Systematic reviews · 2026
Efficacy of probiotics in the management of oral candidiasis: an umbrella review of systematic reviews and meta-analyses.
СтатьяСистематический обзорПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Mehta Vini, Galletti Cosimo, Mathur Ankita, Suresh Namrata, Nandi Dhruva, Flores-Fraile Javier
Аннотация
BACKGROUND: Oral candidiasis (OC) is among the most prevalent oral infections, frequently associated with immunosuppression, denture wearing, advanced age, and excessive antibiotic use. Given the growing concerns about antifungal resistance, probiotics are being explored as potential adjuncts in the management of oral Candida overgrowth. Existing literature provides fragmented evidence; thus, an umbrella review was planned to synthesize the available evidence on the effectiveness of probiotic interventions in reducing oral Candida spp.
METHODS: A comprehensive, independent search was conducted in four databases (PubMed, Embase, Scopus, and Web of Science) covering literature from inception to 31st January 2026. Systematic reviews (SRs) with or without meta-analyses (MAs) assessing the effectiveness of probiotics in reducing oral Candida spp. count in terms of colony-forming units/mL (CFU/mL) were included. The quality assessment of the evidence was evaluated using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
RESULTS: Out of the 157 retrieved records, 7 studies were included in this umbrella review, out of which 5 were SRMAs, and 2 were SRs. The interventions involved multi-strain probiotics delivered through various formulations, routes, and treatment durations. Across the 5 SRMAs, probiotic interventions demonstrated beneficial effects by reducing Candida spp. with effect estimates ranging from odds ratio (OR) 0.06 to 0.71; however, wide interstudy heterogeneity (I2 = 0-78%) restricts the reliability and comparability of these findings. These effect estimates were derived from individual meta-analyses with heterogeneous study populations. Methodological assessment of the 7 included studies using the AMSTAR 2 tool identified 3 studies (42.8%) as having low confidence, while 4 studies (57.1%) were rated critically low. Similarly, the overall quality of evidence, as assessed by GRADE, ranged from low for the adult population to very low for the pediatric population, across three key clinical outcomes: reduction in oral Candida spp., clinical cure rate of OC, and recurrence rate.
CONCLUSIONS: Probiotics may have a potential role in the prevention and treatment of OC; however, the current evidence base cannot be generalized due to significant heterogeneity and methodological constraints. Probiotics can supplement conventional antifungal treatment, but their standalone use is not recommended yet. High-quality, standardized randomized controlled trials and comprehensive SRMAs are necessary to better understand the effectiveness of probiotics in OC management.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251117392.
METHODS: A comprehensive, independent search was conducted in four databases (PubMed, Embase, Scopus, and Web of Science) covering literature from inception to 31st January 2026. Systematic reviews (SRs) with or without meta-analyses (MAs) assessing the effectiveness of probiotics in reducing oral Candida spp. count in terms of colony-forming units/mL (CFU/mL) were included. The quality assessment of the evidence was evaluated using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
RESULTS: Out of the 157 retrieved records, 7 studies were included in this umbrella review, out of which 5 were SRMAs, and 2 were SRs. The interventions involved multi-strain probiotics delivered through various formulations, routes, and treatment durations. Across the 5 SRMAs, probiotic interventions demonstrated beneficial effects by reducing Candida spp. with effect estimates ranging from odds ratio (OR) 0.06 to 0.71; however, wide interstudy heterogeneity (I2 = 0-78%) restricts the reliability and comparability of these findings. These effect estimates were derived from individual meta-analyses with heterogeneous study populations. Methodological assessment of the 7 included studies using the AMSTAR 2 tool identified 3 studies (42.8%) as having low confidence, while 4 studies (57.1%) were rated critically low. Similarly, the overall quality of evidence, as assessed by GRADE, ranged from low for the adult population to very low for the pediatric population, across three key clinical outcomes: reduction in oral Candida spp., clinical cure rate of OC, and recurrence rate.
CONCLUSIONS: Probiotics may have a potential role in the prevention and treatment of OC; however, the current evidence base cannot be generalized due to significant heterogeneity and methodological constraints. Probiotics can supplement conventional antifungal treatment, but their standalone use is not recommended yet. High-quality, standardized randomized controlled trials and comprehensive SRMAs are necessary to better understand the effectiveness of probiotics in OC management.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251117392.