Xylitol nasal spray for prevention of recurrent acute otitis media in children: A prospective two-center cohort study.

OBJECTIVES: The purpose of this study was to assess the effectiveness and safety of xylitol nasal spray as a prophylactic treatment for children with recurrent acute otitis media (AOM). METHODS: This is a prospective pilot study of children aged 1-4 years, diagnosed with recurrent AOM (at least three episodes in the three months before recruitment) between December 1, 2019 and January 31, 2023. Children were treated with nasal xylitol spray 2-3 times daily for 3 months. The number of AOM episodes and treatments administered were compared within 3-month intervals: before recruitment, during xylitol use, and during the three subsequent months. RESULTS: Of 68 children enrolled, 66 (97%) completed the follow-up, until July 2023. Thirty-eight (58%) were males. Sixty-three children (95%) were 12-24-months old. The mean number of AOM episodes during xylitol use, 1.06 (95% confidence interval [CI]: 0.73-1.39), was lower than in the 3-month previous interval, 4.12 (95% CI: 3.89-4.40), p < 0.001; and similar to that in the subsequent 3-month interval, 0.79 (95% CI: 0.49-1.08), p = 0.082. A similar pattern was observed in an analysis of the number of AOM episodes per patient month. The data were similar during spring and summer months as during autumn and winter months. Across the consecutive three-month intervals, decreases were observed in the mean number of AOM episodes treated with systemic antibiotics (3.35, 0.65, and 0.41), p < 0.001; and with topical antibiotics (1.38, 0.55, and 0.32), p < 0.001. No major side effects were recorded. CONCLUSIONS: The findings support the effectiveness and safety of nasal xylitol spray, for preventing recurrent AOM in children aged 1-4 years.

Avaliação antimicrobiana de uma resina Bulk Fill Fluida com inserção do xilitol / Antimicrobial evaluation of a Fluid Bulk Fill resin with xylitol insertion

Introdução: As resinas Bulk Fill apresentam uma boa procura pelos profissionais, pois o seu uso diminui o tempo clínico, como também a melhora qualidade das restaurações, porém não possuem atividade antibacteriana, sendo um dos fatores que ainda causam impacto negativo na vida das pessoas. A biomodificação com o xilitol tem o sentido de produzir ação microbiana e com isso aperfeiçoar as suas características clínicas. Objetivo: Avaliar a ação antimicrobiana de uma resina Bulk Fill flow após a inserção do xilitol. Metodologia: A resina Tetric® N-Flow Bulk Fill foi misturada às concentrações de xilitol (0% [Controle], 2,5% e 5% p/p). Amostras cilíndricas (n=5 do grupo controle e n=3 dos demais grupos experimentais) foram confeccionadas em moldes acrílicos de diâmetro de 2mm espessura, fotoativadas por 10s e armazenadas a 37ºC por 24h. Os espécimes foram esterilizados por luz ultravioleta por 20 minutos antes de serem acomodadas em uma placa de 48 poços estéril, sendo adicionado em cada poço 0,5mL de caldo Mueller Hinton. Então, adicionou-se 50µL do inóculo de S. mutans nos poços correspondentes. A placa foi incubada a 37 ± 1 ˚C durante 48 horas. Após o período de incubação, os espécimes foram gentilmente removidos e o crescimento microbiano foi indicado pela adição de 100µL da solução aquosa de resazurina (SigmaAldrich) a 0,01% com a posterior incubação a 37 ± 1 ˚C por duas horas. Micro-organismos viáveis reduzem o corante mudando sua coloração azul para rosa e a CIM foi definida como a menor concentração da substância que inibiu a mudança de coloração da resazurina. Em um poço contendo o grupo controle foi acrescentado clorexidina a 0,12% com o intuito de comparar o resultado gerado dos grupos testes. Resultado: Não houve inibição do crescimento bacteriano nos poços com inóculos que continham S. mutans e corpo de prova de resina acrescida de xilitol. Conclusão: Esse estudo mostrou que o acréscimo de 2,5% e 5% de Xilitol à resina Tetric® N-Flow Bulk Fill não apresentou inibição do crescimento bacteriano (AU).

