COVID-19 medical therapy: Difference between revisions

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Revision as of 16:09, 9 June 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Treatment of coronavirus infection includes supportive measures and symptomatic management. No specific treatment is available. Given the emergence of the cases during the influenza season, all patients presenting with COVID-19 were given oral and intravenous antibiotics and Oseltamivir (75 mg twice daily via oral route) empirically. Corticosteroids (methylprednisolone 40 - 120 mg/day) were given as a combined regimen if severe community-acquired pneumonia was diagnosed. Oxygen support (e.g., via nasal cannula and invasive mechanical ventilation) was given to patients indicated by the severity of hypoxemia.

Medical Therapy

Treatment of coronavirus infection includes supportive measures and symptomatic management, including:^[1]

Taking pain and fever medications (aspirin should not be given to children).
Using a room humidifier or taking a hot shower to help ease sore throat and cough.
Drinking plenty of liquids, staying home and taking rest.

Severe acute respiratory distress syndrome- coronavirus^[2]^[3]^[4]
Preferred regimen: Supportive therapy
Note: New therapies were studied for SARS during the last outbreaks which concluded:

Ribavirin ineffective and probably harmful due to haemolytic anaemia
Lopinavir PLUS Ritonavir is still controversial and need further investigation
Interferon has no benefit and its studies are inconclusive
Corticosteroids increases risk of fungal infections, some studies showed a higher incidence of psychosis, diabetes, avascular necrosis and osteoporosis
Inhaled Nitric oxide potent mediator of airway inflammation, its has improved oxygenation in some studies

Management of COVID-19

Recently, remdesivir has been shown to exhibit anti-viral activity against COVID-19. Remdesivir inhibits RNA-dependent RNA polymerase in the viral genome hence blocking its replication in the host.^[5]^[6]^[7]^[8]
Given the emergence of the cases during the influenza season, all patients presenting with COVID-19 were given oral and intravenous antibiotics and Oseltamivir (75 mg twice daily via oral route) empirically.^[9]
Corticosteroids (methylprednisolone 40 - 120 mg/day) were given as a combined regimen if severe community-acquired pneumonia was diagnosed.
Oxygen support (e.g., via nasal cannula and invasive mechanical ventilation) was given to patients indicated by the severity of hypoxemia.

Antimicrobials

A a randomized, double-blind, placebo-controlled trial across the United States and parts of Canada testing hydroxychloroquine as postexposure prophylaxis found that after high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure.

Passive immunization

Among patients receiving intensive care with mechanical ventilation for ARDS, a preliminary report of a case series suggest better outcomes receiving convalescent plasma^[10] than a prior case series of 67 similar patients of whom 44 (65.7%) died^[11].

