Potential Roles for Probiotics in the Treatment of COVID-19 Patients and Prevention of Complications Associated with Increased Antibiotic Use

Abstract

Medical care for patients hospitalized with COVID-19 is an evolving process. Most COVID-19 inpatients (58–95%) received empiric antibiotics to prevent the increased mortality due to ventilator-associated pneumonia and other secondary infections observed in COVID-19 patients. The expected consequences of increased antibiotic use include antibiotic-associated diarrhea (AAD) and Clostridioides difficile infections (CDI). We reviewed the literature (January 2020–March 2021) to explore strategies to reduce these consequences. Antimicrobial stewardship programs were effective in controlling antibiotic use during past influenza epidemics and have also been shown to reduce healthcare-associated rates of CDI. Another potential strategy is the use of specific strains of probiotics shown to be effective for the prevention of AAD and CDI prior to the pandemic. During 2020, there was a paucity of published trials using these two strategies in COVID-19 patients, but trials are currently ongoing. A multi-strain probiotic mixture was found to be effective in reducing COVID-19-associated diarrhea in one trial. These strategies are promising but need further evidence from trials in COVID-19 patients.

Probiotics in Pediatrics. A Review and Practical Guide

“…Ma et al evaluated the effect of probiotics on Clostridium difficile -associated diarrhea, and concluded based on 11 RCTs, including 4692 patients, that L. casei ranked the best in reducing AAD (odds ratio (OR) 0.32, 95% CrI 0.14–0.74) [ 31 ]. The impact of probiotic and disease specificity was highlighted in a recent paper in coronavirus disease 2019 (COVID-19) patients [ 32 ].…”

“…Ma et al evaluated the effect of probiotics on Clostridium difficile-associated diarrhea, and concluded based on 11 RCTs, including 4692 patients, that L. casei ranked the best in reducing AAD (odds ratio (OR) 0.32, 95% CrI 0.14-0.74) [31]. The impact of probiotic and disease specificity was highlighted in a recent paper in coronavirus disease 2019 (COVID-19) patients [32]. If the use of probiotics for preventing AAD is considered in the presence of risk factors such as the choice of antibiotic agent, duration of treatment, patient's age, comorbidities, need for hospitalization or previous episodes of AAD, ESPGHAN recommends using L. rhamnosus GG ATCC53103 or S. boulardii CNCM I-745 [33].…”

Patient Nutrition and Probiotic Therapy in COVID-19: What Do We Know in 2021?

“…They impact seroconversion and seroprotection rates in influenza-vaccinated adults [140]. Kullar et al showed that a multistrain probiotic mixture may be effective in reducing the incidence of diarrhea related to COVID-19 [141]. However, this was confirmed in one trial.…”

Role of Probiotic for Prevention and Management of COVID-19: A Literature Review

“…The neighborhood or distal resistant adjustment of the commensal organisms in the lungs and gut influences the beginning of the disease cycle. Nonetheless, the native gut commensals give colonization opposition from the microbial microorganisms by the idea of "obstruction impact" and hence, help in shielding the gut specialty from being changed [13].…”

“…The gut microbiota can drive DC to prime these cells. Indeed, L. reuteri and L. casei, invigorate IFN-γ creation and actuate favorable to fiery Th1 cells [13].…”