The Efficacy of Probiotics as Antiviral Agents for the Treatment of Rotavirus Gastrointestinal Infections in Children: An Updated Overview of Literature

Abstract

Enteric viruses, including the rotavirus, norovirus, and adenoviruses, are the most common cause of acute gastroenteritis. The rotavirus disease is especially prevalent among children, and studies over the past decade have revealed complex interactions between rotaviruses and the gut microbiota. One way to treat and prevent dysbiosis is the use of probiotics as an antiviral agent. This review focuses on the latest scientific evidence on the antiviral properties of probiotics against rotavirus gastroenteric infections in children. A total of 19 studies exhibited a statistically significant antiviral effect of probiotics. The main probiotics that were effective were Saccharomyces cerevisiae var. boulardii, Lacticaseibacillus rhamnosus GG, and various multi-strain probiotics. The underlying mechanism of the probiotics against rotavirus gastroenteric infections in children included immune enhancement and modulation of intestinal microbiota leading to shortening of diarrhoea. However, several clinical studies also found no significant difference in the probiotic group compared to the placebo group even though well-known strains were used, thus showing the importance of correct dosage, duration of treatment, quality of probiotics and the possible influence of other factors, such as the production process of probiotics and the influence of immunisation on the effect of probiotics. Therefore, more robust, well-designed clinical studies addressing all factors are warranted.

Pathogen-Specific Benefits of Probiotic and Synbiotic Use in Childhood Acute Gastroenteritis: An Updated Review of the Literature

“…This review tried to add novelty to the existing literature data by assessing the impact of probiotic and synbiotic use upon symptom duration, severity and immune response in both viral and bacterial gastroenteritis in children. Most of the studies conducted so far which assessed the impact of probiotic use upon childhood enteric infections have focused solely on rotavirus diarrhea and provided the basis for two previous meta-analyses [ 82 , 83 ], as rotavirus still remains the leading cause of diarrhea-associated complications, especially in underdeveloped countries [ 84 , 85 ]. However, norovirus seems to overcome rotavirus as the etiological diarrheic agent which most commonly requires medical care in children, in those countries with high anti-rotavirus vaccination coverage, such as the United States [ 86 ].…”

“…However, norovirus seems to overcome rotavirus as the etiological diarrheic agent which most commonly requires medical care in children, in those countries with high anti-rotavirus vaccination coverage, such as the United States [ 86 ]. Several theories have emerged regarding the possible inhibition of replication exerted by probiotics upon enteric viruses, and probiotic supplementation has been recommended for prevention of rotaviral diarrhea, as well as for diminishing symptom duration [ 82 , 85 ]. As previously presented and detailed in Table 1 , Table 2 , Table 3 and Table 4 , several strains have proven their benefits in rotavirus-associated diarrhea, including individual strains, as well as combined probiotic preparations.…”

Probiotics and Their Antimicrobial Effect

“…One route to treat or prevent infectious diseases caused by viruses is the use probiotics. Steyer and co-authors [ 27 ] conducted a literature review of randomised placebo controlled clinical studies on the antiviral properties against rotavirus gastroenteric infections in children and Hung and co-authors [ 28 ] conducted a literature review on the evidence of oral probiotics as a therapy for the gastrointestinal involvement in COVID-19 patients. Oral probiotics had been evidenced to improve gut health in achieving homeostasis by exhibiting their antiviral effects via the gut–lung axis [ 29 ] and patient with COVID-19 have significant changes in fecal microbiomes, characterized by the enrichment of opportunistic pathogens and the depletion of beneficial commensals, which is vastly associated with disease severity [ 28 , 30 ].…”

“…Saccharomyces cerevisiae var. boulardii , Lacticaseibacillus rhamnosus GG, and various multi-strain probiotics exhibited antiviral properties against rotavirus gastroenteric infections in children [ 27 ]. The underlying mechanism of the probiotics against rotavirus gastroenteric infections in children included immune enhancement and modulation of intestinal microbiota leading to the shortening of diarrhoea.…”

“…The underlying mechanism of the probiotics against rotavirus gastroenteric infections in children included immune enhancement and modulation of intestinal microbiota leading to the shortening of diarrhoea. Many factors influence the outcome of the clinical study, including: correct strain selection and dosage of probiotics, duration of treatment, quality of probiotics as well as the production process of probiotics [ 27 ]. More robust, well-designed clinical studies addressing all factors are warranted.…”