Probiotics and Antimicrobial Proteins

, Volume 9, Issue 2, pp 102–110 | Cite as

Influence of Oral Probiotic Streptococcus salivarius K12 on Ear and Oral Cavity Health in Humans: Systematic Review

  • Katarina ZupancicEmail author
  • Valentina Kriksic
  • Irena Kovacevic
  • Dujo Kovacevic


Traditionally, probiotics are linked to the good health of the intestine and most clinical studies focus on that field. Evidence of oral probiotic use for ear and oral cavity disease prevention with impact on human health is limited. This work reviews existing studies and literature on Streptococcus salivarius K12 as an oral probiotic and effects of S. salivarius K12 on human ear and oral cavity human health. The studies were accessed via database searches: MEDLINE, PubMed, and Elsevier. The search included/focused on/encompassed publications from 2003 to 2016 with keywords related to K12 Streptococcus salivarius, bacteriocin-like inhibitory substances (BLIS) K12, probiotic K12 salivarius, and K12 probiotic health effects. Only a small amount of studies was identified: the total of 68 studies was identified, 35 of which were relevant after screening, and 9 were included in the final analysis. Very little literature is available about the association/correlation between/connection/interrelation of S. salivarius K12 with/and human ear and oral cavity health. S. salivarius K12 may have a role in reducing the occurrence and/or severity of secretory otitis media (SOM) and also in prevention of streptococcal and viral pharyngotonsillitis in children. Research highlights that S. salivarius K12 has shown promising results in treatment of halitosis, but data are still deficient. Further studies need to be initiated to improve understanding of the association of oral probiotic S. salivarius K12 with human ear and oral cavity health.