Introduction: Bulk Fill resins are in good demand among professionals, as their use reduces clinical time and improves the quality of restorations, but they do not have antibacterial activity, which is one of the factors that still hurt people's lives. Biomodification with xylitol aims to improve its clinical characteristics. Objective: To evaluate the antimicrobial action of a Bulk Fill flow resin after inserting xylitol. Methodology: Tetric® N-Flow Bulk Fill resin was mixed with xylitol concentrations (0% [Control], 2.5% and 5% w/w). Cylindrical samples (n=5 from the control group and n=3 from the other groups) were made in acrylic molds with a diameter of 2 mm thick, light-cured for 10 s and stored at 37ºC for 24h. The specimens were sterilized by ultraviolet light for 20 minutes before being placed in a sterile 48-well plate, with 0.5 mL of Mueller Hinton broth added to each well. The plate was incubated at 37 ± 1 ˚C for 48 hours. After the incubation period, the specimens were gently removed, and microbial growth was indicated by adding 100 µL of 0.01% resazurin aqueous solution with subsequent incubation at 37 ± 1 ˚C for two hours. Viable microorganisms reduce the dye, changing its color from blue to pink. The MIC was defined as the lowest concentration of the substance that inhibited the color change of resazurin. In 0.12%, chlorhexidine was added to a well containing the control group to compare the results generated from the test groups. Result: There was no inhibition of bacterial growth in the wells with inocula containing S. mutans and the resin specimen with xylitol added. Conclusion: This study showed that adding 2.5% and 5% Xylitol to the Tetric® N-Flow Bulk Fill resin did not inhibit bacterial growth (AU).

Efeito da incorporação de xilitol na dureza de superfície de um compósito bulk fill fluido / Efeito da incorporação de xilitol na dureza de superfície de um compósito bulk fill fluido

Introdução: Frente à necessidade de maior longevidade das restaurações, o desenvolvimento de resinas antimicrobianas vem sendo necessário. O xilitol, um composto antimicrobiano natural e biocompatível, pode ser um aditivo em potencial para incluir esta propriedade em uma resina bulk fill fluida sem comprometer sua integridade. Objetivo: Avaliar a microdureza de superfície de uma resina antimicrobiana desenvolvida a partir da adição de xilitol (0% ou controle; 2,5%; 5%) em resina bulk fill fluida comercial (Tetric N-Flow Bulk Fill, Ivoclar Vivadent, Schaan, Liechtenstein). Metodologia: 3 grupos (n=12) foram obtidos através da variação da concentração de xilitol (0% ou controle; 2,5%; 5%). Para obter as resinas experimentais, xilitol em pó foi incorporado à resina fluida por espatulação manual por 1 min em uma câmara escura. A partir de um molde de acrílico, discos de 5 mm de diâmetro foram confeccionados através da fotoativação de um incremento único com um aparelho de LED de irradiância 1400 mW/cm² (Bluephase, Ivoclar Vivadent) por 10 s. Os discos foram submetidos à análise de microdureza Vickers (HMV-2, Shimadzu, Tokyo, Japan) na face superior, com uma carga estática de 300g e em um tempo de 10 s, obtendo uma média após três indentações por amostra. A análise estatística foi realizada através da variância ANOVA a um fator e teste de Tukey para a comparação entre os grupos (p < 0,05). Resultados: O grupo xilitol 5% mostrou a menor média de microdureza de superfície quando comparado aos grupos 0% e 2,5%. Conclusão: O xilitol afetou negativamente à dureza da restauração, principalmente quando foi utilizada uma concentração de 5% (AU).

