Abstract
In healthy infants and young children, the development of respiratory tract infections (RTIs) is extremely common. In this paper, we present an international consensus of the available approaches for the prevention of recurrent RTIs in children, including the atopic/allergic ones as well as those with asthma. Few convincing measures for reducing the frequency and clinical relevance of recurrent respiratory episodes in RTI-prone children have been developed until now. Among the most recently suggested measures, immunotherapy is attractive, but only for OM-85 is there a sufficient number of well-conducted clinical trials confirming efficacy in RTIs prevention with an adequate safety profile. In the case of probiotics, it is not clear which bacteria can offer the best results and which dosage and schedule of administration are the most effective. The problems of dosage and the schedule of administration are not solved also for vitamin D, despite some promising efficacy results. While we wait for new knowledge, the elimination or reduction as much as possible of the environmental factors that favor RTIs, vaccination when available and/or indicated, and the systematic application of the traditional methods for infection prevention, such as hand washing, remain the best measures to prevent recurrent infections in RTI-prone children.
Highlights
In otherwise healthy infants and young children, the development of respiratory tract infections (RTIs) is widespread
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]
Demographic and clinical characteristics of children enrolled in these studies were in some cases not uniform, this analysis seems to indicate an actual possibility for the use of OM-85 to prevent new recurrences of RTI in RTI-prone children. Another meta-analysis performed by Del Rio Navarro and the Cochrane group showed a reduction of the mean rate of acute RTIs of 36% in children with recurrent RTIs treated with OM-85 [62]
Summary
In otherwise healthy infants and young children, the development of respiratory tract infections (RTIs) is widespread. There is no consensus on which children should be considered RTI-prone (i.e., suffering from recurrent RTIs), as different countries use different criteria. When lower RTIs occur, the number of infections needed to be considered RTI-prone is reduced to 2–3 episodes/year. We present an international consensus of the available approaches for the prevention of RTIs in children, including the atopic/allergic ones as well as those with asthma. We hope it will assist pediatricians and general practitioners in making better decisions when attending children with recurrent RTIs. A search in Pubmed for all of the studies published up to April 2020 was performed using “children”/“paediatric”/“pediatric” and “respiratory infection” and “prevention” as keywords. The search was limited to articles published in English that provided evidence-based data
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