Streptococcus salivarius by nasal spray for recurrent otitis: how good is the evidence?

Excerpt

The paper by Marchisio et al. [1] entitled ‘Streptococcus salivarius 24SMB administered by nasal spray for the prevention of acute otitis media (AOM) in otitis-prone children’ raises several issues. First, it is reported that 100 healthy children were treated for 10 days with amoxicillin (80 mg/kg/day) plus clavulanic acid. We have concerns about that treatment, given the risk of increasing antibiotic resistance [2] and considering that such combination of antimicrobials in such a high dosage is frequently associated with gastrointestinal side effects [3]. Besides in case of AOM, no analgesic therapy was administered in spite of guidelines consistently recommending high dose of acetaminophen or ibuprofen as first line treatment to reduce pain [3‐7]. Quite surprisingly, the authors report that antipyretics were exclusively administered in case of fever, while the analgesic dose is almost twice the antipyretic dose in the first 24–48 hours of treatment [8]. …