Title: Best Cough Treatment in Jaipur and Antibiotic for COVID-19 (1)
1Antibiotic
- If secondary infection is suspected Procal gt 0.2
- T. Azithromycin 500mg OD x 5 Days
- Or
- T. AmoxClav 625 TDS x 5 days
- Or
- Injection Ceftrioxone 1 gram twice a day if
admitted in - Moderate to severe case.
2Anti inflammatories
- 1) TOCILIZUMAB (Actemra)
- 2)SARILUMAB(Kevzara)
- 3)HYDROXYCHLOROQUINE
3CYTOKINE STORMThe Coronavirus patients Betrayed
by their own Immune systemsA cytokine storm
becomes an all-too-frequent phenomenon ,
particularly among the young. But treatments are
being tested.
- The immune system keeps raging after the virus is
no longer a threat 15 of all severely ill
COVID-19 patients younger patients more often- -
Diagnosed by elevated Interleukin -6, interferon
gamma, TNF alpha Elevated Ferritin levels may be
the most simple and specific test Tocilzumab ,
Sarilumab in severe cases - HCQS in milder cases
4Anti-Inflammatory Drugs
- 1. Tocilzumab -
- Anti-inflammatory drug tocilizumab is also being
investigated as a treatment for coronavirus. The
drug is most commonly used to treat rheumatoid
arthritis - Dose -a. Injectable Solution
- 20mg/ml (4,10 and 20 ml single dose
vials ) - b. Injection, single-use autoinjector
(ACTPen ) for SC - 162mg /0.9 ml
- c. Injection, single use prefilled
syringe for SC - 162mg/0.9 ml
-
5Tocilizumab / Actemra (Roche)
- An IL-6 receptor antagonist
- FDA approved treatment in
- Severe , active ,RA
- CAR T cell induced cytokine release storm - -
- IL-6 drives overactive inflammatory response in
lungs of severely ill COVID-19 patients
6Chloroquine / HCQS
- CHLOROQUINE a widely used anti-malarial
- HYDROXYCHLOROQUINE less toxic analogue
- Both have immunomodulatory effects
- Old drugs in use over gt 50 years
- Safe drugs In WHO list of safe and essential
medicines. - Widely used gt 5 million prescriptions / year in
U.S alone (2018)
7Safety
- Whilst majority of patients require no special
caution - - - Dangerous hemolysis in patients with G6PD
deficiency - Gastric side effects
- Caution in diabetics
- Significant drug interactions
- Risk of cardiac arrhythmias (by QTc prolongation)
8Anecdotal evidence for HCQS
- Doctors in Wuhan observed patients with SLE on
HCQS did not seem to develop COVID-19 - None of wuhan hospitals dermatology departments
80 lupus patients were infected - They hypothesized that this may be due to
long-term use of HCQS - Anecdotal case reports of its use in the previous
SARS outbreak in 2002-2003
9- 1.Chloroquine is effective in preventing the
spread of SARS Co V in cell culture. - 2.Favourable inhibition of virus spread observed
when cells were treated with chloroquine either
prior to or after SARS Co V infection.
10Cellular evidence for HCQS
- I) pH related
- An acidic pH at the surface of the host cell
facilitates coronavirus entry - HCQS alters pH at cell membrane surface thus
inhibiting fusion of virus to cell membrane ie
inhibiting endocytosis - II) Other antiviral mechanisms
- Inhibits nucleic acid replication
- Glycosylation of viral proteins
- Inhibits virus assembly, virus particle
transport, virus release - III) Other receptor mechanisms
- May involve ACE2 cellular receptor inhibition
11Clinical Infectious Diseases
- PK study which showed
- 1) HCQS more effective than Chloroquine in
inhibitory effect on COVID-19 - 2) Reaches high lung concentration
- 3) Optimal dose 400mg bid on Day 1, than
200mg Day 2 - 5 -
12Results after 5 days of HCQS
- Overall faster TTCR
- Faster improvement in cough
- Faster improvement in temperature
- Faster imp
- None progressed to severe disease (4 in the non-
HCQS group)
Our results confirm the short- term efficacy of
HCQS in the treatment of COVID-19 pneumonia
13- ACTUALITES ARTICLES SCIENTIFIQUES Int J
of Antimicrobial Agents 2020 - Clinical and microbiological effect of a
combination of hydroxychloroquine and
azithromycin in 80 - COVID-19 patients with at least a six-day follow
up - an observational study
- 28 mars 2020
- Source Mediterranee Infection
- Auteur Philippe Gautret and AI.
- Corresponding author Didier Raoult
- 80 hospitalized COVID-19 patients
- Rx with HCQS 200 mg TDS for 10 days
- Azithromycin for 5 days
14Results too good to be true?
- Clinical improvement in all but 2 of the 80
patients - Rapid decline in nasopharyngeal viral PCR load by
Day 8 93 - Viral cultures from resp samples negative by Day
5 97 - Allowed rapid discharge from contagious wards
after mean stay of 5 Days
15(No Transcript)
16Criticism
- Small size
- No control limb
- Physicians not blinded
- Milder cases only
- Selection bias could have skewed data
- 6 patients dropped out their data excluded from
analysis- - - PCR tests not consistently performed
- Conflicts of interest
- Promoted on YouTube, Fox News by
author/colleagues before - review
A deeply flawed study The article does not
meet the societys expected standard Int J
Antimicrob Agents
17-
- Lets put our work into running score proper
trials, and see if this effect holds up in well- - Conducted studies, Dahly says
18 To those who say we need 30 multi center
studies and 1000 patients I say when you have a
Rix that works against zero others, this should
become a benchmark. It is unethical not to
administer it. Its that simple
The evidence is anecdotal. The president is
talking abut hope .My job, as a scientist, is to
prove, without a doubt, that a drug is not only
safe by that it actually works.