Introduction: In view of the need for improved longevity of restorations, the development of antimicrobial resins has become necessary. Xylitol, a natural and biocompatible antimicrobial compound, may be a potential additive to include this property in a flowable bulk fill resin without compromising its integrity. Objective: To evaluate the surface microhardness of an antimicrobial resin developed by adding xylitol (0% or control; 2.5%; 5%) to a commercial flowable bulk fill resin (Tetric N-Flow Bulk Fill, Ivoclar Vivadent, Schaan, Liechtenstein). Methodology: 3 groups (n=12) were obtained by changing the xylitol concentration (0% or control; 2.5%; 5%). To obtain the experimental resins, xylitol powder was incorporated into the flowable resin by manual spatulation for 1 min in a darkroom. Based on an acrylic mold, 5 mm diameter disks were made by curing of a single increment with a 1400 mW/cm² irradiance LED device (Bluephase, Ivoclar Vivadent) for 10s. The disks were subjected to Vickers microhardness analysis (HMV-2, Shimadzu, Tokyo, Japan) on the upper face, with a static load of 300g and in a time of 10 s, obtaining an mean after three indentations for sample. Statistical analysis was performed using one-way ANOVA and Tukey's test for comparison between groups (p < 0.05). Results: The 5% xylitol group showed lower mean surface microhardness when compared to the 0% and 2.5% groups. Conclusion: Xylitol negatively affected restoration hardness mainly when a 5% concentration was used (p < 0.01) (AU).

Study protocol for a randomized clinical trial to evaluate the effect of the use of Xylitol gum in the prevention of caries lesions in children living in Ladakh-the Caries Prevention Xylitol in Children (CaPreXCh) trial.

BACKGROUND: Xylitol use is reported to be able to reduce dental plaque amount and cariogenic bacteria and, as a consequence, the caries increment. Only few data on the oral health of Ladakh's population are available. The aim of the present protocol will be to record the caries prevalence of primary and permanent molars of schoolchildren living in Ladakh and to implement a school-based Xylitol programme, named the Caries Prevention Xylitol in Children (CaPreXCh) trial, using chewing gums. METHODS: The protocol is designed as a triple-blind randomized, controlled, parallel-group clinical trial in children aged 5-14 years. The study should have been carried out from August 2021 to August 2024 in Zanskar Valley (Ladakh), but the COVID-19 pandemic does not allow today to make predictions on the exact start. Participants will be randomly allocated into two groups: subjects who will receive a chewing gum with Xylitol (70% w/v) as only sweetener, and those who will receive a sugared chewing gum containing Maltitol (23% w/v). The subjects will be instructed to chew a total of 6 pellets for 5 min divided into 3 intakes a day (2 in the morning, 2 after the midday meal and 2 in the afternoon) for one school year. Clinical examination will comprise an oral examination in which caries index (ICDAS scores), bleeding on probing and plaque pH evaluation after sucrose challenge will be recorded at baseline (t0); the clinical examination will be repeated after 12 months since the beginning of the chewing gum administration period (t1), after another 12-month period (t2) and finally after further 12 months (t3) (24 months from the end of the chewing gum use). The primary outcome will be the caries increment measured both at enamel and dentinal levels on primary and permanent molars. Data analysis will be conducted through Kaplan-Meyer graphs to evaluate caries increment. A comparison of the methods will be carried out with Cox regression with shared frailty. The net caries increment for initial, moderate and severe caries levels, using ICDAS (Δ-initial, Δ-moderate and Δ-severe), will be calculated. DISCUSSION: This trial will be the first trial conducted in India assessing the efficacy of a school-based caries preventive programme through the use of chewing gum containing only Xylitol as a sweetener. The findings could help strengthen the evidence for the efficacy of Xylitol use in community-based caries prevention programmes in children. TRIAL REGISTRATION: Clinical trials.gov NCT04420780 . Registered on June 9, 2020.

A New Peritoneal Dialysis Solution Containing L-Carnitine and Xylitol for Patients on Continuous Ambulatory Peritoneal Dialysis: First Clinical Experience.

