Smallpox medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
There is no specific antiviral treatment for smallpox. The management is supportive and includes hydration, antipyretics, pain medications, and treatment of superimposed bacterial infections.
Medical Therapy
In case of a suspicious case of smallpox infection, the patient should be treated in a negative-pressure room whenever available. He should also be vaccinated, particularly if still in an early stage of the disease, in an attempt to minimize morbidity and mortality. In the presence of multiple patients with suspected or confirmed disease, a special facility or the whole hospital should be isolated and reserved for treating those patients.[1]
So far none of the available antiviral drugs have been proven effective against the smallpox virus. The investigation for a suitable drug has been impaired by:[2][3]
- Absence of human disease
- Difficulty in finding an animal host/model
- Reserved access to the virus
The main form of treatment is to keep the patient comfortable throughout the disease and prevent concomitant infections. This can be achieved by:[4]
- Supportive care is the mainstay of therapy.
- Currently, there are no anti-viral drugs of proven efficacy.
- Recently, animal studies suggest that cidofovir and its cyclic analogues, given at the time of or immediately after exposure, have promise for the prevention of cowpox, vaccinia, and monkeypox.
- Patients need adequate hydration and nutrition, because substantial amounts of fluid and protein can be lost by febrile persons with dense, often weeping lesions.
- 1. Secondary bacterial infection
- Penicillinase-resistant antimicrobial agents should be used
- If smallpox lesions are secondarily infected,
- If bacterial infection endangers the eyes
- Daily eye rinsing is required in severe cases.
- Topical idoxuridine should be considered for the treatment of corneal lesions, although its efficacy is unproved for smallpox.
- If the eruption is very dense and widespread.
References
- ↑ Breman, Joel G.; Henderson, D.A. (2002). "Diagnosis and Management of Smallpox". New England Journal of Medicine. 346 (17): 1300–1308. doi:10.1056/NEJMra020025. ISSN 0028-4793.
- ↑ Moore, Zack S; Seward, Jane F; Lane, J Michael (2006). "Smallpox". The Lancet. 367 (9508): 425–435. doi:10.1016/S0140-6736(06)68143-9. ISSN 0140-6736.
- ↑ Smee DF, Sidwell RW (2003). "A review of compounds exhibiting anti-orthopoxvirus activity in animal models". Antiviral Res. 57 (1–2): 41–52. PMID 12615302.
- ↑ "DIAGNOSIS AND MANAGEMENT OF SMALLPOX".