Recurrence of acute otitis media (RAOM) is a relevant issue in the clinical practice. "Bacteriotherapy" has been proposed as an option in children with RAOM. 24SMB nasal spray has been previously demonstrated to reduce the risk of acute otitis media (AOM) in otitis-prone children. The current retrospective and observational study aimed to confirm this outcome in a real-life setting, such as the common pediatric practice. Group A (108 children) served as control; group B (159 children) was treated with 24SMB and 89a nasal spray after the first AOM episode. Active treatment consisted of 3 monthly courses: 2 puffs per nostril twice/day for a week. Group B showed a significant reduction of AOM episodes in comparison with group A (<0.0001). Notably, all actively treated children with the highest AOM recurrence had a reduction of recurrence, whereas only 50% of the control group children had reduced RAOM (<0.0001). Also, severity grade of AOM significantly diminished after the preventive bacteriotherapy (<0.0001). In conclusion, the current retrospective and observational study demonstrated that 24SMB and 89a nasal spray could be effective in the prevention of RAOM in a real-life setting.