Abstract: ORIGINAL RESEARCH published: 07 July 2020 doi: 10.3389/fmed.2020.00389 Challenges in the Management of SARS-CoV2 Infection: The Role of Oral Bacteriotherapy as Complementary Therapeutic Strategy to Avoid the Progression of COVID-19 Edited by: Alessandro Russo, University of Pisa, Italy Reviewed by: Antonio Vena, University of Genoa, Italy Alice Picciarella, Policlinico Casilino, Italy *Correspondence: Giancarlo Ceccarelli giancarlo.ceccarelli@uniroma1.it † These authors share first authorship Specialty section: This article was submitted to Infectious Diseases, Surveillance, Prevention and Treatment, a section of the journal Frontiers in Medicine Received: 09 May 2020 Accepted: 22 June 2020 Published: 07 July 2020 Citation: d’Ettorre G, Ceccarelli G, Marazzato M, Campagna G, Pinacchio C, Alessandri F, Ruberto F, Rossi G, Celani L, Scagnolari C, Mastropietro C, Trinchieri V, Recchia GE, Mauro V, Antonelli G, Pugliese F and Mastroianni CM (2020) Challenges in the Management of SARS-CoV2 Infection: The Role of Oral Bacteriotherapy as Complementary Therapeutic Strategy to Avoid the Progression of COVID-19. Front. Med. 7:389. doi: 10.3389/fmed.2020.00389 Frontiers in Medicine | www.frontiersin.org Gabriella d’Ettorre 1† , Giancarlo Ceccarelli 1*† , Massimiliano Marazzato 1 , Giuseppe Campagna 2 , Claudia Pinacchio 1 , Francesco Alessandri 3 , Franco Ruberto 3 , Giacomo Rossi 4 , Luigi Celani 1 , Carolina Scagnolari 5 , Cristina Mastropietro 1 , Vito Trinchieri 1 , Gregorio Egidio Recchia 1 , Vera Mauro 1 , Guido Antonelli 5 , Francesco Pugliese 3 and Claudio Maria Mastroianni 1 1 Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy, 2 Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy, 3 Department of Anesthesia and Intensive Care Medicine, Sapienza University of Rome, Rome, Italy, 4 School of Biosciences, Veterinary Medicine University of Camerino, Camerino, Italy, 5 Laboratory of Virology, Department of Molecular Medicine, Affiliated to Istituto Pasteur Italia - Cenci Bolognetti Foundation, Sapienza University, Rome, Italy Background: Gastrointestinal disorders are frequent in COVID-19 and SARS-CoV-2 has been hypothesized to impact on host microbial flora and gut inflammation, infecting intestinal epithelial cells. Since there are currently no coded therapies or guidelines for treatment of COVID-19, this study aimed to evaluate the possible role of a specific oral bacteriotherapy as complementary therapeutic strategy to avoid the progression of COVID-19. Methods: We provide a report of 70 patients positive for COVID-19, hospitalized between March 9th and April 4th, 2020. All the patients had fever, required non-invasive oxygen therapy and presented a CT lung involvement on imaging more than 50%. Forty-two patients received hydroxychloroquine, antibiotics, and tocilizumab, alone or in combination. A second group of 28 subjects received the same therapy added with oral bacteriotherapy, using a multistrain formulation. Results: The two cohorts of patients were comparable for age, sex, laboratory values, concomitant pathologies, and the modality of oxygen support. Within 72 h, nearly all patients treated with bacteriotherapy showed remission of diarrhea and other symptoms as compared to less than half of the not supplemented group. The estimated risk of developing respiratory failure was eight-fold lower in patients receiving oral bacteriotherapy. Both the..