Peritoneal dialysis (PD) is a feasible and effective renal replacement therapy (RRT) thanks to the dialytic properties of the peritoneal membrane (PM). Preservation of PM integrity and transport function is the key to the success of PD therapy, particularly in the long term, since the prolonged exposure to unphysiological hypertonic glucose-based PD solutions in current use is detrimental to the PM, with progressive loss of peritoneal ultrafiltration capacity causing technique failure. Moreover, absorbing too much glucose intraperitoneally from the dialysate may give rise to a number of systemic metabolic effects. Here we report the preliminary results of the first clinical experience based on the use in continuous ambulatory PD (CAPD) patients of novel PD solutions obtained through partly replacing the glucose load with other osmotically active metabolites, such as L-carnitine and xylitol. Ten CAPD patients were treated for four weeks with the new solutions. There was good tolerance to the experimental PD solutions, and no adverse safety signals were observed. Parameters of dialysis efficiency including creatinine clearance and urea Kt/V proved to be stable as well as fluid status, diuresis, and total peritoneal ultrafiltration. The promising tolerance and local/systemic advantages of using L-carnitine and xylitol in the PD solution merit further research.

Secondary oxalosis induced by xylitol concurrent with lithium-induced nephrogenic diabetes insipidus: a case report.

BACKGROUND: Xylitol is an approved food additive that is widely used as a sweetener in many manufactured products. It is also used in pharmaceuticals. Secondary oxalosis resulting from high dietary oxalate has been reported. However, reported cases of oxalosis following xylitol infusion are rare. CASE PRESENTATION: A 39-year-old man with a 16-year history of organic psychiatric disorder was hospitalized for a laparoscopic cholecystectomy because of cholecystolithiasis. He had been treated with several antipsychotics and mood stabilizers, including lithium. The patient had polyuria (> 4000 mL/day) and his serum sodium levels ranged from 150 to 160 mmol/L. Urine osmolality was 141 mOsm/L, while serum arginine vasopressin level was 6.4 pg/mL. The patient was diagnosed with nephrogenic diabetes insipidus (NDI), and lithium was gradually discontinued. Postoperative urine volumes increased further to a maximum of 10,000 mL/day, and up to 10,000 mL/day of 5% xylitol was administered. The patient's consciousness level declined and serum creatinine increased to 4.74 mg/dL. This was followed by coma and metabolic acidosis. After continuous venous hemodiafiltration, serum sodium improved to the upper 140 mmol/L range and serum creatinine decreased to 1.25 mg/dL at discharge. However, polyuria and polydipsia of approximately 4000 mL/day persisted. Renal biopsy showed oxalate crystals and decreased expression of aquaporin-2 (AQP2) in the renal tubules. Urinary AQP2 was undetected. The patient was discharged on day 82 after admission. CONCLUSIONS: Our patient was diagnosed with lithium-induced NDI and secondary oxalosis induced by excess xylitol infusion. NDI became apparent perioperatively because of fasting, and an overdose of xylitol infusion led to cerebrorenal oxalosis. Our patient received a maximum xylitol dose of 500 g/day and a total dose of 2925 g. Patients receiving lithium therapy must be closely monitored during the perioperative period, and rehydration therapy using xylitol infusion should be avoided in such cases.

Randomized controlled study of aerosolized hypertonic xylitol versus hypertonic saline in hospitalized patients with pulmonary exacerbation of cystic fibrosis.

BACKGROUND: Cystic fibrosis (CF) lung disease is characterized by chronic bacterial infection and recurrent pulmonary exacerbations. Xylitol is a 5-carbon sugar that can lower the airway surface salt concentration and augment innate immunity. We examined the safety and efficacy of aerosolized xylitol use for 2 weeks in subjects hospitalized with a pulmonary exacerbation of CF. METHODS: In a 2-week study, 60 subjects with cystic fibrosis and FEV1 > 30% predicted were enrolled to receive aerosolized 7% hypertonic saline (4 ml) or 15% xylitol (5 ml) twice a day for 14 days. Outcomes assessed included change from baseline in FEV1% predicted, change in sputum microbial density, revised CF quality of life questionnaire including the respiratory symptom score, time to next hospitalization for a pulmonary exacerbation, and frequency of adverse events. RESULTS: 59 subjects completed the study (one subject in the saline group withdrew before any study product administration). No significant differences were noted between the 2 arms in mean changes in lung function, sputum microbial density for Pseudomonas aeruginosa and Staphylococcus aureus, body weight, quality of life, and frequency of adverse events. CONCLUSIONS: Aerosolized hypertonic xylitol was well-tolerated among subjects hospitalized for CF pulmonary exacerbation. Future studies examining efficacy for long term use in patients with CF lung disease would be worthwhile. The clinical trial registration number for this study is NCT00928135.

