Bacteriotherapy with Streptococcus salivarius 24SMB and Streptococcus oralis 89a oral spray for children with recurrent streptococcal pharyngotonsillitis: a randomized placebo-controlled clinical study

Eur Arch Otorhinolaryngol. 2019 Mar;276(3):879-887. doi: 10.1007/s00405-019-05346-3. Epub 2019 Feb 15.


Purpose: Group A beta-hemolytic Streptococcus (GABHS) causes a recurrent acute pharyngotonsillitis (RAPT) in children. Moreover, the repeated use of antibiotics contributes to its resistance. However, S. Salivarius 24SMB and S. oralis 89a were effective probiotics in other infections. Thus, we decided to evaluate this combination efficacy compared to placebo in RAPT.

Methods: Patients with microbiologically confirmed GABHS were enrolled in this randomized, placebo-controlled trial. They received the aforementioned combination or placebo as an oral spray. We investigated episodes of frequency and duration, need for antibiotics, school days lost, the treatment impact on life quality, treatment compliance and side effects during a 90-day treatment and a 6-month follow-up.

Results: We included 41 patients in each group. The mean number of GABHS infection was significantly lower during both study periods for the two groups. However, our treatment group showed a lower rate. Moreover, the probiotic group had a lower mean number and a shorter median duration of GABHS episodes during both study periods than controls. Furthermore, the mean duration of antibiotic treatment was lower in the probiotic group during the 90-day and 6-month follow-up periods. Similarly, patients in the probiotic group showed a significantly lower mean number of absence days from school but higher EQ-VAS score. Indeed, all patients included were compliant to treatment.

Conclusions: We identified potential probiotics, possessing desirable features against GABHS pharyngotonsillitis. Our findings represent the first evidence which throws the light on using these probiotics that can reduce antibiotics use which did not have efficient results regarding recurrence.

Keywords: Probiotics; Streptococcus pyogenes; Streptococcus salivarius; Tonsillitis.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • Biological Therapy / methods*
  • Child
  • Child, Preschool
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Oral Sprays
  • Pharyngitis / microbiology
  • Pharyngitis / therapy
  • Probiotics / administration & dosage
  • Probiotics / therapeutic use*
  • Recurrence
  • Streptococcal Infections / microbiology
  • Streptococcal Infections / therapy*
  • Streptococcus agalactiae*
  • Streptococcus oralis*
  • Streptococcus pyogenes
  • Streptococcus salivarius*
  • Tonsillitis / microbiology
  • Tonsillitis / therapy*


  • Anti-Bacterial Agents
  • Oral Sprays