Can Rectal Ozone Insufflation Be Used for COVID-19 Management?

Background

During the COVID-19 pandemic, clinicians faced patients with severe hypoxaemia (dangerously low blood oxygen) and an overactive immune response known as a cytokine storm, with few targeted treatment options available. Ozone (O3) therapy has previously been trialled against other viral infections, including hepatitis B, HIV and Ebola, and is reported to improve tissue oxygenation while exerting anti-inflammatory and immune-modulating effects. Researchers at Suez Canal University in Egypt investigated whether rectal ozone insufflation - delivering a mixture of ozone and oxygen gas into the rectum - might offer a useful adjunct to standard COVID-19 care.

Study design

This is a case report describing two COVID-19 patients treated with rectal ozone insufflation alongside their standard medical care. The first was a 60-year-old woman who required mechanical ventilation and had an initial oxygen saturation of 90%. The second was a 40-year-old man managing his illness in home isolation, with an initial oxygen saturation of 85%. Both received a course of rectal ozone insufflation sessions. As a two-patient case report, there was no control group, no randomisation and no comparison arm - the authors simply documented the clinical course each patient followed after treatment.

Findings

Both patients showed gradual improvement in oxygen saturation and overall clinical status over the course of their ozone insufflation sessions. No adverse effects related to the treatment were reported in either case.

What the authors concluded

The authors concluded that rectal ozone insufflation could be used safely as an adjuvant management approach for patients with COVID-19, suggesting it may help address the hypoxaemia and inflammatory response associated with the disease.

Limitations of this study

This is a case report of only two patients with no control group, so it cannot show that ozone insufflation - rather than standard treatment, supportive care or the natural course of the illness - was responsible for the improvement observed. There was no randomisation or blinding, and findings from two individuals cannot be generalised to the wider COVID-19 population. Larger, controlled and randomised studies would be needed before any firm conclusions could be drawn about the safety or effectiveness of rectal ozone insufflation for COVID-19 management.