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

BACKGROUND: Acute otitis media (AOM) is the most common bacterial infection among young children in the United States. There are limitations and concerns over its treatment with antibiotics and surgery and so effective preventative measures are attractive. A potential preventative measure is xylitol, a natural sugar substitute that reduces the risk of dental decay. Xylitol can reduce the adherence of Streptococcus pneumoniae (S pneumoniae) and Haemophilus influenzae (H influenzae) to nasopharyngeal cells in vitro. This is an update of a review first published in 2011. OBJECTIVES: To assess the efficacy and safety of xylitol to prevent AOM in children aged up to 12 years. SEARCH METHODS: We searched CENTRAL (to Issue 12, 2015), MEDLINE (1950 to January 2016), Embase (1974 to January 2016), CINAHL (1981 to January 2016), LILACS (1982 to January 2016), Web of Science (2011 to January 2016) and International Pharmaceutical Abstracts (2000 to January 2016). SELECTION CRITERIA: Randomised controlled trials (RCTs) or quasi-RCTs of children aged 12 years or younger where xylitol supplementation was compared with placebo or no treatment to prevent AOM. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials from search results, assessed and rated study quality and extracted relevant data for inclusion in the review. We contacted trial authors to request missing data. We noted data on any adverse events of xylitol. We extracted data on relevant outcomes and estimated the effect size by calculating risk ratio (RR), risk difference (RD) and associated 95% confidence intervals (CI). MAIN RESULTS: We identified five clinical trials that involved 3405 children for inclusion. For this 2016 update, we identified one new trial for inclusion. This trial was systematically reviewed but due to several sources of heterogeneity, was not included in the meta-analysis. The remaining four trials were of adequate methodological quality. In three RCTs that involved a total of 1826 healthy Finnish children attending daycare, there is moderate quality evidence that xylitol (in any form) can reduce the risk of AOM from 30% to around 22% compared with the control group (RR 0.75, 95% CI 0.65 to 0.88). Among the reasons for dropouts, there were no significant differences in abdominal discomfort and rash between the xylitol and the control groups. Xylitol was not effective in reducing AOM among healthy children during a respiratory infection (RR 1.13, 95% CI 0.83 to 1.53; moderate quality evidence) or among otitis-prone healthy children (RR 0.90, 95% CI 0.67 to 1.21; low-quality evidence). AUTHORS' CONCLUSIONS: There is moderate quality evidence showing that the prophylactic administration of xylitol among healthy children attending daycare centres can reduce the occurrence of AOM. There is inconclusive evidence with regard to the efficacy of xylitol in preventing AOM among children with respiratory infection, or among otitis-prone children. The meta-analysis was limited because data came from a small number of studies, and most were from the same research group.

Effects of xylitol on carbohydrate digesting enzymes activity, intestinal glucose absorption and muscle glucose uptake: a multi-mode study.