Streptococcus salivarius K12 BLIS K12 Otitis media Oral health 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Ma F, Zhou C, Wang J, Liu T, Liu J (2015) Probiotics in the treatment of peptic ulcer infected by Helicobacter pylori and its safety. Pak J Pharm Sci 28:1087–1090 Google Scholar
  2. 2.
    Reid G, Dols J, Miller W (2009) Targeting the vaginal microbiota with probiotics as a means to counteract infections. Curr Opin Clin Nutr Metab Care 12:583–587CrossRefGoogle Scholar
  3. 3.
    Borchert D, Sheridan L, Papatsoris A, Faruquz Z, Barua JM, Junaid I, Pati Y, Chinegwundoh F, Buchholz N (2008) Prevention and treatment of urinary tract infection with probiotics: review and research perspective. Indian J Urol 24:139–144CrossRefGoogle Scholar
  4. 4.
    Fuchs-Tarlovsky V, Marquez-Barba MF, Sriram K (2016) Probiotics in dermatologic practice. Nutrition 32:289–295CrossRefGoogle Scholar
  5. 5.
    Food and Agriculture Organization of the United Nations/ World Health Organization (FAO/WHO) (2002) Guidelines for the evaluation of probiotics in food. Report of a Joint FAO/WHO expert group on drafting guidelines for the evaluation of probiotics in foodGoogle Scholar
  6. 6.
    Hye-Ji K, Sin-Hyeog I (2015) Probiotics as an immune modulator. J Nutr Sci Vitaminol 61:S103–S105CrossRefGoogle Scholar
  7. 7.
    Britton RA, Versalovic J (2008) Probiotics and gastrointestinal infections. Interdiscip Perspect Infect Dis 2008:290769CrossRefGoogle Scholar
  8. 8.
    Smith DJ, Anderson JM, King WF, van Houte J, Taubman MA (1993) Oral streptococcal colonization of infants. Oral Microbiol Immunol 8:1–4 CrossRefGoogle Scholar
  9. 9.
    Wescombe PA, Tagg JR (2012) Developing oral probiotics from Streptococcus salivarius. Future Microbiol 7:1355–1371CrossRefGoogle Scholar
  10. 10.
    Cosseau C, Devine DA, Dullaghan E, Gardy JL, Chikatamarla A, Gellatly S, Yu LL, Pistolic J, Falsafi R, Tagg J, Hancock RE (2008) The commensal Streptococcus salivarius K12 downregulates the innate immune responses of human epithelial cells and promotes host-microbe homeostasis. Infect Immun 76:4163–4175CrossRefGoogle Scholar
  11. 11.
    Hyink O, Wescombe PA, Upton M, Ragland N, Burton JP, Tagg JR (2007) Salivaricin A2 and the novel lantibiotic salivaricin B are encoded at adjacent loci on a 190-kilobase transmissible megaplasmid in the oral probiotic strain Streptococcus salivarius K12. Appl Environ Microbiol 73:1107–1113CrossRefGoogle Scholar
  12. 12.
    Burton JP, Wescombe PA, Moore CJ, Chilcott CN, Tagg JR (2006) Safety assessment of the oral cavity probiotic Streptococcus salivarius K12. Appl Environ Microbiol 72:3050–3053CrossRefGoogle Scholar
  13. 13.
    Saxelin M, Tynkkynen S, Mattila-Sandholm T, de Vos WM (2005) Probiotic and other functional microbes: from markets to mechanisms. Curr Opin Biotechnol 16:204–211CrossRefGoogle Scholar
  14. 14.
    Coyte PC, Asche CV, Elden LM (1999) The economic cost of otitis media in Canada. Int J of Pediatr Otorhinolaryngol 49:27–36CrossRefGoogle Scholar
  15. 15.
    Burrows HL, Blackwood RA, Cooke JM, Harrison RV, Passamani PP (2013) Otitis media guideline team. University of Michigan Health System, Otitis media guidelineGoogle Scholar
  16. 16.
    Rosenfeld RM, Schwartz SR, Pynnonen MA, Tunkel DE, Hussey HM, Fichera JS, Grimes AM et al (2013) Clinical practice guideline: tympanostomy tubes in children. Otolaryngol Head Neck Surge 149:S1–S35. doi: 10.1177/0194599813487302 CrossRefGoogle Scholar
  17. 17.
    Loos BG, Bernstein JM, Dryja DM, Murphy TF, Dickinson DP (1989) Determination of the epidemiology and transmission of nontypable Haemophilus influenzae in children with otitis media by comparison of total genomic DNA restriction fingerprints. Infect Immun 57:2751–2757 Available at: Google Scholar
  18. 18.
    Worrall G (2007) Acute otitis media. Can Fam Physician 53:2147–2148Google Scholar
  19. 19.
    Bollen CM, Beikler T (2012) Halitosis: the multidisciplinary approach. Int J Oral Sci 4:55–63CrossRefGoogle Scholar
  20. 20.
    Gokdogan O, Catli T, Ileri F (2015) Halitosis in otorhinolaryngology practice. Iran J Otorhinolaryngol 27:145–153Google Scholar
  21. 21.
    Hughes FJ, McNab R (2008) Oral malodour—a review. Arch Oral Niol 53:1–7 Available at: CrossRefGoogle Scholar
  22. 22.
