Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/02—Bacterial antigens
  • A61K39/085—Staphylococcus
• • A—HUMAN NECESSITIES
  • A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
  • A23K—FODDER
  • A23K10/00—Animal feeding-stuffs
  • A23K10/10—Animal feeding-stuffs obtained by microbiological or biochemical processes
  • A23K10/16—Addition of microorganisms or extracts thereof, e.g. single-cell proteins, to feeding-stuff compositions
  • A23K10/18—Addition of microorganisms or extracts thereof, e.g. single-cell proteins, to feeding-stuff compositions of live microorganisms
• • A—HUMAN NECESSITIES
  • A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
  • A23K—FODDER
  • A23K50/00—Feeding-stuffs specially adapted for particular animals
  • A23K50/10—Feeding-stuffs specially adapted for particular animals for ruminants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
  • A61K35/66—Microorganisms or materials therefrom
  • A61K35/74—Bacteria
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
  • A61K35/66—Microorganisms or materials therefrom
  • A61K35/74—Bacteria
  • A61K35/741—Probiotics
  • A61K35/744—Lactic acid bacteria, e.g. enterococci, pediococci, lactococci, streptococci or leuconostocs
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
  • A61K35/66—Microorganisms or materials therefrom
  • A61K35/74—Bacteria
  • A61K35/741—Probiotics
  • A61K35/744—Lactic acid bacteria, e.g. enterococci, pediococci, lactococci, streptococci or leuconostocs
  • A61K35/747—Lactobacilli, e.g. L. acidophilus or L. brevis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/04—Antibacterial agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/02—Immunomodulators
  • A61P37/04—Immunostimulants
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
  • C12N1/00—Microorganisms, e.g. protozoa; Compositions thereof; Processes of propagating, maintaining or preserving microorganisms or compositions thereof; Processes of preparing or isolating a composition containing a microorganism; Culture media therefor
  • C12N1/20—Bacteria; Culture media therefor
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
  • C12N1/00—Microorganisms, e.g. protozoa; Compositions thereof; Processes of propagating, maintaining or preserving microorganisms or compositions thereof; Processes of preparing or isolating a composition containing a microorganism; Culture media therefor
  • C12N1/20—Bacteria; Culture media therefor
  • C12N1/205—Bacterial isolates
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12R—INDEXING SCHEME ASSOCIATED WITH SUBCLASSES C12C - C12Q, RELATING TO MICROORGANISMS
  • C12R2001/00—Microorganisms ; Processes using microorganisms
  • C12R2001/01—Bacteria or Actinomycetales ; using bacteria or Actinomycetales
  • C12R2001/225—Lactobacillus
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12R—INDEXING SCHEME ASSOCIATED WITH SUBCLASSES C12C - C12Q, RELATING TO MICROORGANISMS
  • C12R2001/00—Microorganisms ; Processes using microorganisms
  • C12R2001/01—Bacteria or Actinomycetales ; using bacteria or Actinomycetales
  • C12R2001/225—Lactobacillus
  • C12R2001/25—Lactobacillus plantarum
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12R—INDEXING SCHEME ASSOCIATED WITH SUBCLASSES C12C - C12Q, RELATING TO MICROORGANISMS
  • C12R2001/00—Microorganisms ; Processes using microorganisms
  • C12R2001/01—Bacteria or Actinomycetales ; using bacteria or Actinomycetales
  • C12R2001/46—Streptococcus ; Enterococcus; Lactococcus

Definitions

• the present invention relates to a pharmaceutical preparation for prophylaxis against and treatment of Staphylococcus induced infections and conditions, to a kit therefor, to a method for prophylaxis against and treatment of Staphylococcus induced infections and conditions, and to uses of said pharmaceutical preparation or kit.
• Staphylococcus infections have since long been a widely spread problem around the world, which also gradually has been aggravated due to development of resistance against different antibiotic medicaments used for treatment of Staphylococcus infections.
• Staphylococci are spherically formed Gram-positive bacteria that are common in our daily environment. Under a microscope they appear round and form in grape-like clusters.