References

↑ https://www.cdc.gov/coronavirus/2019-ncov/about/prevention-treatment.html. Missing or empty |title= (help)
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ Stockman LJ, Bellamy R, Garner P (2006). "SARS: systematic review of treatment effects". PLoS Med. 3 (9): e343. doi:10.1371/journal.pmed.0030343. PMC 1564166. PMID 16968120.
↑ Groneberg DA, Poutanen SM, Low DE, Lode H, Welte T, Zabel P (2005). "Treatment and vaccines for severe acute respiratory syndrome". Lancet Infect Dis. 5 (3): 147–55. doi:10.1016/S1473-3099(05)01307-1. PMID 15766649.
↑ Gordon CJ, Tchesnokov EP, Feng JY, Porter DP, Götte M (April 2020). "The antiviral compound remdesivir potently inhibits RNA-dependent RNA polymerase from Middle East respiratory syndrome coronavirus". J. Biol. Chem. 295 (15): 4773–4779. doi:10.1074/jbc.AC120.013056. PMC 7152756 Check |pmc= value (help). PMID 32094225 Check |pmid= value (help).
↑ Grein J, Ohmagari N, Shin D, Diaz G, Asperges E, Castagna A, Feldt T, Green G, Green ML, Lescure FX, Nicastri E, Oda R, Yo K, Quiros-Roldan E, Studemeister A, Redinski J, Ahmed S, Bernett J, Chelliah D, Chen D, Chihara S, Cohen SH, Cunningham J, D'Arminio Monforte A, Ismail S, Kato H, Lapadula G, L'Her E, Maeno T, Majumder S, Massari M, Mora-Rillo M, Mutoh Y, Nguyen D, Verweij E, Zoufaly A, Osinusi AO, DeZure A, Zhao Y, Zhong L, Chokkalingam A, Elboudwarej E, Telep L, Timbs L, Henne I, Sellers S, Cao H, Tan SK, Winterbourne L, Desai P, Mera R, Gaggar A, Myers RP, Brainard DM, Childs R, Flanigan T (April 2020). "Compassionate Use of Remdesivir for Patients with Severe Covid-19". N. Engl. J. Med. doi:10.1056/NEJMoa2007016. PMC 7169476 Check |pmc= value (help). PMID 32275812 Check |pmid= value (help).
↑ Cao YC, Deng QX, Dai SX (April 2020). "Remdesivir for severe acute respiratory syndrome coronavirus 2 causing COVID-19: An evaluation of the evidence". Travel Med Infect Dis: 101647. doi:10.1016/j.tmaid.2020.101647. PMC 7151266 Check |pmc= value (help). PMID 32247927 Check |pmid= value (help).
↑ "Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial - The Lancet".
↑ Huang, Chaolin; Wang, Yeming; Li, Xingwang; Ren, Lili; Zhao, Jianping; Hu, Yi; Zhang, Li; Fan, Guohui; Xu, Jiuyang; Gu, Xiaoying; Cheng, Zhenshun; Yu, Ting; Xia, Jiaan; Wei, Yuan; Wu, Wenjuan; Xie, Xuelei; Yin, Wen; Li, Hui; Liu, Min; Xiao, Yan; Gao, Hong; Guo, Li; Xie, Jungang; Wang, Guangfa; Jiang, Rongmeng; Gao, Zhancheng; Jin, Qi; Wang, Jianwei; Cao, Bin (2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". The Lancet. doi:10.1016/S0140-6736(20)30183-5. ISSN 0140-6736.
↑ Shen C, Wang Z, Zhao F, Yang Y, Li J, Yuan J; et al. (2020). "Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma". JAMA. doi:10.1001/jama.2020.4783. PMID 32219428 Check |pmid= value (help).
↑ Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S; et al. (2020). "Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China". JAMA Intern Med. doi:10.1001/jamainternmed.2020.0994. PMC 7070509 Check |pmc= value (help). PMID 32167524 Check |pmid= value (help).

[1] ttps://www.cdc.gov/coronavirus/2019-ncov/about/prevention-treatment.html. Missing or empty |title= (help)

[2] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[pmid16968120-3] Stockman LJ, Bellamy R, Garner P (2006). "SARS: systematic review of treatment effects". PLoS Med. 3 (9): e343. doi:10.1371/journal.pmed.0030343. PMC 1564166. PMID 16968120.

[pmid15766649-4] Groneberg DA, Poutanen SM, Low DE, Lode H, Welte T, Zabel P (2005). "Treatment and vaccines for severe acute respiratory syndrome". Lancet Infect Dis. 5 (3): 147–55. doi:10.1016/S1473-3099(05)01307-1. PMID 15766649.

[pmid32094225-5] Gordon CJ, Tchesnokov EP, Feng JY, Porter DP, Götte M (April 2020). "The antiviral compound remdesivir potently inhibits RNA-dependent RNA polymerase from Middle East respiratory syndrome coronavirus". J. Biol. Chem. 295 (15): 4773–4779. doi:10.1074/jbc.AC120.013056. PMC 7152756 Check |pmc= value (help). PMID 32094225 Check |pmid= value (help).

[pmid32275812-6] Grein J, Ohmagari N, Shin D, Diaz G, Asperges E, Castagna A, Feldt T, Green G, Green ML, Lescure FX, Nicastri E, Oda R, Yo K, Quiros-Roldan E, Studemeister A, Redinski J, Ahmed S, Bernett J, Chelliah D, Chen D, Chihara S, Cohen SH, Cunningham J, D'Arminio Monforte A, Ismail S, Kato H, Lapadula G, L'Her E, Maeno T, Majumder S, Massari M, Mora-Rillo M, Mutoh Y, Nguyen D, Verweij E, Zoufaly A, Osinusi AO, DeZure A, Zhao Y, Zhong L, Chokkalingam A, Elboudwarej E, Telep L, Timbs L, Henne I, Sellers S, Cao H, Tan SK, Winterbourne L, Desai P, Mera R, Gaggar A, Myers RP, Brainard DM, Childs R, Flanigan T (April 2020). "Compassionate Use of Remdesivir for Patients with Severe Covid-19". N. Engl. J. Med. doi:10.1056/NEJMoa2007016. PMC 7169476 Check |pmc= value (help). PMID 32275812 Check |pmid= value (help).

