The effectiveness of the synbiotic Maxilac® for the new coronavirus infection after antibacterial therapy

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Abstract

The new coronavirus infection (COVID-19) that emerged in 2019 is a infection caused by the SARS-CoV-2 virus. Although SARS-CoV-2 predominantly affects the respiratory system, numerous studies suggest significant gastrointestinal involvement in COVID-19, particularly in children.

Aim. To evaluate the effect of the synbiotic Maxilac® in children with COVID-19 after antibacterial therapy (ABT).

Materials and methods. A clinical post-approval open-label observational prospective single-center study with minimal intervention was conducted. The microbiome of children with COVID-19 was studied. Twelve children with COVID-19 complicated by a bacterial infection (pneumonia, sinusitis, otitis) were included, receiving ABT and then taking the synbiotic Maxilac® for 4 weeks. Patient data were collected: symptoms, medical history, clinical status, study of intestinal microbiota (IM) by 16S sequencing, stool test for zonulin, and review of drug therapy. The material was sampled in patients with COVID-19 at 3 time points: at the time of acute COVID-19 disease, at the time of recovery from COVID-19, and 4 weeks after starting the synbiotic therapy.

Results. The administration of the synbiotic Maxilac® to patients who received ABT for bacterial complications of COVID-19 relieves clinical gastroenterological symptoms, prevents the development of dysbiosis, and normalizes intestinal permeability. The results indicated significant changes in IM after ABT in complicated COVID-19 and the normalizing effect of synbiotic Maxilac® on IM during administration for 30 days. The synbiotic Maxilac® in the group of children with COVID-19 who received ABT had no side effects and was safe.

Conclusion. Children with COVID-19, complicated by a bacterial infection, treated with ABT are recommended to receive the synbiotic Maxilac® for at least 30 days after recovery.

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About the authors

Valeriya P. Novikova

Saint Petersburg State Pediatric Medical University

Author for correspondence.
Email: novikova-vp@mail.ru
ORCID iD: 0000-0002-0992-1709

D. Sci. (Med.), Prof.

Russian Federation, Saint Petersburg

Anna V. Polunina

Saint Petersburg State Pediatric Medical University

Email: novikova-vp@mail.ru
ORCID iD: 0000-0003-2613-1503

Assistant

Russian Federation, Saint Petersburg

Svetlana L. Bannova

Saint Petersburg State Pediatric Medical University

Email: novikova-vp@mail.ru
ORCID iD: 0000-0003-1351-1910

Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Aleksey L. Balashov

Saint Petersburg State Pediatric Medical University; City Polyclinic №56, Saint Petersburg

Email: novikova-vp@mail.ru
ORCID iD: 0000-0002-1116-3118

Cand. Sci. (Med.)

Russian Federation, Saint Petersburg; Saint Petersburg

Vasilisa V. Dudurich

CerbaLab Ltd

Email: novikova-vp@mail.ru
ORCID iD: 0000-0002-6271-5218

biologist-geneticist

Russian Federation, Saint Petersburg

Lavrentii G. Danilov

CerbaLab Ltd

Email: novikova-vp@mail.ru
ORCID iD: 0000-0002-4479-3095

bioinformatician

Russian Federation, Saint Petersburg

Alexander E. Blinov

Saint Petersburg State Pediatric Medical University

Email: novikova-vp@mail.ru
ORCID iD: 0000-0002-2895-7379

Senior Res. Officer

Russian Federation, Saint Petersburg

Olga N. Varlamova

Saint Petersburg State Pediatric Medical University

Email: novikova-vp@mail.ru
ORCID iD: 0000-0002-2195-0756

Res. Officer

Russian Federation, Saint Petersburg

Antonina V. Seits

Saint Petersburg State Pediatric Medical University

Email: novikova-vp@mail.ru
ORCID iD: 0009-0003-4031-1188

Student

Russian Federation, Saint Petersburg

Evgeniia A. Kukes

Pirogov Russian National Research Medical University

Email: novikova-vp@mail.ru
ORCID iD: 0000-0002-2275-6875
Russian Federation, Moscow

