We reviewed the evidence about the effectiveness and safety of xylitol to prevent acute middle ear infection (acute otitis media; AOM) in children up to 12 years old.

Background
AOM is the most common bacterial infection among young children in the United States. Although serious complications are rare, this common childhood ailment imposes a huge impact on the healthcare system. In the United States, it accounted for almost 20 million office visits. Antibiotic treatment of AOM is costly and raises concerns about the development of antibiotic-resistant strains of bacteria. Surgery is invasive and costly, and because of these factors, effective measures for preventing AOM are sought. An alternative treatment is xylitol or birch sugar. Xylitol has been used for decades as a natural non-sugar sweetener principally in chewing gums, confectionery, toothpaste and medicines, and can reduce the risk of tooth decay.

Search date

We searched the literature up to January 2016. This is an update of a review that was last published in 2011.

Study characteristics
We identified five clinical trials that involved 3405 children, mostly from the same research group. Four trials were conducted in Finland and enrolled healthy children (three trials) or children with an acute respiratory infection (one trial). The fifth trial was conducted in the USA and enrolled otitis-prone children who were recruited from attendance at general medical practices.

Study funding sources

All five trials received governmental funding; and the Finnish study investigators have a US patent for the use of xylitol to treat respiratory infections.

Key results

Xylitol, administered in chewing gum, lozenges or syrup, can reduce the occurrence of AOM among healthy children with no acute upper respiratory infection from 30% to 22%. There is no difference in side effects (namely, abdominal discomfort and rash). Based on these results we would expect that out of 1000 children up to 12 years of age, 299 would experience an AOM compared with between 194 and 263 children who would experience an AOM if they are provided with xylitol chewing gum. The preventive effect among healthy children with respiratory infection or among otitis-prone children is inconclusive.

Quality of the evidence
The quality of evidence was moderate for healthy children and children with respiratory infections but low for otitis-prone children.

Translation: now available in simplified Chinese