrition. 2025 Feb 21;12:1553674.
5. Chen C, Liu P, Xiao L, Cao Q, Zhou DA, Liu X, et al. Probiotics for treating acute diarrhea in children: an evidence synthesis. Frontiers in Pediatrics. 2025;13:1722257.
6. Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, editors. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia: Elsevier; 2024. p. 2645-47
7. Puligandla PS, Laberge JM. Respiratory infections: pneumonia, lung abscess, and empyema. InSeminars in pediatric surgery 2008 Feb 1 (Vol. 17, No. 1, pp. 42-52). WB Saunders.
8. Thoda C, Touraki M. Immunomodulatory properties of probiotics and their derived bioactive compounds. Applied Sciences. 2023 Apr 9;13(8):4726.
9. Ozdemır B, Yalçın SS. The role of body temperature on respiratory rate in children with acute respiratory infections. African Health Sciences. 2021 Jun;21(2):640.
10. Hedstrom AB, von Saint Andre-von AO, Grassia KL, Nielsen KR. Markers of pediatric respiratory distress predictive of poor outcome in low-and middle-income countries: a systematic review. Journal of Global Health Reports. 2020 Aug 10;4.
11. World Health Organization. Revised WHO classification and treatment of pneumonia in children at health facilities: evidence summaries.
12. Shah SN, Bachur RG, Simel DL, Neuman MI. Does this child have pneumonia? The rational clinical examination systematic review. Jama. 2017 Aug 1;318(5):462-71.
13. Angurana SK, Suthar R, Nallasamy K, Bansal A. Probiotics in critically ill children: a systematic review and meta-analysis of randomized controlled trials. Intensive Care Medicine–Paediatric and Neonatal. 2025 Nov 27;3(1):50.
14. JM CS, Mateos JA. Effect of Lactobacillus casei on the incidence of infectious conditions in children. Nutricion hospitalaria. 2006 Jul 1;21(4):547-51.
15. Hojsak I, Abdović S, Szajewska H, Milošević M, Krznarić Ž, Kolaček S. Lactobacillus GG in the prevention of nosocomial gastrointestinal and respiratory tract infections. Pediatrics. 2010 May 1;125(5):e1171-7.
16. Smiian OI. Application of Bifi-forma in a complex treatment of children of the early age with non-hospital pneumonia. Likars' ka Sprava. 2010 Oct 1(7-8):71-6.
17. Leyer GJ, Li S, Mubasher ME, Reifer C, Ouwehand AC. Probiotic effects on cold and influenza-like symptom incidence and duration in children. Pediatrics. 2009 Aug 1;124(2):e172-9.