Oral Probiotic Spray Effective for Recurrent Streptococcal Pharyngontonsilits in Children

by | Aug 11, 2020 | 2019, Infant and Children's Health, Probiotics

Written by Angeline A. De Leon, Staff Writer. The use of an oral spray of Streptococcus salivarius 24SMB and Streptococcus oralis 89a effectively treated recurrent acute pharyngotonsillitis in children and reduced the need for antibiotics that do not prevent recurrence.

Infant and Children's HealthGroup A beta-hemolytic Streptococcus (GABHS) is a gram-positive bacteria responsible for the development of recurrent acute pharyngotonsillitis (RAPT, an inflammatory condition involving infection of the tonsils and throat) in children 1. For patients with GABHS-positive RAPT, the most common approach to treatment involves the use of antibiotics, although the efficacy and prophylactic capacity of antibiotic treatment remains questionable 2. The oral probiotic Streptococcus salivary (S. salivary), a common member of the oral microflora in healthy individuals, has been shown to reduce recurrent pharyngeal infections in children and adults 3. S. salivary demonstrates the ability to restore nasopharyngeal flora balance 4, and S. orals 89a, a probiotic strain of S. salivary, is purported to specifically exhibit interference activity against streptococcal tonsillitis 5. When combined with another strain of S. salivary, S. salivary 24SMB, S. orals 89a has been found to effectively prevent recurrent otitis (ear infection) 6. To examine whether the synergistic benefit of using S. salivary 24SMB and S. orals 89a may be similarly applied to treat infections of the throat, researchers in Italy (2019) evaluated the efficacy of an oral spray combining both probiotic strains to treat RAPT in children 7.

Using a prospective, randomized, single-blind, placebo-controlled pilot study design, researchers recruited a total of 81 children (aged 6 to 11 years) with clinically confirmed GABHS. Patients were randomly assigned to receive 2 puffs of an oral spray containing a suspension of S. salivary 24SMB and S. orals 89a (125 x 109 colony forming units/mL) (2 x 109 CFU per puff) or an identical placebo once daily for 3 months. Frequency of GABHS pharyngotonsillar infections were evaluated throughout the treatment period and at 6-month follow-up based on monthly clinic visits and weekly reports made by parents over the phone. Secondary measures included symptom duration of each GAPHS episode, number of days antibiotic therapy was needed, number of school absences, and health-related quality of life.

Results indicated that over the course of the entire study period (from the start of the 90-day treatment period until 6-month follow-up), the mean number of GABHS infections episodes was significantly lower for the probiotic group vs. placebo (1.00 +/- 0.92 vs. 2.39 +/- 1.05, p < 0.00001). Median duration of GABHS infection was also lower for the probiotic group than the placebo group during the 90-day treatment period (0 days (Interquartile Range: 0-3) vs. 3 days (IQR: 4-4.5), p < 0.00001). During the treatment period, the probiotic group also demonstrated a significantly lower number of days under antibiotic therapy (3.90 +/- 4.94 days vs. 10.24 +/- 6.12 days, p < 0.00001), fewer days of absence from school (1.49 +/- 1.91 days vs. 3.66 +/- 2.08 days, p < 0.00001), and higher mean score on health-related quality of life (as measured by the EuroQol-5 Dimension) (83.41 +/- 4.65 vs. 77.39 +/- 5.54, p < 0.00001). Clinical outcomes remained significant up through the 6-month follow-up period.

Evidence from the current trial supports the clinical efficacy of S. salivarius 24SMB and S. oralis 89a as potential oral probiotics in the treatment of recurrent GABHS in children. The combination of both probiotic strains, in the form of an oral spray, appeared to exhibit a synergistic effect that successfully shortened the frequency and duration of GABHS infections, decreased the number of days antibiotic therapy was needed, and reduced the frequency of school absences, while enhancing quality of life. Use of the probiotic spray also produced significant changes that were evident up through 6 months post-treatment. In the future, it would be valuable for researchers to examine the effects of a combined S. salivarius 24SMB and S. oralis 89a oral spray on gut microbiota and to compare its performance to a positive control such as antibiotic treatment. Limitations of the current trial pertain to its relatively small sample size and its single-blind study design.

Source: Andaloro C, Santagati M, Stefani S, et al. Bacteriotherapy with Streptococcus salivarius 24SBC and Streptococcus oralis 89a oral spray for children with recurrent streptococcal pharyngotonsillitis: a randomized placebo-controlled clinical study. 2019; 276(3): 879-887. DOI: 10.1007/s00405-019-05346-3.

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

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Posted August 11, 2020.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

References:

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