COVID-19 medical therapy

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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

Antimicrobials

A preliminary randomized controlled trial of hydroxychloroquine suggests benefit[6].

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[7] than a prior case series of 67 similar patients of whom 44 (65.7%) died[8].

References

  1. https://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.
  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.
  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.
  5. 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.
  6. Zhaowei, Chen; et al. "Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial". medRxiv. doi:10.1101/2020.03.22.20040758v2.
  7. 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).
  8. 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).