Xylitol for preventing acute otitis media in children up to 12 years of age.

Systematic review and meta-analysis of randomized trials in children up to 12 years of age. Most participants were healthy daycare children in Finland, with some trials enrolling children with acute respiratory infections; vehicles were compared with placebo or no treatment, and analyses were also stratified by age and vehicle type.

Xylitol was tested as prophylaxis for acute otitis media in several vehicles, including syrup, chewing gum, and lozenges, with daily doses generally around 8.4 g to 10 g xylitol. Regimens in the active arms typically lasted 2 to 3 months for prevention trials, while the acute respiratory infection trial used xylitol until symptom resolution or up to 3 weeks.

Overall, xylitol reduced the occurrence of acute otitis media in healthy children by about 25% versus control. In the pooled analysis of 1826 children from 3 studies, the risk ratio was 0.75 (95% CI 0.65 to 0.88) with an absolute risk difference of -0.07 (95% CI -0.12 to -0.03). Chewing gum appeared more effective than syrup, with reductions of about 41% for chewing gum and about 30% for syrup, while lozenges did not show a significant benefit. Xylitol given only during respiratory infection did not prevent acute otitis media.

The evidence base was small and came mainly from a few trials, largely from the same research group in Finland, which limits generalizability. Vehicles, populations, and timing of administration differed across studies, and adverse-event data were limited. Practical use may also be constrained by poor acceptability of chewing gum in some settings, especially for school-aged children.