• the Staphylococcus genus includes more than thirty species, e.g. Staphylococcus aureus, Staphylococcus epidermidis , and Staphylococcus saprophyticus.
• Staphylococcus aureus belongs to the normal human bacterial flora and is present on the skin, on mucous membranes, and in the nostrils (nares).
• Staphylococcus epidermidis is present on the skin, in the nostrils, and in the oral cavity, while Staphylococcus saprophyticus is present in the urinary tract.
• Staphylococcal enterotoxins produced when these strains are allowed to grow in improperly stored food are a common cause of food poisoning leading to vomiting and diarrhoea.
• Staphylococcus epidermidis is mostly present on the skin of humans and may induce infections with pus formation under the skin, in particular for persons with reduced immune resistance. These strains may also give rise to sepsis, in particular for severely diseased patients, e.g. having long term intravenous catheters.
• Staphylococcus saprophyticus rarely induces diseases, but may in certain situations give rise to urinary tract infections.
• Staphylococcus aureus gives rise to a wide variety of diseases in humans and animals through either toxin production or invasion.
• Staphylococcus aureus, S. aureus for short also known as golden staph
• Staphylococcus aureus is the most common cause of Staphylococcus infections, and can cause a range of illnesses from minor skin infections, such as pimples, impetigo, boils, cellulitis folliculitis, furuncles, carbuncles, scalded skin syndrome and abscesses, to life-threatening diseases, such as pneumonia, meningitis, osteomyelitis endocarditis, toxic shock syndrome (TSS), and septicemia.
• TSS toxic shock syndrome
• Its incidence is from skin, soft tissue, respiratory, bone, joint, and endovascular to wound infections. It is still one of the four most common causes of nosocomial infections, often causing post-surgical wound infections.
• S. aureus may occur as a commensal on human skin, and in about a third of the population, it frequently also occurs in the nose, but in the throat less commonly.
• the occurrence of S. aureus under these circumstances does not always indicate infection and therefore does not always require treatment. It can survive on domesticated animals such as dogs, cats, pigs and horses. It can survive for some hours on dry environmental surfaces.
• S. aureus can infect other tissues when the normal barriers have been breached, e.g. skin or mucosal lining. This leads to furuncles (boils) and carbuncles (a collection of furuncles).
• S. aureus infection can cause a severe disease called Staphylococcal scalded skin syndrome (SSSS).
• SSSS Staphylococcal scalded skin syndrome
• S. aureus infections can be spread through contact with pus from an infected wound, skin-to-skin contact with an infected person by producing hyaluronidase that destroy tissues, and contact with objects such as towels, sheets, clothing, or athletic equipment used by an infected person. Deeply situated S. aureus infections can be very severe. Prosthetic joints put a person at particular risk for septic arthritis, and staphylococcal endocarditis (infection of the heart valves) and pneumonia, which may be rapidly spread. S. aureus is extremely prevalent in atopic dermatitis patients, who are less resistant to it than other people. It often causes complications.
• S. aureus is one of the causal agents of mastitis in dairy cows.
• Staphylococcus strains have an extraordinary ability to develop resistance against antibiotics. Staphylococcal resistance to penicillin is mediated by penicillinase (a form of ⁇ -lactamase) production: an enzyme which breaks down the ⁇ -lactam ring of the penicillin molecule.
• Penicillinase-resistant penicillins such as methicillin, oxacillin, cloxacillin, dicloxacillin, and nafcillin, are able to resist degradation by staphylococcal penicillinase.
• MRSA infections in both the hospital and community setting are commonly treated with non- ⁇ -lactam antibiotics such as clindamycin (a lincosamine) and co-trimoxazole (also commonly known as trimethoprim/sulfamethoxazole). Resistance to these antibiotics has also led to the use of new, broad-spectrum anti-Gram positive antibiotics such as linezolid because of its availability as an oral drug.
• First-line treatment for serious invasive infections due to MRSA currently include glycopeptide antibiotics (vancomycin and teicoplanin).
