European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 3, pp 879–887 | Cite as

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

  • Claudio AndaloroEmail author
  • Maria Santagati
  • Stefania Stefani
  • Ignazio La Mantia



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.


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.


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.


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.


Streptococcus pyogenes Tonsillitis Streptococcus salivarius Probiotics 




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional committee of the School of Medicine—ASP 3 Catania (ID: 083/17) and with the 1964 Helsinki declaration.

Informed consent

Informed consent was obtained from all parents of children included in the study.


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Copyright information

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

Authors and Affiliations

  1. 1.Ear, Nose and Throat UnitSanta Marta e Santa Venera HospitalAcirealeItaly
  2. 2.LabMMAR, Department of Biomedical and Biotechnological Sciences, Section of MicrobiologyUniversity of CataniaCataniaItaly
  3. 3.Department of Medical Sciences, Surgical and Advanced Technologies, GF IngrassiaUniversity of CataniaCataniaItaly

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