Pediatr Drugs 2003; 5 (4): 223-228 THERAPY IN PRACTICE 1174-5878/03/0004-0223/$30.00/0  Adis Data Information BV 2003. All rights reserved. Ribosomal Immunotherapy for Recurrent Respiratory Tract Infections in Children Marie C. B´ en´ e and Gilbert C. Faure Immunology Laboratory of the University Hospital, Faculty of Medicine of Nancy, Nancy, France Contents Abstract ............................................................................................................... 223 1. Recurrent Respiratory Tract Infections and Physiologic Development of the Mucosal Immune System ....................... 223 2. Recurrent Respiratory Tract Infections and Bacterial Vaccines ........................................................... 224 3. Ribosomal Mucosal Vaccination ...................................................................................... 225 4. Clinical Trials of Ribosomal Mucosal Vaccination ....................................................................... 225 5. Therapeutic Schedule ............................................................................................... 226 6. Other Immunostimulating Effects of Ribosomal Therapy ................................................................. 226 7. Pharmacoeconomics of Ribosomal Vaccination ....................................................................... 227 8. Conclusions ........................................................................................................ 227 Recurrent respiratory tract infections are common in children. They reflect the immaturity of the immune Abstract system in its encounter with environmental antigens. Little or no specific protective immune response has yet been established. These infections represent an important public health problem in terms of both treatment (anti-inflammatory or antibacterial drugs for children) and economy. Immunotherapy has been proposed as a means of preventing these recurrent infections by providing children with small doses of inactive bacterial antigens liable to trigger specific and protective immune responses. Among such drugs, ribosomal preparations (to which this review is limited) appear to be not only well tolerated, but also ideally targeted to induce mucosal responses. One preparation of ribosomal mucosal vaccine is commercially available in several countries. Numerous clinical trials in the world have confirmed the positive role of this mucosal ribosomal bacterial vaccine in significantly reducing the number of infections, courses of antibacterials, and absenteeism. In vitro and ex vivo investigations have confirmed that such vaccines indeed trigger protective specific immune responses. In this review, the pathophysiology of recurrent respiratory 1. Recurrent Respiratory Tract Infections and tract infections in children will be discussed, and the various Physiologic Development of the Mucosal approaches designed to treat them will be described. The paper Immune System will then focus on the specific use of ribosomal preparations, the Recurrent infections of the upper respiratory tract are common use of which has been widely explored, both in clinical trials and in childhood. Acute exacerbations of chronic bronchitis, otitis experimental protocols investigating their mode of action. The media, or bacterial rhinosinusitis, mainly involving Streptococcus positive impact of ribosomal immunotherapy in terms of public pneumoniae and Haemophilus influenzae, account for approxi- health will also be discussed. mately 75% of antibacterial prescriptions written during visits by children to physicians in the US. [1] Risk factors include exposure to pathogens in shared community life (baby care centers and