• glycopeptide antibiotics do not penetrate very well into infected tissues. This is a particular concern with infections of the brain and meninges, and in endocarditis. Glycopeptides must not be used to treat methicillin-sensitive S. aureus as outcomes are inferior.
• VRSA Vancomycin-resistant S. aureus
• VISA vancomycin-intermediate S. aureus
• S. aureus truly resistant to glycopeptide antibiotics was only reported in 2002.
• Three cases of VRSA infection have been reported in the United States as of 2005.
• Staphylococcus infections including MRSA, occur most frequently among the persons in hospitals and health care facilities. MRSA infections that occur in otherwise healthy people who have not been recently hospitalized or have not undergone any medical procedure are known as community-associated (CA)-MRSA-infections. The colonisation of MRSA can be long-resting, sometimes over years.
• MRSA may colonize at different locations in the human body, such as in the ear, the nasal and the pharyngeal region, in the gastro-intestinal region, in the urine, and on the skin.
• skin infections are boils, abscesses, styes (infection of glands in the eyelid), carbuncles, cellulites, and impetigo. If colonized in the blood or in other organs or parts within the body, an infection occurs, e.g. septicaemia (blood poisoning), septic shock, septic arthritis, osteomyelitis, internal abscesses, meningitis, pneumonia, and endocarditis. Long-term carriers have a higher risk of infection and may also spread the MRSA to other people.
• MRSA MRSA-resistant swine-resistant swine-resistant swine-resistant swine-resistant swine-resistant swine-resistant swine-resistant swine-resistant swine-resistant swine-resistant swine-resistant swine-resistant swine-resistant swine-resistant swine-resistant swine-resistant swine-resistant swine, a special antibiotic cream on the skin or inside the nose to remove the bacteria. It may also be necessary to wash the skin and hair with an antiseptic shampoo and lotion. In the hospital a private room is also needed to stop MRSA spreading.
• the object of the present invention is to reduce or eliminate the problems disclosed above in connection with Staphylococcus induced infections and conditions.
• this object is achieved by a pharmaceutical preparation for prophylaxis against and treatment of Staphylococcus induced infections or conditions in humans and animals, wherein it comprises a combination of
• the present invention relates to a kit for prophylaxis against and treatment of Staphylococcus induced infections and conditions, wherein it comprises two or more separate formulations intended to be administered at the same time, or in sequence within a predetermined time period, to a human or an animal in need thereof, wherein said kit comprises the combination of a) and b) above and each formulation in the kit comprises at least one strain according to a) above and/or at least one strain according to b) above.
• the present invention also relates to a method for prophylaxis against and/or treatment of a Staphylococcus induced infection or condition, wherein the pharmaceutical preparation or the kit according to the present invention is administered to a human or animal having need thereof.
• the present invention relates to use of the pharmaceutical preparation or the kit according to the present invention for the preparation of a medicament for prophylaxis against and/or treatment of Staphylococcus induced infections or conditions in humans and animals.
• the pharmaceutical preparation or the kit according to the present invention may also be used for the preparation of a medicament for prophylaxis against and/or treatment of virus infections such as rhinovirus, coronavirus, parainfluenza virus, and adenovirus, in the upper respiratory tract.
• virus infections such as rhinovirus, coronavirus, parainfluenza virus, and adenovirus
• the present inventors have surprisingly found that a new combination of different known micro-organism strains gives rise to an unforeseeable advantageous effect during prophylaxis against and treatment of Staphylococcus induced infections and conditions, i.e. it has an inhibitory, repressive, competitive and/or killing effect on Staphylococcus strains, e.g. Staphylococcus aureus, Staphylococcus epidermidis , and Staphylococcus saprophyticus .
• Staphylococcus strains e.g. Staphylococcus aureus, Staphylococcus epidermidis , and Staphylococcus saprophyticus .
• the combined strains originate from two main groups of microorganisms, more precisely ⁇ -Streptococcus strains, and Lactobacillus strains.
• Streptococcus strains in the pharmaceutical preparation according to the present invention are previously disclosed in WO 90/09186 (Essum AB). In this document these Streptococcus strains are disclosed to be useful in a pharmaceutical preparation for prophylaxis against and/or treatment of ⁇ -streptococcal tonsillitis.
