Respiratory Tract Infections Clinical Trial
Official title:
Effect of Vaxoral® (OM-85) on Frequency of Respiratory Tract Infections and Size of Adenoid Tissue in Preschool Children With Adenoid Hypertrophy
Clinical research question: Can OM-85 reduce the recurrence of respiratory tract infections (RTIs) in children with AH by stimulating the immunological response of the host and therefore, as a consequence reduce the size of adenoid tissue in children with adenoid hypertrophy? Can this prevent further complications such as surgery need? Half of participants will receive OM-85, while other half will receive a placebo.
OM-85 significantly reduces RTIs in children. This effect was proved by many clinical studies
and meta-analyses. A Cochrane meta-analysis first published in 2006 and updated recently
(Del-Rio-Navarro 2012) showed that immunostimulants (IS) could reduce acute RTIs (ARTIs) by
almost 39% when compared to placebo. Among the different IS, OM-85 showed the most robust
evidence with 4 trials of "A quality" according to the Cochrane grading criteria. Pooling six
OM-85 studies, the Cochrane review reported a mean number of ARTIs reduction by -1.20 [95%
Confidence Interval (CI): -1.75, -0.66 ] and a percentage difference in ARTIs by -35.9% [95%
CI: -49.46, -22.35 ] compared to placebo.
Adenoid hypertrophy (AH) is one of the most important respiratory disease in preschool
children. In normal conditions adenoid tissue enlarges up to 5 years and become smaller
afterwards. But in some children who have recurrent upper respiratory tract infections
(URTI)s, it keeps growing and this can be associated with complications. AH may cause
recurrent respiratory infections and each infection contribute to enlargement of adenoid
tissue thus promoting a vicious cycle. Additionally enlarged adenoids are known to be
reservoir for microbes and cause of recurrent or long lasting RTIs.
AH is associated with chronic cough, recurrent and chronic sinusitis, recurrent tonsillitis,
recurrent otitis media with effusion, recurrent other respiratory problems such as, nasal
obstruction and sleep disturbances, sleep apneas. Eventually, AH causes loss of appetite and
growth delay; it is often associated with misusing or over use of antibiotics and often
eventually requires surgery. It decreases quality of life both in children and parents and it
represents a burden not only for families but also for health care system and society due to
increased health cost4.
In one study which investigated the structural and immunological aspects of tonsils and
adenoids of 105 children (54 males and 51 females, aged between 4 and 18 years) who were
affected by chronic inflammatory hypertrophy of palatine tonsils and adenoids which had not
responded to previous medical treatments and who underwent adenotonsillectomy because of
recurrent inflammatory episodes with fever, it was demonstrated that deficit in the
activa-tion of the immune system could be represented by the small quan-tity of messenger
ribonucleic acid (mRNA)s for interleukin-2 (IL-2) and interleukin-4 (IL-4) detected in our
population, suggesting a defective activation of Th1 and Th2 lymphocytes.
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