Immunosen and Stimuno Syrup for Recurrent Infections
There is no high-quality evidence supporting the use of Immunosen or Stimuno syrup for preventing or treating recurrent infections, and these products are not recommended in established clinical guidelines.
Evidence Base and Recommendations
Lack of Guideline Support
- Major international guidelines including EULAR, AGA, and European consensus statements on immunomodulatory therapy do not mention or recommend Immunosen or Stimuno syrup for any indication 1.
- These products are not included in evidence-based treatment algorithms for recurrent infections in any patient population 1.
What the Evidence Shows About Immunostimulants
While some bacterial lysate immunomodulators have been studied for recurrent respiratory infections, the evidence quality is limited:
- Bacterial lysates (OM-85 BV) showed modest reduction in respiratory infection incidence by approximately 0.21 episodes per month compared to placebo in pediatric studies 2.
- Pidotimod demonstrated similar modest benefits, reducing infection incidence by 0.19 episodes per month in susceptible children 3, 2.
- A polyvalent bacterial lysate (LW 50020) showed placebo-corrected infection rate reductions of 39% in children and 44% in adults, though study quality was limited 4.
However, these are different products than Immunosen or Stimuno, and even for these studied agents, the evidence remains insufficient for formal guideline recommendations.
Clinical Context and Cautions
When Immunomodulation Is NOT Recommended
- Non-hospitalized patients with infections: Current evidence does not support initiating immunomodulatory therapy 1.
- Hospitalized patients not requiring oxygen: No evidence supports immunomodulatory therapy for treating infections at this stage 1.
- Recurrent infections in immunocompromised patients: Focus should be on identifying underlying causes and using proven prophylactic antibiotics when indicated 1, 5.
Risk Considerations
- Immunomodulatory therapies carry risks including increased susceptibility to opportunistic infections, particularly when combined with corticosteroids or other immunosuppressants 1.
- Age >50 years is an independent risk factor for opportunistic infections when using immunomodulators (OR 3.0) 1.
- Comorbidities including diabetes, chronic lung disease, and alcoholism increase infection risk with immunomodulatory therapy 1.
Recommended Approach for Recurrent Infections
Instead of unproven immunostimulants, focus on:
- Identifying underlying causes: Immunodeficiency, anatomic abnormalities, environmental exposures 1.
- Appropriate antimicrobial prophylaxis when indicated (e.g., trimethoprim-sulfamethoxazole for specific immunocompromised states) 5.
- Vaccination: Ensuring up-to-date immunizations against preventable respiratory pathogens.
- Evidence-based immunomodulation only when clearly indicated: Such as vedolizumab for chronic antibiotic-dependent pouchitis or tocilizumab with glucocorticoids for severe COVID-19 requiring oxygen 1.
Bottom Line
Immunosen and Stimuno syrup lack credible evidence for efficacy and are not part of evidence-based treatment algorithms. For patients with recurrent infections, pursue proper diagnostic workup to identify treatable underlying causes rather than relying on unproven immunostimulants 1, 5.