Bacteriotherapy holds promise for treatment of recurrent AOM


A novel therapy to prevent recurrent acute otitis media (RAOM) shows promise in offering a new way to safely and effectively address this challenging problem.

A novel therapy to prevent recurrent acute otitis media (RAOM) shows promise in offering a new way to safely and effectively address this challenging problem.

Preliminary evidence from a retrospective observational study shows that children with RAOM treated prophylactically with a nasal spray composed of 2 saprophytic bacteria had a significant reduction of acute otitis media (AOM) episodes compared with children who did not receive the prophylactic treatment.1

Called bacteriotherapy, the treatment is based on the rationale that “good” bacteria can have a preventive effect on infections and can be used in the nasopharynx to inhibit the growth of local pathogens. Prior studies have shown the viability of colonizing the upper airways safely with Streptococcus salivarius 24SMB through use of a nasal spray in healthy people, and other data show the capability of this treatment to reduce the risk of new episodes of AOM in children prone to developing otitis.2.3

Study protocol

To confirm the benefits of this treatment approach in a real-life setting, investigators evaluated the efficacy of bacteriotherapy in a cohort of 267 children (115 males and 112 females) treated in a common practice run by family pediatricians in the Sicilian city of Catania. All children in the study were aged between 3 and 10 years and had a diagnosis of RAOM. Children were excluded from the study if they had severe allergic symptoms, congenital or acquired immunodeficiency, craniofacial abnormalities, sleep apnea, Down syndrome, chronic metabolic disorders, or interfering medications.

Investigators randomized children to 2 treatment approaches following their first episode of AOM during the months of November 2015 to March 2016: Group A (control group) consisted of 108 children who were treated with a standard course of antibiotics or analgesic/anti-inflammatory drugs as needed only during an episode of AOM. Group B (active group) consisted of 159 children who received a nasal spray composed of S. salivarious 24SMB and Streptococcus oralis 89a as preventive therapy 5 days following antibiotic treatment for AOM. Active treatment consisted of administration of 2 puffs of the nasal spray per nostril twice a day for 7 days. The course was administered for 3 consecutive months.

To assess the efficacy of bacteriotherapy to prevent RAOM, the study looked at the number of AOM episodes during the study period. The study also looked at the effect of bacteriotherapy on the severity grade of AOM episodes.

Impressive results

The study found that children in Group B treated with bacteriotherapy had a significant reduction in RAOM compared with children in the control group, with 9.4% of children in group B showing the same number of AOM episodes compared with 68.5% in group A (P<0.0001).

In addition, the study found a significant reduction in the severity grade of AOM episodes in children treated after preventive bacteriotherapy. During the first AOM episode, 78 (49%) of children in Group B had mild AOM, 58 (36%) moderate AOM, and 23 (15%) severe AOM. After preventive bacteriotherapy, the severity grade of AOM was mild AOM in 96 (81%) of the children and moderate AOM in 22 (19%). No child experienced severe AOM after preventive bacteriotherapy.

Emphasizing the challenge RAOM presents to pediatricians and parents, senior author of the study Giorgio Ciprandi, MD, Allergy and Respiratory Diseases Clinic, IRCCS-AOU San Martino, Genoa, Italy, underscored that the possibility of preventing it “represents a real objective in clinical practice.”

As such, these preliminary results hold promise to achieve this objective. “Noteworthy, bacteriotherapy is usually safe and well tolerated,” says Ciprandi, adding that this treatment approach also permits the reduced use of antibiotics.


1. La Mantia I, Varricchio A, Ciprandi G. Bacteriotherapy with Streptococcus salivarius 24SMB and Streptococcus oralis 89a nasal spray for preventing recurrent acute otitis media in children: a real-life clinical experience. Int J Gen Med. 2017;10:171-175.

2. Santagati M, Scillato M, Muscaridola N, Metoldo V, La Mantia I, Stefani S. Colonization, safety, and tolerability study of the Streptococcus salivarius 24SMBc nasal spray for its application in upper respiratory tract infections. Eur J Clin Microbiol Infect Dis. 2015;34(10):2075-2080.

3. Marchisio P, Santagati M, Scillato M, et al. Streptococcus salivarius 24SMB administered by nasal spray for the prevention of acute media otitis in otitis-prone children. Eur J Clin Microbiol Infect Dis. 2015;34(12):2377-2383.


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