Table 2 Recommendations

Probiotics, Prebiotics, Symbiotics, Postbiotics

In the absence of proof of efficacy, the use of oral probiotic formulations should not be recommended for the prevention of RRIs (weak negative recommendation).

Given the scarcity of supporting evidence, the use of nasal spray formulations containing Streptococcus salivarius 24SMB should not be recommended for the prevention of RRIs (weak negative recommendation).

In the absence of proof of efficacy and safety, the use of prebiotics and symbiotics should not be recommended for the prevention of RRIs (weak negative recommendation).

In the absence of proof of efficacy and safety, the use of postbiotics should not be recommended for the prevention of RRIs (weak negative recommendation).

Lysates and bacterial extracts

The evidence available to date does not allow recommendation of the routine use of bacterial lysates for the prevention of RRIs (weak negative recommendation).

Among the lysates, OM-85 has demonstrated a consistent likelihood of efficacy and can be recommended in selected populations of children, always considering the cost-benefit ratio (weak positive recommendation).

Vitamins and trace elements

Due to the lack of studies conducted, the heterogeneity of the populations studied, the diversity of dosages, formulations and duration of treatments, zinc and other trace elements should not be used in the prophylaxis of RRIs (weak negative recommendation).

There is no evidence that low levels of vitamin A and vitamin E create a predisposition to respiratory infections in children. There is more evidence that reduced levels of vitamin D are associated with an increased incidence of respiratory infections, particularly viral infections, in the first years of life. The heterogeneity of the populations studied, and the diversity of the outcomes considered mean that it is not possible to recommend the use of vitamin D in the prevention of RRIs. In populations with low socioeconomic status and clearly insufficient levels of vitamin D, and in patients with recurrent acute otitis, there may be a greater likelihood of efficacy in the prevention of RRIs (weak negative recommendation). Due to the lack of studies conducted, the heterogeneity and small size of the study populations, and the diversity of dosages and duration of treatment, routine vitamin C supplementation should not be used in the prevention of RRIs (strong negative recommendation).

Complementary/alternative medicines

The studies currently available on the efficacy of homoeopathy, natural substances and phytotherapy, do not allow recommendations on the use of these products in the prevention of RRIs at this time. This is due, in some cases, to the small number of studies, and, in others, to methodological shortcomings or the fact that they do not include patients of exclusively paediatric age.

Vaccinations

There is little evidence regarding the role of influenza and anti-pneumococcal vaccinations specifically for the prevention of RRIs. However, in view of the safety, efficacy and cost-benefit data on the use of these vaccinations, they are still recommended in paediatric age groups (weak positive recommendation).

Nasal therapies with hyaluronic acid, thermal waters and resveratrol

Based on the limited evidence on nasal therapies with hyaluronic acid, thermal waters and resveratrol for the prevention of RRIs currently available, it is not possible to make a recommendation, but their use is not discouraged.

Modification of risk factors

There is little literature on modifying risk factors for the prevention of RRIs, so the evidence currently available does not allow recommendation in this sense. However, limiting exposure to environmental and household pollutants is recommended and exposure to second-hand smoke is strongly discouraged.

Adeno/Tonsillectomy

Adeno/Tonsillectomy is not recommended for the reduction of RRIs (strong negative recommendation). Adeno/Tonsillectomy is not recommended for the reduction of the number of visits to the doctor for RRIs (strong negative recommendation). Adeno/Tonsillectomy is not recommended for the reduction of the number of days of illness (strong negative recommendation). As regards the impact of Adeno/Tonsillectomy in reducing the use of respiratory tract medications (including bronchodilators, mucolytics, antihistamines, steroids), no recommendation can be made.

Antibiotic prophylaxis

No studies are available on the efficacy of antibiotic prophylaxis in preventing RRIs, so no recommendations can be made. However, in view of the need to promote rational use of antibiotics in order to contain the selection of resistant bacterial strains, reduce costs and reduce adverse events, the panel suggests that antibiotic prophylaxis for the prevention of RRIs should be discouraged.