Multisystemic effect of probiotics: evaluation of comprehensive treatment of acute tonsillitis in children

Background. Tonsillitis accounts for approximately 0.4 % of outpatient visits in Europe and the United States. The disease is usually caused by a viral infection, and the pathogen is transmitted by airborne droplets from patients with acute tonsillitis. Group A beta-hemolytic streptococcus is the cause of tonsillitis in 15–30 % of children aged 5 to 15 years, which increases the risk of systemic complications. The purpose of the study was to investigate the effectiveness of a complex probiotic containing live cultures of Streptococcus salivarius K12 and Lactobacillus rhamnosus LGG bacteria and vitamin D (cholecalciferol) in the comprehensive treatment of acute tonsillitis in children. Materials and methods. The study involved 48 children aged 5 to 14 years who were randomly divided into two groups: the main group included 28 patients who received a probiotic supplement for 20 days in comprehensive treatment; the control group consisted of 20 children who were prescribed standard therapy without a probiotic. All children were assessed using the McIsaac scale, which allowed us to determine the scope of examination and treatment. Results. The bacterial cause of the disease was verified in 12 (42.86 %) and 7 (35 %) children of the main and control groups, respectively, and an antibacterial drug was prescribed. The patients did not differ in age, sex, disease duration, and clinical course of tonsillitis at baseline (p > 0.05). Sore throat, swelling/patches on the tonsils, lymphadenopathy, and fever were observed with equal frequency in patients of both groups. Describing the dynamics of local symptoms during treatment, it should be noted that in more than a third of children receiving a probiotic supplement, sore throat disappeared on the third day, unlike the control group, where almost every third patient (30 %) continued to complain of sore throat even on day 7 of the disease. The average duration of sore throat in the main group was 2.67 ± 0.62 days, in the control group — 4.91 ± 1.16 days (p < 0.05). We obtained similar dynamics by assessing the presence or absence of edema and patches on the tonsils. After 6 months, the following criteria were evaluated: recurrence of tonsillitis and the frequency of acute respiratory diseases, and the analysis of factors correlated with them was conducted. It should be noted that condition on day 7 of treatment was the strongest predictor of relapse (R2 = 0.78). That is, the achievement of complete clinical remission by day 7 of acute tonsillitis significantly reduces the formation of a tendency to chronicity and the occurrence of repeated episodes. The second important criterion was taking a probiotic, which is also associated with a reduced risk of recurrence (p = 0.0128). Conclusions. The use of probiotics in the treatment of acute tonsillitis increases the likelihood of clinical recovery by day 7 of the disease and, accordingly, reduces the frequency of recurrence in the near future. This model has a good predictive value (AUC = 0.75, 95% CI 0.6495–0.8505, p < 0.0001) and indicates that the use of Streptococcus salivarius K12 and Lactobacillus rhamnosus LGG probiotic and vitamin D reduces the risk of recurrent tonsillitis in children.