The present study investigated the possible mechanism(s) behind the effects of xylitol on carbohydrate digesting enzymes activity, muscle glucose uptake and intestinal glucose absorption using in vitro, ex vivo and in vivo experimental models. The effects of increasing concentrations of xylitol (2.5%-40% or 164.31 mM-2628.99 mM) on alpha amylase and alpha glucosidase activity in vitro and intestinal glucose absorption and muscle glucose uptake were investigated under ex vivo conditions. Additionally, the effects of an oral bolus dose of xylitol (1 g per kg BW) on gastric emptying and intestinal glucose absorption and digesta transit in the different segments of the intestinal tract were investigated in normal and type 2 diabetic rats at 1 hour after dose administration, when phenol red was used as a recovery marker. Xylitol exhibited concentration-dependent inhibition of alpha amylase (IC50 = 1364.04 mM) and alpha glucosidase (IC50 = 1127.52 mM) activity in vitro and small intestinal glucose absorption under ex vivo condition. Xylitol also increased dose dependent muscle glucose uptake with and without insulin, although the uptake was not significantly affected by the addition of insulin. Oral single bolus dose of xylitol significantly delayed gastric emptying, inhibited intestinal glucose absorption but increased the intestinal digesta transit rate in both normal and diabetic rats compared to their respective controls. The data of this study suggest that xylitol reduces intestinal glucose absorption via inhibiting major carbohydrate digesting enzymes, slowing gastric emptying and fastening the intestinal transit rate, but increases muscle glucose uptake in normal and type 2 diabetic rats.

Xylitol: a review on bioproduction, application, health benefits, and related safety issues.

Xylitol is a pentahydroxy sugar-alcohol which exists in a very low quantity in fruits and vegetables (plums, strawberries, cauliflower, and pumpkin). On commercial scale, xylitol can be produced by chemical and biotechnological processes. Chemical production is costly and extensive in purification steps. However, biotechnological method utilizes agricultural and forestry wastes which offer the possibilities of economic production of xylitol by reducing required energy. The precursor xylose is produced from agricultural biomass by chemical and enzymatic hydrolysis and can be converted to xylitol primarily by yeast strain. Hydrolysis under acidic condition is the more commonly used practice influenced by various process parameters. Various fermentation process inhibitors are produced during chemical hydrolysis that reduce xylitol production, a detoxification step is, therefore, necessary. Biotechnological xylitol production is an integral process of microbial species belonging to Candida genus which is influenced by various process parameters such as pH, temperature, time, nitrogen source, and yeast extract level. Xylitol has application and potential for food and pharmaceutical industries. It is a functional sweetener as it has prebiotic effects which can reduce blood glucose, triglyceride, and cholesterol level. This review describes recent research developments related to bioproduction of xylitol from agricultural wastes, application, health, and safety issues.

Biochemical perspectives of xylitol extracted from indigenous agricultural by-product mung bean (Vigna radiata) hulls in a rat model.

BACKGROUND: The production of xylitol from lignocellulosic material is of great interest around the world. It can be used as bulk sweetener and its possible lower energy value has increased acceptance for discerning consumers. Xylitol was produced from indigenous agricultural by-product (mung bean hulls) through Candida tropicalis fermentation. Further, xylitol incorporation at different concentrations (0, 100 and 200 g kg⁻¹) was carried out with the purpose of appraising the suitability and claimed health benefits of this dietetic ingredient in food products. Asserted biochemical perspectives of the xylitol intake were evaluated through biological studies for normal and streptozotocin-induced diabetic rats. RESULTS: The addition of xylitol significantly affected feed intake, weight gain, liver and cecum weight in both normal and diabetic rats. The biochemical profile of serum was improved with xylitol incorporation in the diet. Serum glucose, cholesterol and triglycerides levels were decreased depending on xylitol intake level. CONCLUSION: The results of the present study demonstrated that mung bean hulls have high potential as a new feedstock for xylitol production. In addressing the current concerns of obesity and diabetes, xylitol extracted from such agricultural waste should be considered in diet-based therapies for weight loss programmes.

Machining human dentin by abrasive water jet drilling.

