We have followed the papers of Dr. Steurer-Stey on the field of immunostimulants in the prevention of respiratory disease [1,5,6]. In the last paper, she studied the effect of OM-85-BV and other bacterial extracts in the prevention of acute respiratory tract infections (ARTIs) in children [6].Although the systematic review deals with oral purified bacterial extracts, the results and conclusions referred only to OM-85 BV. The authors included ten OM-85 BV studies, plus one study with LW50020 (Luivac) and another with IRS19. Considering only these products, they omitted to include one OM-85 BV study and another LW50020 study [4]. Yet, other products with a similar profile were not considered in the search; ismigen, lantigen B, and pulmonar OM, among others. There are two lantigen B studies that could be included [4].Other products of bacterial origin, such as D53 (Ribovac, Ribomunyl, Immucothel, proteoglycans of K. pneumoniae, plus bacterial ribosomes) and RU41740 (biostim, glycoprotein, and membranes of Klebsiella pneumoniae), were not mentioned. There are 16 D53 studies and five RU41740 studies reported in the literature [4].We agree that the reported outcomes were very diverse and that they were not standardized and, therefore, difficult to combine and analyze. However, the authors found that nine out of the 13 included studies reported the number of ARTIs, but they did not analyze this finding, which may be the primary outcome for the meta-analysis.We have realized three meta-analyses/systematic reviews on the use of immunostimulants for the prevention of ARTIs in children [2][3][4]. In the three instances, we combined the data as the mean and standard deviation of the number of ARTIs in the placebo and treatment groups, and the number of ARTIs as percentages regarding the mean number of ARTIs in the placebo group as 100%. The meta-analyses used a random-effects model and the results were presented as weighted mean differences (WMD) with 95% confidence intervals. Cochrane's Review Manager software was used in all of the analyses.In the Cochrane Database Systematic Review [4], the subanalysis including all of the bacterial products disclosed a mean difference in the number of ARTIs of −1.47 (−1.92, −1.01), I-squared 93.9%, and a mean percentage difference of −42.93 (−50.53 to −35.32), I-squared 67.6%; in both cases, the number of studies was 23 and there were 1,971 participants. The main sources of heterogeneity were the number of ARTIs in the placebo group and the kind of product used.In a comparative meta-analysis [3], the effect of OM-85 BV was a mean difference in the number of ARTIs of −1.20 (−1.70, −0.69), I-squared 82.5%, and a mean percentage difference of −39.28 (−52.58, −25.98), I-squared 69.2; the number of studies was 8 and there were 669 participants.We conclude that there is evidence of the reduction in the incidence of ARTIs using this kind of bacterial immunostimulant in children. Yet, due to the high heterogeneity and the poor to moderate quality of the trials, the results must be cautiously int...
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