COVID-19 medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2], Syed Hassan A. Kazmi BSc, MD [3],Sabawoon Mirwais, M.B.B.S, M.D.[4],

Overview

COVID-19 is an inflammatory hypercytokinemia disease. The aim of therapy is prevention of viral replication and controlling the inflammatory process. On February 09, 2021 FDA approved emergency use authorization of monoclonal antibodies including bamlanivimab and etesevimab for mild to moderate covid-19 patients who are high risk for progression of disease ( age > 65years, medical comorbidities).

Antiviral Agents

Remdesivir

  1. Severe renal impairment (eGFR <30 ml/min)
  2. Severe hepatic dysfunction or alanin transferase (ALT)ᐳ 5-times upper limit

Favipiravir (Avigan)

Clofazimine

Atazanavir

Hydroxychloroquine and Chloroquine

Umifenovir (Arbidol)

Lopinavir-Ritonavir or kalerta

  • Lopinavir-Ritonavir Inhibits the activity of the HIV-1 protease.
  • In the Recovery Trial kaletra was not effective in reducing of mortality, duration of hospitalization or prevention of ventilation.[15]
  • In an open-label randomized controlled trial, the comparison between patients with COVID-19 received either lopinavir-ritonavir 400/100 mg, orally twice daily plus standard of care or standard care alone showed no benefit of administration of lopinavir-ritonavir.[16]
  • Only one study in Korea in the initial phase of outbreak accepted using this combination.[17]
  • Side effects: Diarrhea, nausea, asthenia

Oseltamivir (Tamiflu)

Supportive Agents

Interferon-1

Azithromycin

Vitamin C (Ascorbic Acid)

  1. Maturation of T lymphocytes and NK( natural killer) cells that are involved in the immune response to viral agents.
  2. Inhibition of reactive oxygen species (ROS) production
  3. Remodulation of the cytokine network in systemic inflammatory syndrome.
  • Study in COVID-19 patients in china showed administration of high dose IV,Vitamin C (1500mg per day) in moderate and severe cases was correlated with improvement in oxygenation indexes and recovery.[26]

Corticosteroids

Dexamethasone

  1. Decreased days of intubation
  2. Decreased mortality

Methylprednisolone

  1. Controlled of hypercytokinemia
  2. Anti-inflammatory effect in superimposed infection in COVID-19
  3. Increased blood pressure when it is low
  4. Decreased risk of death in ARDS related COVID-19[32]


Niclosamide and Ivermectin

  • Mechanism of action is the Inhibition of binding of coronavirus onto the cells.[33]

Convalescent Plasma

  • Serious side effects were not reported.[38]

Anticoagulation

In COVID-19 hypercoagulable state induces micro-macro-vascular thrombosis.


  • Efficacy of heparin in COVID-19 includes  : 1.anti inflammatory properties,2. prevention of viral attachment via changing in covid 19 spike protein 3.anticoagulation effect. [42]

Ibuprofen

Tocilizumab (Actemra)

  1. Hypoxia
  2. Lung infiltration on CXR
  3. High inflammatory markers (CRP>3g/dl, ferritin>400ng/dl
  4. Clinical deterioration
  1. Confirmed bacterial or fungal infection
  2. Platelet count<100000/cc
  3. Neutrophil count<2000/cc
  4. Alanin aminotrasferase or aspartat aminotransferase >5times upper limit normal

References

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