The aim of this experimental in-vitro study was to investigate the machining of human dentin using an abrasive water jet and to evaluate the influence of different abrasives and water pressures on the removal rate. Seventy-two human teeth had been collected after extraction and randomly divided into six homogeneous groups (n=12). The teeth were processed in the area of root dentin with an industrial water jet device. Different abrasives (saccharose, sorbitol, xylitol) and water pressures (15 or 25 MPa) were used in each group. Dimensions of dentin removal were analysed using a stripe projection microscope and both drilling depth as well as volume of abrasion were recorded. Morphological analyses of the dentin cavities were performed using scanning electron microscopy (SEM). Both drilling depth and volume of abrasion were significantly influenced by the abrasive and the water pressure. Depending on these parameters, the drilling depth averaged between 142 and 378 µm; the volume of abrasion averaged between 0.07 and 0.15 mm3. Microscopic images revealed that all cavities are spherical and with clearly defined margins. Slight differences between the abrasives were found with respect to the microroughness of the surface of the cavities. The results indicate that abrasive water jet machining is a promising technique for processing human dentin.

Comparison of nasal hyperosmolar xylitol and xylometazoline solutions on quality of life in patients with inferior turbinate hypertrophy secondary to nonallergic rhinitis.

BACKGROUND: The purpose of this study was to objectively determine and compare the efficacy and effectiveness of xylitol solution (Xlear Nasal Sprey®) compared with xylometazoline and physiological saline with respect to quality of life (QoL) in patients with nasal congestion. METHODS: A prospective, randomized study was performed in 42 patients who had nasal obstruction and hypertrophied turbinate mucosa that was refractory to medical treatment. The study population was randomized into 3 groups according to the application of xylometazoline, physiological saline, and xylitol hyperosmolar solution. The efficacy of treatment was evaluated objectively (4-phase rhinomanometry) and subjectively (visual analogue scale VAS.) before and after the application of the nasal solutions. QoL was evaluated by means of Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). RESULTS: VAS scores and 4-phase rhinomanometry scores were better in the group treated with xylometazoline compared to those treated with xylitol or saline. The xylitol procedure yielded better results than the saline procedure, but differences were not statistically significant in both objective and subjective evaluation methods. For overall QoL, there was a significant improvement from baseline for the xylometazoline and xylitol groups. However, the improvement in the xylometazoline group was significantly greater than that obtained in the xylitol group. CONCLUSION: Xlear Nasal Spray® is an effective modality in the treatment of nasal congestion and has positive effect on the QoL of patients. Further studies are needed in order to plan an ongoing treatment of Xlear Nasal Sprey® at certain intervals for continuous relief of symptoms and a better and longstanding QoL.

Xylitol toxicosis in dogs.

The sugar alcohol xylitol is a popular sweetener used in gums, candies, and baked goods. While xylitol has a wide margin of safety in people and most mammalian species, when ingested by dogs it is believed to stimulate excessive insulin secretion leading to severe hypoglycemia, potentially followed by acute hepatic failure and coagulopathies. Additional clinical findings may include thrombocytopenia, hypokalemia, and hyperphosphatemia. The prognosis for recovery in dogs that develop uncomplicated hypoglycemia is generally good with prompt and aggressive veterinary care.

