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Preventing recurrent acute otitis media with Streptococcus salivarius 24SMB and Streptococcus oralis 89a five months
Anna Cantarutti1, Federico Rea1, Daniele Donà2
1Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
Insights
This study found that a five-month nasal spray treatment with Streptococcus salivarius and Streptococcus oralis reduced acute otitis media (AOM) episodes and antibiotic prescriptions in children with recurrent AOM.
Area of Science:
- Pediatrics
- Microbiology
- Infectious Diseases
Background:
- Acute otitis media (AOM) is a common childhood illness frequently treated with antibiotics.
- Recurrent AOM affects approximately one-third of children under three years old.
- Nasopharyngeal flora may play a role in preventing AOM by inhibiting otopathogens.
Purpose of the Study:
- To evaluate the efficacy of a five-month nasal spray treatment containing Streptococcus salivarius 24SMB and Streptococcus oralis 89a.
- To determine if this treatment prevents recurrent AOM and reduces antibiotic prescriptions in children diagnosed with recurrent AOM.
Main Methods:
- An observational prospective cohort study was conducted with children aged 1-6 years diagnosed with recurrent AOM.
- 81 children received a five-month intermittent nasal spray treatment (7 days/month) with S. salivarius 24SMB and S. oralis 89a.
- A 1:1 matched control group of untreated children was selected for comparison.
Main Results:
- The analysis included 158 children (79 treated, 70 untreated).
- A statistically significant 34% reduction in AOM episodes was observed in the treated group compared to the untreated group.
- Antibiotic dispensing was significantly lower in treated children (24% reduction).
Conclusions:
- Intermittent nasal spray treatment with S. salivarius 24SMB and S. oralis 89a may effectively prevent antibiotic use associated with recurrent AOM in children.
- The findings suggest a potential preventative strategy for recurrent AOM.
- Larger studies are recommended to further investigate this clinical problem.
Introduction:
Acute otitis media (AOM) is the most common childhood disease leading to antibiotic use. More than 80% of children under three years of age experience at least one episode, and about one-third of these report significant recurrence of episodes. In recent years, several studies reported that normal nasopharyngeal flora inhibits growth of common otopathogens, suggesting that maintenance of an "adequate" nasopharyngeal flora might prevent occurrence of upper respiratory tract infections, including AOM. This study aims to determine whether five-month treatment with Streptococcus salivarius 24SMB and Streptococcus oralis 89a nasal spray prevents recurrence of AOM and prescription of antibiotics in children with diagnosis of recurrent AOM.
Methods:
Observational prospective cohort study including children aged 1-6 years with diagnosis of recurrent AOM registered with 31 Italian family pediatricians. 81 children were enrolled in the study from September 2016 to the end of the five therapeutic cycles of the Streptococcus salivarius 24SMB and Streptococcus oralis 89a supplied 7 days each month for 5 consecutive months. For each treated child, one untreated control was randomly selected, 1:1 matched for gender, age, and follow-up.
Results:
158 children (79 treated and 70 untreated) were included into the analysis (mean age, 3.9 years; 47% female). Univariate analysis showed a statistically significant 34% (95% CI 1%-56%) reduction in number of AOM episodes in treated children compared with those not treated. Significantly fewer antibiotics were dispensed among treated children (24%, 95% CI 1%-41%).
Conclusions:
Our findings suggest that intermittent treatment of children with diagnosis of recurrent AOM with nasal spray containing Streptococcus salivarius 24SMB and Streptococcus oralis 89a for a period of five months might be effective in preventing antibiotic use associated with recurrent episodes of AOM. Additional larger studies to address this important clinical problem are recommended.
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