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Effect of recolonisation with “interfering” α streptococci on recurrences of acute and secretory otitis media in children: randomised placebo controlled trial

BMJ 2001; 322 doi: (Published 27 January 2001) Cite this as: BMJ 2001;322:210
  1. Kristian Roos (kristian.roos{at}, associate professora,
  2. Eva Grahn Håkansson, research associateb,
  3. Stig Holm, professorc
  1. a Ear, Nose, and Throat Department, Lundby Hospital, 41717 Gothenburg, Sweden
  2. b Department of Clinical Bacteriology, University of Umeå, 90187 Umeå, Sweden
  3. c Department of Clinical Microbiology, University of Umeå
  1. Correspondence to: K Roos
  • Accepted 29 September 2000


Objective: To study the effect of recolonisation with α streptococci with the ability to inhibit the growth of otopathogens (“interfering” activity) on the recurrence of acute otitis media in susceptible children and the effect on the frequency of secretory otitis media.

Design: Double blind, randomised, placebo controlled study.

Setting: Ear, nose, and throat clinic with three doctors.

Participants: 130 children prone to otitis media aged between 6 months and 6 years, 108 of whom were eligible and followed for 3 months.

Main outcome measures: Recurrence of otitis media during follow up and a normal tympanic membrane at the last valid visit.

Interventions: Children with no recurrences during the last month received phenoxymethylpenicillin (n=22), and those with a recurrence within 1 month received amoxicillin clavulanic acid (n=86), both twice daily for 10 days. These were followed by a streptococcal or placebo solution sprayed into the nose for a further 10 days. At day 60 the same spray was started for another 10 days.

Results: At 3 months 22 children (42%) given the streptococcal spray were healthy and had a normal tympanic membrane compared with 12 (22%) of those given placebo. This difference was shown separately for recurrences of both acute otitis media and secretory otitis media.

Conclusions: Selected bacteria with the ability to inhibit the growth of common otopathogens can be used to protect against recurrent acute otitis media and secretory otitis media in children.


  • Funding The study was supported by the Swedish National Board for Industrial and Technical Development and the Teknikbro Foundation and grants from Samariten Foundation, Stockholm.

  • Competing interests We have been involved in the interference between potentially pathogenic bacteria and apathogens in the upper respiratory tract for many years. This has resulted in several theses at the University of Umeå and Gothenburg. This study is a continuation of ongoing scientific studies covering the upper respiratory tract. We believe that bacterial interference is of importance for the normal defence system and has a clinical impact. We hope that it might be routinely applied as an alternative, or supplement, to antibiotic treatment in the future. We have therefore applied for a patent in some countries for the bacterial strains used in the study.

  • Accepted 29 September 2000
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