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

BACKGROUND: Acute otitis media (AOM) is the most common bacterial infection among young children in the United States with limitations and concerns over its treatment with antibiotics and surgery. Therefore, effective preventative measures are attractive. A potential preventative measure is xylitol, a natural sugar substitute that reduces the risk for dental decay. Xylitol can reduce the adherence of Streptococcus pneumoniae (S. pneumoniae) and Haemophilus influenzae (H. influenzae) to nasopharyngeal cells in vitro. OBJECTIVES: To assess the efficacy and safety of xylitol to prevent AOM in children up to 12 years old. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1950 to August Week 1, 2011), EMBASE (1974 to August 2011), CINAHL (1982 to August 2011), Health and Psychosocial Instruments (1985 to August 2011), Healthstar (OVID) (1966 to August 2011) and International Pharmaceutical Abstracts (2000 to August 2011). SELECTION CRITERIA: Randomised controlled trials (RCTs) or quasi-RCTs of children aged 12 years or younger where xylitol supplementation was compared to placebo or no treatment to prevent AOM. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials from search results, assessed and rated study quality and extracted relevant data for inclusion in the review. We contacted trial authors to request missing data. We noted data on any adverse events of xylitol. We extracted data on relevant outcomes and estimated the effect size by calculating risk ratio (RR), risk difference (RD) and associated 95% confidence intervals (CI). MAIN RESULTS: We identified four studies of adequate methodological quality that met our eligibility criteria. In three RCTs with a total of 1826 healthy Finnish children attending day care, there was a reduced risk of occurrence of AOM in the xylitol group (in any form) compared to the control group (RR 0.75; 95% CI 0.65 to 0.88). The fourth RCT included 1277 Finnish day care children with a respiratory infection and found no effect of xylitol on reducing the occurrence of AOM (RR 1.13; 95% CI 0.83 to 1.53). Xylitol chewing gum was superior to xylitol syrup in preventing AOM among healthy children (RR 0.59; 95% CI 0.39 to 0.89) but not during respiratory infection (RR 0.68; 95% CI 0.43 to 1.07). There was no difference between xylitol lozenges and xylitol syrups in preventing AOM among healthy children (RR 0.77; 95% CI 0.53 to 1.11) or among children during respiratory infection (RR 0.74; 95% CI 0.47 to 1.14). Similarly, no difference was noted between xylitol chewing gum and xylitol lozenges in preventing AOM among healthy children (RR 0.73; 95% CI 0.47 to 1.13) or among children during respiratory infection (RR 0.92; 95% CI 0.59 to 1.46). Among the reasons for drop-outs, there were no significant differences in abdominal discomfort and rash between the xylitol and the control groups. AUTHORS' CONCLUSIONS: There is fair evidence that the prophylactic administration of xylitol among healthy children attending day care centres reduces the occurrence of AOM by 25%. This meta-analysis is limited since the data arise from a small number of studies, mainly from the same research group.

Effect of xylitol gum on the level of oral mutans streptococci of preschoolers: block-randomised trial.

OBJECTIVES: To assess the influence of xylitol chewing gum consumption on mutans streptococci level of 3-4 years old Japanese preschoolers. METHODS: 248 participants were examined regarding caries-related factors at baseline and were followed up at 6, 9, and 12 months after the baseline: assessors were blinded, subjects were open labelled and blocked parallel randomised; 142 were selected to use xylitol gum for 3 months (from months 6 to 9) and 106 were controls. RESULTS: 161 participants were analysed (xylitol n = 76, control n = 85). Nineteen caries-related variables, including xylitol gum consumption, were analysed for any association with the main outcome, plaque mutans streptococci scores development within the intervention period, by logistic regression. Six showed statistically significant associations by univariate analysis (P < 0.05). However, only xylitol gum consumption remained a significant negative association (P < 0.05) by multiple analyses. Interestingly, over 10% xylitol group children experienced diarrhoea, which was larger than previous investigations. CONCLUSION: Xylitol gum is effective in avoiding increased plaque mutans streptococci in young children.

Xylitol as a prophylaxis for acute otitis media: systematic review.

A systematic review was conducted to evaluate evidence regarding xylitol, a sugar alcohol, as a prophylaxis for acute otitis media (AOM) in children. The authors searched PubMed and other databases to identify evidence. Criteria for included studies were: appear in English-language, peer-reviewed journals; at least quasi-experimental designs; use xylitol; and present outcome data. The authors completed evaluation forms for the included studies at all phases of the review. The authors reviewed 1479 titles and excluded 1435. Abstracts and full texts were reviewed for the remaining 44; four randomized controlled trials met inclusion criteria. Xylitol was a generally well accepted prophylaxis for AOM with few side effects when administered via chewing gum or syrup at 10 g/day given five times daily. Meta-analysis revealed significant treatment effects (Risk ratio = 0.68; 95% confidence interval = 0.57 to 0.83). Xylitol can be a prophylaxis for AOM, but warrants further study, especially of vehicles other than chewing gum for young children, and information is needed regarding cost, duration of administration required, and expected long-term effects.