CORRECTION OF DYSBIOTIC ABNORMALITIES IN CHILDREN WITH ACUTE RESPIRATORY DISORDERS

Background:  A  special  attention  in  the treatment  of  acute   respiratory  disorders  (ARD) in  children   should   be   paid   to   correction   of defense mechanisms  of the body, including elimination    of    dysbiotic    abnormalities.    The use  of  probiotics,  whose  mechanism   of  action is directed  to restoration  of qualitative and quantitative composition  of normal microbiota, is considered  to be perspective  in the combination therapy  of ARD  patients. Aim: to  assess  clinical and  laboratory  efficacy of probiotic  Florin forte in children  with  ARD.  Materials and  methods: One  hundred  and   eleven   children  aged   from3 months  to 14 years with ARD were included into the study. In 81.1% of cases they had concomitant obstruction of upper  respiratory  ways. From day1 after admission to the hospital, 81 patients  (the main  group)  were  administered probiotic  Florin forte  as a part  of combination  therapy  for 5 to7 days, and  30 children  (the  comparator group) were  administered  the  standard   treatment without  probiotics. Parameters  of oropharyngeal and  mucosal  microflora, immune  parameters of anti-infectious resistance (phagocytic activity, phagocytic index, neutrophilic index of digestion), as  well  as  secretory   immunoglobulin  A levels in  saliva  were  measured  during  the  course  of the  illness. Results: In the  patients  of the  main group   under   the   combination  therapy,  there was   a   significantly   more    rapid    elimination of    respiratory     symptoms     and     intoxication (p < 0.05), with shorter  duration  of hospitalization (4.43 ± 0.19  days vs 6.03 ± 0.25  in the  comparator group, p < 0.001). The acute  phase  of the  disease in both  groups  of patients  was characterized  by dysbiotic   abnormalities   in  oropharyngeal   and gut  microbiota, with  a decrease  in non-specific host    resistance    parameters.   After   treatment, there was a significantly higher number  of indigenous   microbial  associations   in  the   main group, compared to that in the comparator group (43.4% vs 16.7%, p < 0.01), and  a higher  growth of enterobacteria  (16.9% vs 33.3%,  respectively, p < 0.1). In the patients  taking the probiotic, there was a trend towards restoration  of qualitative and quantitative  composition   of the  gut  microflora: in the main group, there was an increase in proportions of children  with a normal  counts  of bifidobacteria  (from 26.4% in the  acute  phase  to45.3%  after  treatment,  p < 0.05)  and  lactobacilli (from 7.5% to  16.9%, respectively,  p < 0.05), and a decrease of proportion of children with hemolytic Escherichia coli (in 32.1% before  treatment and in22.6%  after  treatment,  p > 0.05).  Improvements of immune parameters of the anti-infectious resistance  system  were  found  only in the  main group: the phagocytic  index at 120 minutes  after incubation  of neutrophils  was 4.26 ± 0.04  before treatment and 3.94 ± 0.09 after treatment (р < 0.05); the  neutrophil   digestion   index,  5.70 ± 0.71  and10.83 ± 0.94   (р < 0.01),  and   secretory   IgA   level in  saliva,  0.05 ± 0.03   and   0.125 ± 0.03   mcg/mL, respectively  (р < 0.05).  Conclusion:  Inclusion  of probiotic  Florin forte  into  combination  therapy of ARD patients  promoted more rapid clinical recovery, improvement of biocenotic  parameters in oropharyngeal and gut mucosa and an increase in anti-infectious resistance of the host.

children, acute respiratory disorder, microbiota, dysbiosis, oropharynx, gut, Florin forte