References

  1. Tregoning JS, Flight KE, Higham SL, et al. Progress of the COVID-19 vaccine effort: viruses, vaccines and variants versus efficacy, effectiveness and escape. Nat Rev Immunol. 2021;21(10):626-36. doi: 10.1038/s41577-021-00592-1
  2. Files JK, Sarkar S, Fram TR, et al. Duration of post-COVID-19 symptoms is associated with sustained SARS-CoV-2-specific immune responses. JCI Insight. 2021;6(15). doi: 10.1172/jci.insight.151544
  3. Lamers MM, Beumer J, van der Vaart J, et al. SARS-CoV-2 productively infects human gut enterocytes. Science. 2020;369(6499):50-4. doi: 10.1126/science.abc1669
  4. Zang R, Gomez Castro MF, McCune BT, et al. TMPRSS2 and TMPRSS4 promote SARS-CoV-2 infection of human small intestinal enterocytes. Sci Immunol. 2020;5(47). doi: 10.1126/sciimmunol.abc3582
  5. Zuo T, Liu Q, Zhang F, et al. Depicting SARS-CoV-2 faecal viral activity in association with gut microbiota composition in patients with COVID-19. Gut. 2021;70(2):276-84. doi: 10.1136/gutjnl-2020-322294
  6. Xiao F, Sun J, Xu Y, et al. Infectious SARS-CoV-2 in Feces of Patient with Severe COVID-19. Emerg Infect Dis. 2020;26(8):1920-2. doi: 10.3201/eid2608.200681
  7. Natarajan A, Zlitni S, Brooks EF, et al. Gastrointestinal symptoms and fecal shedding of SARS-CoV-2 RNA suggest prolonged gastrointestinal infection. Med. 2022;3(6):371-87.e9. doi: 10.1016/j.medj.2022.04.001
  8. Zollner A, Koch R, Jukic A, et al. Postacute COVID-19 is Characterized by Gut Viral Antigen Persistence in Inflammatory Bowel Diseases. Gastroenterology. 2022;163(2):495-506.e8. doi: 10.1053/j.gastro.2022.04.037
  9. Cheung KS, Hung IFN, Chan PPY, et al. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis. Gastroenterology. 2020;159(1):81-95. doi: 10.1053/j.gastro.2020.03.065
  10. Mao R, Qiu Y, He JS, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5(7):667-78. doi: 10.1016/S2468-1253(20)30126-6
  11. Song Y, Liu P, Shi XL, et al. SARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19. Gut. 2020;69(6):1143-4. doi: 10.1136/gutjnl-2020-320891
  12. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. doi: 10.1001/jama.2020.1585
  13. Gilbert JA, Blaser MJ, Caporaso JG, et al. Current understanding of the human microbiome. Nat Med. 2018;24(4):392-400. doi: 10.1038/nm.4517
  14. Новикова В.П., Полунина А.В., Баннова С.Л., и др. Состояние желудочно-кишечного тракта у детей при новой коронавирусной инфекции и в постковидный период. Роль синбиотика в коррекции клинических симптомов, кишечной микробиоты и проницаемости кишечной стенки. РМЖ. Мать и дитя. 2023;6(3):283-9 [Novikova VP, Polunina AV, Bannova SL, et al. Gastrointestinal tract in children with novel coronavirus infection and post-COVID-19 syndrome. The role of synbiotics for improving clinical symptoms, gut microbiota, and intestinal permeability. Russian Journal of Woman and Child Health. 2023;6(3):283-9 (in Russian)]. doi: 10.32364/2618-8430-2023-6-3-10
  15. Гриневич В.Б., Лазебник Л.Б., Кравчук Ю.А., и др. Поражения органов пищеварения при постковидном синдроме. Клинические рекомендации. Экспериментальная и клиническая гастроэнтерология. 2022;12:4-68 [Grinevich VB, Lazebnik LB, Kravchuk YuA, et al. Gastrointestinal disorders in post-COVID syndrome. Clinical guidelines. Experimental and Clinical Gastroenterology. 2022;12:4-68 (in Russian)]. doi: 10.31146/1682-8658-ecg-208-12-4-68
  16. Новикова В.П., Хавкин А.И., Горелов А.В., Полунина А.В. Ось «легкие-кишечник» и COVID-инфекция. Инфекционные болезни. 2021;19(1):91-6 [Novikova VP, Khavkin AI, Gorelov AV, Polunina A.V. The lung-gut axis and COVID-19. Infekc. Bolezni (Infectious Diseases). 2021;19(1):91-6 (in Russian)]. doi: 10.20953/1729-9225-2021-1-91-96