[pmid32247927-7] Cao YC, Deng QX, Dai SX (April 2020). "Remdesivir for severe acute respiratory syndrome coronavirus 2 causing COVID-19: An evaluation of the evidence". Travel Med Infect Dis: 101647. doi:10.1016/j.tmaid.2020.101647. PMC 7151266 Check |pmc= value (help). PMID 32247927 Check |pmid= value (help).

[urlRemdesivir_in_adults_with_severe_COVID-19:_a_randomised,_double-blind,_placebo-controlled,_multicentre_trial_-_The_Lancet-8] "Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial - The Lancet".

[HuangWang2020-9] Huang, Chaolin; Wang, Yeming; Li, Xingwang; Ren, Lili; Zhao, Jianping; Hu, Yi; Zhang, Li; Fan, Guohui; Xu, Jiuyang; Gu, Xiaoying; Cheng, Zhenshun; Yu, Ting; Xia, Jiaan; Wei, Yuan; Wu, Wenjuan; Xie, Xuelei; Yin, Wen; Li, Hui; Liu, Min; Xiao, Yan; Gao, Hong; Guo, Li; Xie, Jungang; Wang, Guangfa; Jiang, Rongmeng; Gao, Zhancheng; Jin, Qi; Wang, Jianwei; Cao, Bin (2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". The Lancet. doi:10.1016/S0140-6736(20)30183-5. ISSN 0140-6736.

[pmid32219428-10] Shen C, Wang Z, Zhao F, Yang Y, Li J, Yuan J; et al. (2020). "Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma". JAMA. doi:10.1001/jama.2020.4783. PMID 32219428 Check |pmid= value (help).

[pmid32167524-11] Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S; et al. (2020). "Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China". JAMA Intern Med. doi:10.1001/jamainternmed.2020.0994. PMC 7070509 Check |pmc= value (help). PMID 32167524 Check |pmid= value (help).

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 ====Antimicrobials====
-* A a [https://www.nejm.org/doi/full/10.1056/NEJMoa2016638 randomized, double-blind, placebo-controlled trial] across the United States and parts of Canada testing hydroxychloroquine as postexposure prophylaxis found that after high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure.
+* A a [https://www.nejm.org/doi/full/10.1056/NEJMoa2016638 randomized, double-blind, placebo-controlled trial] across the United States and parts of Canada testing [[hydroxychloroquine]] as postexposure [[prophylaxis]] found that after high-risk or moderate-risk exposure to Covid-19, [[hydroxychloroquine]] did not prevent [[illness]] compatible with Covid-19 or confirmed [[infection]] when used as postexposure [[prophylaxis]] within 4 days after exposure.
 ====Passive immunization====
-Among patients receiving intensive care with [[mechanical ventilation]] for [[ARDS]], a preliminary report of a case series suggest better outcomes receiving convalescent plasma<ref name="pmid32219428">{{cite journal| author=Shen C, Wang Z, Zhao F, Yang Y, Li J, Yuan J | display-authors=etal| title=Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. | journal=JAMA | year= 2020 | volume=  | issue=  | pages=  | pmid=32219428 | doi=10.1001/jama.2020.4783 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32219428  }} </ref> than a prior case series of 67 similar patients of whom 44 (65.7%) died<ref name="pmid32167524">{{cite journal| author=Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S | display-authors=etal| title=Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. | journal=JAMA Intern Med | year= 2020 | volume=  | issue=  | pages=  | pmid=32167524 | doi=10.1001/jamainternmed.2020.0994 | pmc=7070509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32167524  }} </ref>.
+* Among patients receiving intensive care with [[mechanical ventilation]] for [[ARDS]], a preliminary report of a case series suggest better outcomes receiving convalescent plasma<ref name="pmid32219428">{{cite journal| author=Shen C, Wang Z, Zhao F, Yang Y, Li J, Yuan J | display-authors=etal| title=Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. | journal=JAMA | year= 2020 | volume=  | issue=  | pages=  | pmid=32219428 | doi=10.1001/jama.2020.4783 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32219428  }} </ref> than a prior case series of 67 similar patients of whom 44 (65.7%) died<ref name="pmid32167524">{{cite journal| author=Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S | display-authors=etal| title=Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. | journal=JAMA Intern Med | year= 2020 | volume=  | issue=  | pages=  | pmid=32167524 | doi=10.1001/jamainternmed.2020.0994 | pmc=7070509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32167524  }} </ref>.
 ==References==
 {{reflist|2}}