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Background: Streptococcus salivarius K12 has been shown to inhibit the growth of Streptococcus pyogenes due to bacteriocins release. Because of its ability to colonize the oral cavity, we have tested the strain K12 for its efficacy in preventing streptococcal pharyngitis and/or tonsillitis in adults., Methods: Forty adults with a diagnosis of recurrent oral streptococcal pharyngitis were enrolled in the study. Twenty of these subjects took for 90 days a tablet containing Streptococcus salivarius K12 (Bactoblis®). The other 20 subjects served as untreated controls. A 6-month follow-up was included to evaluate any persistent protective role., Results: The 20 adults who completed the 90-day course of Bactoblis® showed a reduction in their episodes of streptococcal pharyngeal infection (about 80%). The 90 days treatment was also associated with an approximately 60% reduction in the incidence of reported pharyngitis in the 6-month period following use of the product. The product was well tolerated by the subjects with no treatment-related side effects or drop-outs reported., Conclusion: Prophylactic administration of Streptococcus salivarius K12 to adults having a history of recurrent oral streptococcal pathology reduced the number of episodes of streptococcal pharyngeal infections and/or tonsillitis.

A total of 342 patients with clinical signs of tonsillitis and suspected group A beta-haemolytic streptococci (GAS) aetiology, verified with rapid test and GAS culture, were enrolled in a randomized, placebo-controlled, double-blind, multicentre study. They received antibiotic treatment for 10 days, followed by 10 days of alpha-streptococcal or placebo spray treatment in the ratio of 2 : 1. Pharyngeal status, throat culture and adverse events were investigated up to 75 days after treatment. The frequency of bacteriologically verified clinical recurrence was 13% in the alpha-streptococcal group and 15% in the placebo group at the follow-up on day 22. The corresponding figures at the last valid visit after 45-75 days were 19% and 30%, respectively, a statistically significant difference (p = 0.037). Furthermore, at the last valid visit 5% of subjects in the alpha-streptococcal and 12% in the placebo group were healthy carriers, bacteriological treatment failures, of GAS (p = 0.029). Treatment with alpha-streptococci and placebo spray were equally well tolerated. Thus, re-colonization with alpha-streptococci seem to hinder late recurrences of GAS pharyngotonsillitis.

Objective: To test the hypothesis that treatment failures of streptococcal pharyngotonsillitis may be caused by reinfection by the patients' own streptococci remaining on a toothbrush or in the bedclothes., Design: To elucidate the role of streptococcal contamination of the environment, hygienic measures regarding change of toothbrush and bed linen and washing of toys were given to half of the patients/families. Throat specimens were taken from all the patients before treatment with phenoxymethylpenicillin for 5 days, and the patients were followed-up for 1 month. At a home visit after 6-10 days, throat specimens were taken from the patients and all permanent residents of the home. Environmental samples were taken from pillowcases, floors, toothbrushes, dummies, and toys., Setting: Six health care centres., Subjects: 114 patients of all ages suffering from group A streptococcal pharyngotonsillitis, and 289 family members., Measurements and Main Results: 54 patients/families received hygiene instructions. The total number of recurrences was 40 (35%). There was no difference in treatment failure rate between patients/families that had taken or not taken hygienic measures., Conclusions: Hygienic measures have no decisive influence on the risk of recurrence of streptococcal pharyngotonsillitis.