• the Streptococcus sanguis II strains and the Streptococcus mitis strains in question were deposited with the National Collection of Industrial and Marine Bacteria Ltd (NCIMB), Torry Research Station, PO Box 31, 135 Abbey Road, Aberdeen AB9 8DG, Great Britain, on the 3 Feb. 1989, and have the accession numbers NCIMB 40104, NCIMB 40105, NCIMB 40106, and NCIMB 40107, respectively.
• Alternative names for these four strains are ⁇ 89a, ⁇ 502, ⁇ 505, and ⁇ 7213.
• the isolation, typing and medical function of these Streptococcus strains are disclosed in detail in WO 90/09186.
• a pharmaceutical preparation for prophylaxis and/or treatment of acute otitis media (inflammation of the ear) and middle otitis (inflammation of the middle ear) is disclosed in WO 99/53932 (Bacterum AB).
• Said preparation comprises some of the Streptococcus strains present in the combined pharmaceutical preparation according to the present invention, i.e.
• the strains NCIMB 40873, 40874, 40875, and 40876 were deposited on 19 Mar. 1997 in National Collection of Industrial and Marine Bacteria Ltd (NCIMB), 23 St. Machar Drive, Aberdeen, AB2 1RY, Great Britain.
• NCIMB National Collection of Industrial and Marine Bacteria Ltd
• the strain with the accession number NCIB 40104 was deposited on 3 Feb. 1989 (see WO 90/09186 above), and was thereafter designated NCIMB 40104.
• the isolation, typification and medical function of these strains are disclosed in detail in WO 99/53932.
• the ⁇ - Streptococcus lactis strain L1A is disclosed in WO90/00850 and has the accession number NCIMB 40157. This strain was at the time classified as an ⁇ - Streptococcus strain being ⁇ -hemolytic, but has thereafter been re-classified as a Lactococcus lactis strain. Following the original classification, this strain is grouped under the Streptococcus strains a) in the combination according to the present invention.
• a pharmaceutical preparation for prophylaxis against and/or treatment of gastrointestinal disorders in man and animals is disclosed in WO 98/55131 (Essum AB), wherein said preparation comprises a viable micro-organism strain in the form of the Lactobacillus casei rhamnosus strain LB21 with the accession number NCIMB 40564 and/or one or more variants thereof with an essentially similar function.
• the above-mentioned LB21 strain was deposited on 11 Jun. 1993 in National Collection of Industrial and Marine Bacteria Ltd (NCIMB), 23 St. Machar Drive, Aberdeen, AB2 1RY, Great Britain. The isolation, typing and medical function of this LB21 strain are disclosed in detail in WO 98/55131.
• Lactobacillus casei rhamnosus LB21 which is included here with the alternative term Lactobacillus rhamnosus LB21 in part b) of the combined pharmaceutical preparation according to the present invention, was isolated from faeces of infants and has proved to have a particularly pronounced inhibitory effect on the majority of the bacteria that are important to different types of intestinal infections in man, such as Staphylococcus aureus in general, but not MRSA, but substantially in view of different species such as Salmonella, Shigella, Pseudomonas, Klebsiella - Enterobacter, Campylobacter, Clostridium difficile, Helicobacter pylori etc.
• the strongly inhibitory effect of precisely LB21 on intestinally pathogenic bacteria is probably due to the fact that it produces specific acids but also a specific low-molecular protein or a specific low-molecular peptide, which is thermally stable, has a molecular weight below 5000 Daltons and which in a unique fashion has a detrimental effect on intestinally pathogenic bacteria.
• Lactobacillus plantarum strain LB3 having the accession number DSM 17852
• the Lactobacillus plantarum strain LB7 having the accession number DSM 17853
• Other Lactobacillus strains mentioned in the Examples below, e.g. LB45, LB64, LB66, LB87, LB99, LB931, and LB Ess-1 are also useful in the pharmaceutical preparation according to the present invention.