    Murray RC, Chennupati SK (2012) Chronic streptococcal and non-streptococcal pharyngitis. Infect Disord Drug Targets 12:281–285CrossRefGoogle Scholar
  23. 23.
    Bonsignori F, Chiappini E, De Martino M (2010) The infections of the upper respiratory tract in children. Int J Immunopathol Pharmacol 23:16–19Google Scholar
  24. 24.
    Vicedomini D, Lalinga G, Lugli N, D'Avino A (2014) Diagnosis and management of acute pharyngotonsillitis in the primary care pediatrician’s office. Minerva Pediatr 66:69–76 Available at: Google Scholar
  25. 25.
    van Zon A, van der Heijden GJ, van Dongen TM, Burton MJ, Schilder AG (2013) Antibiotics for otitis media with effusion in children. Clin Otolaryngol 38:54–55CrossRefGoogle Scholar
  26. 26.
    Haukioja A (2010) Probiotics and oral health. Eur J Dent 4:348–355 Available at: Google Scholar
  27. 27.
    Ljungh A, Wadström T (2009) Lactobacillus molecular biology: from genomics to probiotics. Biotechnol J 4:283–283CrossRefGoogle Scholar
  28. 28.
    Jain P, Sharma P (2012) Probiotics and their efficacy in improving oral health: a review. J Appl Pharm Sci 2:151–163 Available at: Google Scholar
  29. 29.
    Di Pierro F, Donato G, Fomia F, Adami T, Careddu D, Cassandro C, Albera R (2012) Preliminary pediatric clinical evaluation of the oral probiotic Streptococcus salivarius K12 in preventing recurrent pharyngitis and/or tonsillitis caused by Streptococcus pyogenes and recurrent accute otitis media. Int J Gen Med 5:991–997 Available at. CrossRefGoogle Scholar
  30. 30.
    Di Pierro F, Colombo M, Zanvit A, Risso P, Rottoli SA (2014) Use of Streptococcus salivarius K12 in the prevention of streptococcal and viral pharyngotonsillitis in children. Drug Healthc Pat Saf 6:15–20 Available at: CrossRefGoogle Scholar
  31. 31.
    Gregori G, Righi O, Risso P, Boiardi G, Demuru G, Ferzetti A, Galli A et al (2016) Reduction of group a beta-hemolytic streptococcus pharyngo-tonsillar infections associated with use of the oral probiotic streptococcus salivarius k12: a retrospective observational study. Ther Clin Risk Manag 12:87–91 Available at: CrossRefGoogle Scholar
  32. 32.
    Di Pierro F, Adami T, Rapacioli G, Giardini N, Streitberger C (2013) Clinical evaluation of the oral probiotic Streptococcus salivarius K12 in the prevention of recurrent pharyngitis and/or tonsillitis caused by Streptococcus pyogenes in adults. Expert Opin Biol Ther 13:339–343 Available at: CrossRefGoogle Scholar
  33. 33.
    Burton JP, Chilcott CN, Moore CJ, Speiser G, Tagg JR (2006) A preliminary study of the effect of probiotic Streptococcus salivarius K12 on oral malodour parameters. J Appl Microbiol 100:754–764 Available at: CrossRefGoogle Scholar
  34. 34.
    Masdea L, Kulik EM, Hauser-Gerspach I, Ramseier AM, Filippi A, Waltimo T (2012) Antimicrobial activity of Streptococcus salivarius K12 on bacteria involved in oral malodour. Arch Oral Biol 57:1041–1047 Available at: CrossRefGoogle Scholar
  35. 35.
    Power DA, Burton JP, Chilcott CN, Dawes PJ, Tagg JR (2008) Preliminary investigations of the colonisation of upper respiratory tract tissues of infants using a paediatric formulation of the oral probiotic Streptococcus salivarius K12. Eur J Clin Microbiol Infect Dis 27:1261–1263 Available at: CrossRefGoogle Scholar
  36. 36.
    Walls T, Power D, Tagg J (2003) Bacteriocin-like inhibitory substance (BLIS) production by the normal flora of the nasopharynx: potential to protect against otitis media? J Med Microbiol 52:829–833 Available at: CrossRefGoogle Scholar
  37. 37.
    Di Pierro F, Di Paquale D, Di Cicco M (2015) Oral use of Streptococcus salivarius K12 in children with secretory otitis media: preliminary results of a pilot, uncontrolled study. Int J Gen Med 15:303–308 Available at: CrossRefGoogle Scholar
  38. 38.
    Yaegaki K, Coil JM (2000) Examination, classification, and treatment of halitosis: clinical perspectives. J Can Dent Assoc 66:257–261Google Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Katarina Zupancic
    • 1
    Email author
  • Valentina Kriksic
    • 2
  • Irena Kovacevic
    • 3
  • Dujo Kovacevic
    • 4
  1. 1.Medikor, Department of NutritionZagrebCroatia
  2. 2.Institution for Home Healthcare DomniusZagrebCroatia
  3. 3.University of Applied Health StudiesZagrebCroatia
  4. 4.Department of SurgeryUniversity Hospital Centre “Sisters of Mercy”ZagrebCroatia

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