Table 1.
Consensus statements on products used for prevention of respiratory tract infections (RTIs) in RTI-prone children.
| Product | Main Data | Main Limitations | Consensus Statement and Suggestions for Future Research |
|---|---|---|---|
| Pidotimod | Positive influence on innate and adaptive immunity in vitro, efficacy in prevention of RTIs in RTI-prone children, duration and severity of respiratory symptoms, antibiotic use, good safety profile. | Licensed for children ≥3 yrs, to be given 2 hrs before or after meals, available only in few countries, few studies available with sufficient details on randomization method and using blind approach, heterogeneity in dosages and schedule of administration. | Pidotimod could play a role in prevention of respiratory recurrences in RTI-prone children ≥3 yrs old, although further randomized, double-blind studies are needed to confirm population that could have advantages and to define the dosages and schedule of administration. |
| OM-85 | Positive influence on innate and adaptive immunity in vitro, downregulation of inflammatory state, efficacy in prevention of RTIs in RTI-prone children, duration and severity of respiratory symptoms, antibiotic use, days of absence from day-care of children and working days lost by parents, efficacy in children with recurrent wheezing and asthma, excellent safety profile. | Absence of biomarkers able to predict the best responder profile and a precise-host tailored medicine. | OM-85 should be recommended for prevention of respiratory recurrences in RTI-prone children ≥6 months old, although further studies on detection of biomarkers able to support the identification of best responder profile and a precise-host tailored medicine are needed. |
| Ribomunyl | Modulation of innate and adaptive immunity in vitro, some clinical evidence in reduction of RTI and antibiotic courses. | Availability of few studies with enrolment of a relatively low number of children. Not available on the market worldwide anymore. | Ribomunyl cannot be recommended for the prevention of recurrences in RTI-prone children. |
| PBML and LW50020 | Stimulation of innate and adaptive immunity in vitro. | Few clinical evidences. | PBML and LW50020 cannot be recommended for the prevention of recurrences in RTI-prone children. |
| B-glucans | Enhancement of activity of innate and adaptive immunity in vitro. | Contrasting results in efficacy against respiratory recurrences, good safety and tolerability profile. | B-glucans cannot be recommended for the prevention of recurrences in RTI-prone children. |
| Probiotics | Modulation of innate and adaptive immunity in vitro, main data on Lactobacillus spp. and Bifidobacterium spp. that in some studies reduced episodes of upper RTI, antibiotic use and school absences. | Very few data on RTI-prone children, heterogeneity in type of probiotic tested, dose and duration of administration. | Probiotics cannot be recommended for the prevention of recurrences in RTI-prone children. |
| Vitamins | Vitamin A and vitamin C: No reliable data on vitamin A and vitamin C Vitamin D: Modulation of innate and adaptive immunity in vitro, safe protection against acute RTIs, with major benefits in very deficient individuals and those not receiving bolus doses. |
Vitamin A and vitamin C: No evidence for the prevention of RTIs in children. Vitamin D: Few data on RTI-prone children. |
Vitamin A and vitamin C cannot be recommended for the prevention of recurrences in RTI-prone children. Vitamin D could play a role in children with recurrent RTIs, although further methodologically adequate studies in RTI-prone children are needed to clarify the lowest minimum vitamin D serum level associated with an increased risk of RTIs, the most effective dosage, schedule of administration and duration of treatment. |
| Echinacea | Stimulation of macrophage with production of cytokines as well as antiviral and antibacterial action in vitro. | No evidence for the prevention of RTIs in humans. | Echinacea cannot be recommended for the prevention of recurrences in RTI-prone children. |
| Honeybee products (propolis and royal jelly). |
Antioxidant, immunomodulatory, antibacterial, antiviral and anti-inflammatory properties in vitro. | Effect in only one study on recurrent acute otitis media; absence of well-conducted studies including RTI-prone children suffering from RTIs other than otitis. | Honeybee cannot be recommended for the prevention of recurrences in RTI-prone children. |