• the LB45, LB64, LB66, LB87, and LB99 have not yet been deposited, but may be purchased from Essum AB, Box 3160, 903 04 Ume ⁇ , Sweden.
• the Lactobacilus plantarum strain LB931 has the accession number DSM11918
• the Lactobacillus fermentum strain LB Ess-1 has the accession number DSM17851. They have been deposited on 9 Jan. 1998 and on 6 Jan. 2006, respectively, at Deutsche Mascheroder Weg 1b, D-38124 Braunschweig.
• the unique combination of the bacterial strains in the pharmaceutical preparation according to the present invention exerts an advantageous synergistic effect in that, on the first hand, the Streptococcus strains occupies the epithelial cells, the matrix and the mucosal membranes and the skin creating a kind of physical barrier and prevents the staphylococci to attach to these cells. Thus, the bacterial flora on the afflicted part of the body is balanced and strengthened.
• the Lactobacillus strains according to the present invention produce substances that inhibit the growth of the Staphylococci, e.g.
• MRSA mainly strengthens the natural defence by modulating both the innate and the adaptive immune systems due to the structure of their bacteria cell walls and not due to metabolites produced by these Lactobacillus strains.
• Studies made in vivo by spraying the LB21 in the nose and thereafter sampling the nasopharyngeal fluid to measure the cytokines showed that IL-8 increased significantly after spray treatment.
• IL-8 is an important mediator of the immune reaction in the innate immune system response.
• the synergistic effect in vivo of special strains of ⁇ -streptococci and Lactobacilli may depend on antimicrobial components e.g. bacteriocins from the ⁇ -streptococci and their physical barrier on the mucous, together with the specific acids produced by the Lactobacillus strains and the stimulation of the immune system.
• antimicrobial components e.g. bacteriocins from the ⁇ -streptococci and their physical barrier on the mucous, together with the specific acids produced by the Lactobacillus strains and the stimulation of the immune system.
• the combination of bacterial strains according to the present invention has shown good results in both in vitro and in vivo experiments with a view to reducing or eliminating harmful Staphylococcus strains on mucosal membranes and on the skin. Such good effects are not obtained if any one of the strains a) and b) according to the present invention is used only separately.
• the LB21 strain has shown an advantageous effect on only Staphylococcus aureus in general in the intestine during tests in vitro
• the combination between LB21 and one or more of the Streptococcus strains in group a) gives a much improved effect in vitro.
• Staphylococcus aureus strains e.g. MRSA, i.e. methicillin-resistant Staphylococcus aureus , which is a huge worldwide problem.
• more than one strain from each of the groups a) and b) according to the present invention as defined in claim 1 may be used.
• the Streptococcus sanguis strains ⁇ 89a, ⁇ 502, and ⁇ 505 are used as Streptococcus strains.
• Lactobacillus rhamnosus LB21 and, optionally, one or more of the Lactobacillus plantarum strains LB3, LB7, and also LB931, are used in group b) as Lactobacillus strains.
• the combination of Streptococcus sanguis ⁇ 89a and Lactobacillus rhamnosus LB21 is used. Other combinations of strains from group a) and b) are also effective.
• Streptococcus strains and Lactobacillus strains having the same or essentially similar effect are also useful in the combination of strains in the pharmaceutical preparation according to the present invention.
• the MRSA is killed within 16 h, and with only ⁇ -Streptococci the MRSA is not killed but only reduced as to the number.
• Staphylococcus induced infections and conditions is intended to mean an undesired propagation of Staphylococcus strains leading to an infection with painful swelling of tissues, as well as any other disease or infection by other micro-organism as a result of the Staphylococcus infection.
• This expression is also intended to include the condition where an individual has been colonised with Staphylococci, i.e. is a carrier of Staphylococci, e.g. a MRSA carrier, but has not yet developed an infection, i.e. does not suffer from any disease. However, such an individual has the ability to spread the Staphylococci to other individuals during a long period. Such individuals also are at high risk for developing MRSA infections.
• Pneumonia soft-tissue infection
• central venous catheter infection are the most common infections.
