Paediatric Recurrent Ear, Nose and Throat Infections and Complications: Can We Do More?

Abstract

Recurrent respiratory tract infections (rRTIs), of which there are three main groups-otitis media, tonsillitis and sinusopathies-are very common in paediatric populations and are associated with significant morbidity and mortality due to complications. These infections substantially reduce quality of life for paediatric patients and their families and are a significant personal, medical and economic burden on the patients, the patients' families and the healthcare system. Most rRTIs are of viral origin; however, indiscriminate use of antibiotics in their treatment has led to development of bacterial resistance. Effective management of rRTIs to reduce the burden of disease and to avoid overuse of antibiotics has become a great therapeutic challenge. New strategies for the management of paediatric rRTIs include focus on prevention using non-specific immunomodulators to boost the body's natural defences against infection and to downregulate Enhanced digital features To view enhanced digital features for this article go to

Prevention of New Respiratory Episodes in Children with Recurrent Respiratory Infections: An Expert Consensus Statement from the World Association of Infectious Diseases and Immunological Disorders (WAidid)

“…OM-85 is a lysate of 21 strains of bacterial pathogens derived from the eight major species and sub-species that are a common cause of RTIs (Haemophilus influenzae, Streptococcus pneumoniae, Klebsiella pneumoniae, Klebsiella ozaenae, Staphylococcus aureus, Streptococcus pyogenes Streptococcus viridans, Moraxella catarrhalis) [ 19 ]. Several studies have shown that both innate and adaptive immunity are strongly influenced by OM-85 [ 50 , 51 , 52 , 53 , 54 ]. Oral OM-85 administration stimulates dendritic cell maturation in gastrointestinal Peyer’s patches, resulting in the increase of the immune defenses also in the lung mucosa [ 19 ].…”

“…Moreover, OM-85 stimulates antimicrobial peptide release and the activation of macrophages with the increased secretion of antiviral cytokines and chemokines such as IFN alpha and beta. Finally, B cell-activating cytokines are produced with increases in both serum and mucosal polyclonal immunoglobulins (IgG and IgA) [ 50 , 51 , 52 , 53 , 54 ].…”

Involvement of Mesenchymal Stem Cells in Oral Mucosal Bacterial Immunotherapy

“…Recurrent respiratory tract infections (RRTIs) are a leading cause of morbidity and mortality in children and adults (1,2). While many of the RRTIs are of viral origin, antibiotics are often misused in these conditions leading to bacterial resistance and microbiota disruption (3)(4)(5).…”

“…Therefore, implementation of effective strategies to improve their management has become a therapeutic challenge (6). An increasing number of studies are focused on prophylactic and therapeutic interventions that enhance the body's natural defenses against infections and/or downregulate the accompanying harmful inflammatory process (2,7). Mucosal immunotherapy with bacteria-derived products or whole cell bacteria may play that role.…”

“…Mucosal bacterial immunotherapy induces a broad range of both non-specific and specific immune responses in mucosal and extra-mucosal tissues (7,(12)(13)(14). Immune mechanisms include the induction of antimicrobial peptide and antiviral cytokine release, neutrophil and monocyte recruitment and also the modulation of the adaptive response, mainly through its effects on dendritic cells (DCs) (2,13,15,16).…”