Italy was the first European country affected by a severe outbreak of the Severe Acute Respiratory Syndrome - CoronaVirus-2 (SARS-CoV-2) epidemic emerged from Wuhan region (China), with a high morbidity and mortality associated with the disease. In light of its pandemic spread and the very limited therapeutic options, COronaVIrus Disease 19 (COVID-19) is considered an unprecedented global health challenge. Therefore, the evaluation of new resources, designed in the first instance for other pathologies but potentially active against COVID-19, represents a priority in clinical research. This is an interventional, non-pharmacological, open, randomized, prospective, non-profit study on the adjuvant use of oxygen ozone therapy plus probiotic supplementation in the early control of disease progression in patients with COVID-19. Contextually, all patients are treated with the current standard of care on the basis of the interim guidelines of the Italian Society of Infectious and Tropical Diseases. The main purpose of the study is to evaluate the effectiveness of an ozone therapy-based intervention (accompanied by supplementation with probiotics) in containing the progression of COVID-19 and in preventing the need for hospitalization in intensive care units.
Several studies analyzed the mechanisms by which ozone therapy could combat viral infections.
In particular, 1) the improvement of the release of oxygen in the peripheral tissues, 2) the
anti-inflammatory action 3) a virucidal activity have been described.
In view of these properties, a number of international clinical trials on the topic are
currently ongoing.
Hospitalization, dietary changes, use of antibiotics and systemic inflammation related to
COVID-19 are all variables that contribute to changes in the intestinal and lung microbiota
with significant repercussions on the outcomes of the disease. Furthermore, the use of ozone
therapy could also lead to a modification of the microbial flora. Probiotic supplementation
can help to correct these issues.
Other: Oxygen-ozone therapy, probiotic supplementation and Standard of care
- systemic autohemotherapy with Ozone 30 mcg / ml 250ml 2 times / day for 7 days
Dietary Supplement: SivoMixx (200 billion)
Composition of SivoMixx: Streptococcus thermophilus DSM322245, Bifidobacterium lactis DSM 32246, Bifidobacterium lactis DSM 32247, Lactobacillus acidophilus DSM 32241, Lactobacillus helveticus DSM 32242, Lactobacillus paracasei DSM 32243, Lactobacillus plantarum DSM 32244, Lactobacillus brevis DSM 27961 (NB: DSM n°... : bacterial strain identification code)
Drug: Azithromycin
dose: 500mg 1 cp / day (alternatively lopinavir/ritonavir cps 200/50 mg, 2 cps x 2 / day or darunavir 800 mg 1 cp / day + ritonavir 100 mg 1 cp / day or darunavir/cobicistat 800/150 mg 1 cp / day)
Drug: hydroxychloroquine
dose: 200 mg, 1 cp x 2 / day
Inclusion Criteria:
- Age > 18 years
- Nasopharyngeal swab positive for COVID-19
- COVID-19 stages I - II - III (*1)
- Hospitalization in the Department of Infectious Diseases
Exclusion Criteria:
- COVID-19 stages IV - V - VI (*1)
- Hospitalization in Intensive Care Units
- Pregnancy
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency
- Patients who deny consent to the proposed treatment
- Inability to provide informed consent
- Contraindications to performing oxygen-ozone therapy
- hyperhomocysteinemia
- favism or thyroiditis
- coagulopathies
- neurodegenerative diseases
- angina (in particular Prinzmetal's angina) or with previous myocardial infarction
(*1) Compliant with indications published by:
Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI).
Care pathway for the patient with COVID-19.
Section 2 - Recommendations for local management of the critically ill patient - Version 2
Available on
http://www.siaarti.it/SiteAssets/News/COVID19%20-%20documenti%20SIAARTI…
%20-%20Sezione%202%20-%20Raccomandazioni%20per%20la%20gestione%20locale%20-%20Rev%202.0.pdf
Last accessed 20/04/2020
Posted on 26.03.2020
On page 2 of the previous document :
"6 identified stages:
- sick disease - mild COVID-19 (I stage)
- light pneumonia - mild COVID-19 (II stage)
- serious pneumonia - severe COVID-19 (III stage)
- Acute respiratory distress syndrome (ARDS) - critical COVID-19 (IV stage)
- sepsis - critical COVID-19 (V stage)
- septic shock - critical COVID-19 (VI stage)"
Francesco Pugliese
Rome, RM, Italy
Investigator: Francesco Pugliese, MD PhD
Contact: 00390649978024
f.pugliese@uniroma1.it
Investigator:
Francesco Pugliese, MD, PhD
00390649978024
f.pugliese@uniroma1.it
Fabio Araimo, MD
f.araimo@policlinicoumberto1.it
Francesco Pugliese, MD, PhD, Principal Investigator
University of Rome Sapienza - Policlinico Umberto I Rome (Italy)