• other infections and conditions are, as also stated above, minor skin infections, such as pimples, impetigo, boils, cellulitis folliculitis, furuncles, carbuncles, scalded skin syndrome, and abscesses, as well as life-threatening diseases, such as meningitis, osteomyelitis endocarditis, toxic shock syndrome (TSS), and septicemia.
• minor skin infections such as pimples, impetigo, boils, cellulitis folliculitis, furuncles, carbuncles, scalded skin syndrome, and abscesses
• life-threatening diseases such as meningitis, osteomyelitis endocarditis, toxic shock syndrome (TSS), and septicemia.
• TSS toxic shock syndrome
• prophylaxis against Staphylococcus induced infections and conditions is intended to mean both prophylaxis for an individual, which not yet is a carrier of Staphylococci, and prophylaxis of an individual, which is a carrier of Staphylococci, from developing an infection or another Staphylococcus induced condition, but also to hinder the carrier to spread it to other persons.
• ready-for-use preparation used herein is intended to mean the final preparation to be administered to a human or an animal.
• predetermined time period used herein is intended to mean the maximum time period during which two or more different formulations in a kit can be administered while still maintaining an acceptable killing or inhibitory effect on Staphylococcus strains.
• the strains defined in group a) and the strains defined in group b) in the strain combination of the pharmaceutical preparation according to the present invention need necessarily not be present in the one and same preparation.
• the combination in the one and same preparation is more advantageous of several reasons, e.g. due to facilitated production and administration, the strains in group a) and the strains in group b) may be present in separate formulations and may be administered separately at the same time or within a predetermined time period.
• the present invention constitutes a kit containing two or more different formulations, each containing at least one strain from group a) and/or at least one strain from group b).
• the kit may also contain one formulation containing two or more strains belonging to group a) or several formulations each containing one strain belonging to group a).
• the kit may also contain one formulation containing two or more strains belonging to group b) or several formulations each containing one strain belonging to group b).
• said one or more formulations containing strains belonging to group a) and said one or more formulations containing strains belonging to group b) in the kit should be administered to the human or animal in need thereof within an as small time period as possible, preferably at the same time.
• a predetermined time period between said one or more formulations containing strains belonging to group a) and said one or more formulations containing strains belonging to group b) could be as long as 24 hours, more preferably 12 hours, and most preferably at the same time.
• the order of administration of such one or more formulations in a kit does not matter.
• the pharmaceutical preparation or the kit according to the present invention may be intended for an oral, oromucosal, pharyngeal, nasal, dental, cutaneous/skin, vaginal, rectal, ear, or dialysis formulation.
• the predetermined time period between administration of different formulations in the kit embodiment of the present invention may not be so long that the synergistic action not is obtained, e.g. due to non-optimal colonisation or undesired interaction with other strains, and is at most 24 hours, as stated above.
• the pharmaceutically acceptable medium may be any medium conventionally used in the medical area, also containing conventionally used auxiliary agents and excipients, or may be a soured or fermented milk product, preferably sour milk, yoghurt and milk or fruit juice, ice-cream, soup and fruit drinks.
• the pharmaceutically acceptable medium may also be an NaCl solution, a glucose solution or skim milk, or be an animal feed stuff, preferably whey, dry fodder or a concentrated suspension, when administering the preparation according to the invention to animals.
• the strains in the pharmaceutical product and the kit according to the present invention may be present in a lyophilizated form in the product ready for use.
• the pharmaceutical preparation may be administered in the form of e.g. a spray, e.g. a pharyngeal spray or a buccal spray, a powder, a tablet, a cachet, a granule, a capsule, a suspension in a preferred medium, a mouth wash or a drink, syrup or solution.
• a spray e.g. a pharyngeal spray or a buccal spray
• a powder e.g. a pharyngeal spray or a buccal spray
• a powder e.g. a pharyngeal spray or a buccal spray
• a powder e.g. a pharyngeal spray or a buccal spray
• a tablet e.g. a pharyngeal spray or a buccal spray
• a powder e.g. a pharyngeal spray or a buccal spray
• a tablet e.g. a pharyngeal
• a pharmaceutical preparation in the form of a gel, a salve, an ointment, a foam, a paste, a lotion, an emulsion, a patch, a stick, a cream, e.g. a washing cream or an oil suspension, is administered.
