Background: Disruption of the gut microbiota has been increasingly recognized in respiratory infections, contributing to impaired intestinal barrier function, systemic inflammation, and worse clinical outcomes. Microbiome-based therapeutic interventions (MBTIs), including probiotics and synbiotics, may modulate host immune responses through the gut-lung axis; however, their clinical efficacy in acute COVID-19 remains uncertain.Methods: We conducted a systematic review and meta-analysis of 14 randomized controlled trials involving 1,644 participants (812 intervention; 832 control). Eleven studies evaluated probiotics and three evaluated synbiotics, with sample sizes ranging from 39 to 300. Random-effects models calculated risk ratios (RRs) and mean differences (MDs), with subgroup analyses by MBTI type; heterogeneity was assessed using the I² statistic.Results: MBTIs were associated with reductions in all-cause mortality (RR = 0.51, 95% CI 0.28–0.90; I² = 0%; p = 0.02), disease progression (RR = 0.55, 95% CI 0.39–0.77; I² = 0%; p = 0.0005), hospital stay (MD = –1.00 days, 95% CI –1.94 to –0.05; I² = 74%; p = 0.040), and C-reactive protein (MD = –0.61 mg/L, 95% CI –1.01 to –0.21; I² = 91%; p = 0.003) versus standard care. Probiotics showed the most consistent benefits compared with synbiotics.Conclusions: Microbiome-based therapeutic interventions, particularly probiotics, may improve clinically relevant outcomes in COVID-19, likely through immunomodulation and modulation of the gut-lung axis. These findings support the potential role of microbiome-targeted therapies as adjunctive strategies in respiratory infections, although further well-designed trials are required.

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Background: Aspiration pneumonia (AP) remains a major cause of morbidity and mortality, yet non-invasive tools for monitoring lung injury in preclinical models are limited. Lung ultrasound (LUS) is widely used clinically, but existing murine scoring systems lack anatomical resolution and have not been validated for aspiration-related injury. Methods: We developed the Modified Lung Edema Ultrasound Score (MLEUS), a region-structured adaptation of the Mouse Lung Ultrasound Score (MoLUS), designed to accommodate the heterogeneous and gravity-dependent injury patterns characteristic of murine AP. Male C57BL/6 mice were assigned to sham, 6 h, 24 h, or 48 h groups. Regional LUS findings were compared with histological injury scores and wet-to-dry (W/D) ratios. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). Results: Global LUS–histology correlation was weak (ρ = 0.33, p = 0.114). In contrast, regional performance varied markedly. The right upper (RU) zone showed the strongest correspondence with histological injury (r = 0.55, p = 0.005), whereas right and left diaphragmatic regions demonstrated minimal association. LUS abnormalities were detectable as early as 6 h, preceding clear histological progression. Inter-rater reliability was good (ICC = 0.87). Conclusions: MLEUS provides a reproducible, region-specific framework for evaluating aspiration-induced lung injury in mice. Although global correlations with histology were limited, region-dependent analysis identified that the RU zone as a reliable acoustic window for concurrent injury assessment. Early ultrasound changes highlight the sensitivity of LUS to dynamic aeration and interstitial alterations rather than cumulative tissue damage. These findings support the use of LUS as a complementary, non-invasive physiological monitoring tool in small-animal respiratory research and clarify its methodological scope relative to existing scoring frameworks.