Possibilities and potential of bacteriophages in the treatment of atopic dermatitis in children

Possibilities and potential of bacteriophages in the treatment of atopic dermatitis in children

S.F. Gladkov¹, N.K. Perevoshchikova² 

¹Clinic of Allergology and Immunology LLC, Yurga

²Kemerov State Medical University, Kemerovo 

Aim: to determine the efficacy of selective phage decontamination (SPD) from excessive growth of Staphylococcus aureus, Klebsiella pneumoniae and Klebsiella oxytoca as the main trigger mechanism of atopic dermatitis (AD).

Patients and Methods: the study prospectively included 47 children (mean age 4.57±0.71 weeks) who were treated at the clinic with the Allergy and Immunology Department with a diagnosis of AD in the period of 2019–2021 (group 1). All patients in this group underwent SPD in the form of monotherapy. A group of 38 children (mean age 13.92±3.44 months) who visited the clinic of the Allergy and Immunology Department with a diagnosis of AD in the same period (group 2) was also retrospectively formed. Patients of this group did not undergo SPD at the disease onset. The study evaluated the efficacy of SPD in children at the start of the atopic march (AM).

Results: the conducted SPD, based on the results of microbiological stool analysis, revealed the associations presence of S. aureus 6.59±0.90 lg CFU/g, K. pneumoniae 5.48±0.85 lg CFU/g and K. oxytoca 5.00±1.78 lg CFU/g in children of the group 1. It allowed for the complete elimination of intestinal colic already on the 2nd or 3rd day. Reduction of pathological impurities in feces and normalization of the defecation frequency occurred after 3.82±0.63 days, a significant decrease in the severity of the skin syndrome — after 5.29±0.85 days of phage therapy. The SCORAD index at the time of the initial visit in group 1 averaged 15.5±2.4 points. At the end of the first course it was 0 points in 36 (76.5%) children, after the second course — in 11 (23.4%). SPD conducted in all children of group 1 allowed to prevent the recurrence of the disease and stop AM, which was confirmed by the follow-up in the catamnesis. A retrospective analysis of the AM progression in group 2 revealed the absence of positive trend due to the annual increase in the spectrum of sensitization. The analysis of control bacterial inoculation showed a significant decrease in the titer of S. aureus, K. pneumoniae and K. oxytoca in children of group 1.

Conclusion: phage therapy, even in the form of monotherapy, aimed at decontamination of the gastrointestinal tract from S. aureus, K. pneumoniae and K. oxytoca in children at the AD onset, allowed to effectively reduce the titers of these microorganisms, which, in turn, made it possible to effectively manage AM.

Keywords: atopic dermatitis, atopic march, intestinal microbiota, bacteriophages, decontamination, treatment.

For citation: Gladkov S.F., Perevoshchikova N.K. Possibilities and potential of bacteriophages in the treatment of atopic dermatitis in children. RMJ. 2023;2:63–66.