• the pharmaceutical preparation according to the present invention is administered in the form of a tablet, optionally with sustained release, a capsule, preferably enterocoated and/or colon-coated, a suspension, a solution, a drink, syrup, or a soup.
• the pharmaceutical preparation according to the present invention has also surprisingly been shown to prevent virus induced infections and conditions in the upper respiratory tract, e.g. by such virus strains as rhinovirus, coronavirus, parainfluenza virus and adenovirus. More precisely, previous experiments performed with only the Lactobacillus strain LB21 have shown that among 130 children less virus infections arise in the upper respiratory tract and the intestine, compared to children who not were administered with LB21. The combination according to the present invention seems to further decrease the amount of virus infections. Thus, in one embodiment the Lactobacillus strain LB21 may be used for the production of a medicament for treatment of virus induced infections and conditions in the upper respiratory tract.
• virus strains as rhinovirus, coronavirus, parainfluenza virus and adenovirus.
• a combination of the Lactobacillus strain LB21 and the ⁇ - Streptococcus sanguis II strain ⁇ 89a may be used for the same purpose.
• virus induced infections and conditions is intended to mean an undesired propagation of virus leading to an infection, such as common cold, sore throat, runny nose, nasal congestion, sneezing, and cough.
• said one or more Streptococcus strains is/are present in a total amount of 10 4 -10 11 cfu (colony-forming units)/ml, preferably 10 5 -10 10 cfu/ml, most preferably 10 6 -10 9 cfu/ml, of the ready-to-use preparation.
• said one or more Lactobacillus strains is/are present in the pharmaceutical preparation, alternatively the kit, according to the present invention in a total amount of 10 4 -10 11 cfu (colony-forming unit)/ml, preferably 10 5 -10 10 cfu/ml, most preferably 10 6 -10 9 cfu/ml, of the ready-to-use preparation.
• Lactobacillus LB21 was cultured in 5 ml MRS broth (37° C., 5% CO 2 , 8 h). 1% (450 ⁇ l) LB21 culture was reinoculated in 6 tubes containing 45 ml fresh pre-heated MRS broth and was incubated at 37° C. and 5% CO 2 for 16 h. Thereafter the tubes were centrifuged at 3800 rpm at 20° C. for 20 min. The supernatants were discarded and the pellets were resuspended in 5 ml pre-heated PBS and incubated at 37° C. and 5% CO 2 for 5 h. Once an hour the tubes were gently mixed.
• the tubes were centrifuged at 3800 rpm at 8° C. for 20 min. All the supernatants were collected in a new tube, and the pH was measured (4.0-4.3) The supernatants were then sterile filtered through a 0.22 ⁇ m filter. The filtrates were stored in ⁇ 20° C. in aliquots of 1 ml in 10 ml tubes until use.
• MRSA Five different strains of MRSA (22, 26, 28, 29, and 33; isolated from MRSA colonised patients) were cultured in 5 ml TH broth at 37° C. for 6 h. Thereafter, 1% (50 ⁇ l) of the MRSA culture was reinoculated in 5 ml fresh pre-heated TH broth and incubated in 37° C. for 17 h. The strains were then diluted in PBS and added to the LB21 PBS filtrates, to a mixture of LB21/Streptococcus ( ⁇ 89a) filtrate and to a control in PBS at a final concentration of 10 4 -10 5 cfu/ml. To all PBS filtrates, 5% TH broth was also added. The tubes were incubated at 37° C.
• e.g. 1.60E+04 means 1.60 ⁇ 10 4 , etc.
• Example 2a A further test was done according to Example 2a) but with new combinations of bacteria.
• LB931 and LB Ess-1 were tested in a combination with ⁇ 89a and Streptococcus lactis L1A, and the concentration of remaining MRSA were measured after different time periods.
• the test strain was MRSA 22.

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