  17. Полунина А.В., Новикова В.П., Блинов А.Е., и др. Динамика уровня зонулина в стуле при инфекции COVID-19 и в постковидный период у детей. Инфекционные болезни. 2022;20(3):35-40 [Polunina AV, Novikova VP, Blinov AE, et al. Dynamics of fecal zonulin levels in COVID-19 and in the post-covid period in children. Infekc. Bolezni (Infectious Diseases). 2022;20(3):35-40 (in Russian)]. doi: 10.20953/1729-9225-2022-3-35-40
  18. Xu R, Liu P, Zhang T, et al. Progressive deterioration of the upper respiratory tract and the gut microbiomes in children during the early infection stages of COVID-19. J Genet Genomics. 2021;48(9):803-14. doi: 10.1016/j.jgg.2021.05.004
  19. Zolnikova O, Komkova I, Potskherashvili N, et al. Application of probiotics for acute respiratory tract infections. Italian Journal of Medicine. 2018;12(1):32-8. doi: 10.4081/itjm.2018.931
  20. Hao Q, Dong BR, Wu T. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev. 2015;(2):CD006895. doi: 10.1002/14651858.CD006895.pub3
  21. Wang Y, Li X, Ge T, et al. Probiotics for prevention and treatment of respiratory tract infections in children: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2016;95(31):e4509. doi: 10.1097/MD.0000000000004509
  22. Manzanares W, Lemieux M, Langlois PL, Wischmeyer PE. Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis. Crit Care. 2016;19:262. doi: 10.1186/s13054-016-1434-y
  23. Sarkar A, Yoo JY, Valeria Ozorio Dutra S, et al. The Association between Early-Life Gut Microbiota and Long-Term Health and Diseases. J Clin Med. 2021;10(3). doi: 10.3390/jcm10030459
  24. Lange K, Buerger M, Stallmach A, Bruns T. Effects of Antibiotics on Gut Microbiota. Dig Dis. 2016;34(3):260-8. doi: 10.1159/000443360
  25. Mamieva Z, Poluektova E, Svistushkin V, et al. Antibiotics, gut microbiota, and irritable bowel syndrome: what are the relations? World J Gastroenterol. 2022;28(12):1204-19. doi: 10.3748/wjg.v28.i12.1204
  26. Горелов А.В., Усенко Д.В., Мелехина Е.В., и др. Влияние пробиотика Saccharomyces boulardii CNCM I-745 на развитие антибиотикассоциированного синдрома у детей, получающих системную антибактериальную терапию по поводу инфекций нижних дыхательных путей. Вопросы практической педиатрии. 2024;22(2):15-22 [Gorelov AV, Usenko DV, Melekhina EV, et al. The effect of the Saccharomyces boulardii CNCM I-745 probiotic on the development of antibiotic-associated syndrome in children receiving systemic antibacterial therapy for lower respiratory tract infections. Clinical Practice in Pediatrics. 2024;22(2):15-22 (in Russian)]. doi: 10.20953/1817-7646-2024-2-15-22

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2. Fig. 1. Differences at the level of phylum in the microbiome of children with COVID-19 and bacterial complications and receiving antibacterial therapy (ABT) at the onset of the disease, 2 weeks after ABT and one month after treatment with the synbiotic Maxilac®: a – Campilobacterota; b – Desulfobacterota; c – Patescibacteria.

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3. Fig. 2. Differences at the level of species in the microbiome of children with COVID-19 and bacterial complications and receiving ABT at the onset of the disease, 2 weeks after ABT and one month after treatment with the synbiotic Maxilac®: a – Campylobacteria; b – Desulfovibrionia; c – Gammaproteobacteria; d – Incertae_Sedis; e – Saccharimonadia; f – Verrucomicrobiae.

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4. Fig. 3. Comparison of the Shannon diversity index at the onset of the disease, at the recovery after ABT, and one month after starting Maxilac®.

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5. Fig. 4. Change over time of gastroenterological symptoms in children with bacterial complications and receiving ABT at the onset of the disease, 2 weeks after ABT, and one month after the start of the synbiotic Maxilac®.

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