SARS Treatment

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SARS Treatment

• Loletta Kit-Ying SO
• Arthur Chun-Wing LAU
• Loretta Yin-Chun YAM

Prepared by Gino C. MATIBAG
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Pictures of SARS
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A standardized treatment protocol for adult SARS
in Hong Kong

• Antibacterial treatment
• Start levofloxacin 500mg OD IV or PO
• Or clarithromycin 500mg BID plus
  amoxicillin-clavulanate 375mg TID PO if patient
  is lt18 years pregnant, or TB suspect.

Source So, et al. Lancet 20033611615-6 http//w
ww.thelancet.com/journal/vol361/iss9369/full/llan.
361.9369.original_research.25590.1
4
A standardized treatment protocol for adult SARS
in Hong Kong

• Add combination treatment with ribavirin
  methylprednisolone when
• Extensive or bilateral chest radiographic
  involvement
• Or persistent chest radiographic involvement and
  persistent
• Or clarithromycin 500mg BID plus
  amoxicillin-clavulanate 375mg TID PO if patient
  is lt18 years pregnant, or TB suspect.

Source So, et al. Lancet 20033611615-6 http//w
ww.thelancet.com/journal/vol361/iss9369/full/llan.
361.9369.original_research.25590.1
Source So, et al. Lancet 20033611615-6 http//w
ww.thelancet.com/journal/vol361/iss9369/full/llan.
361.9369.original_research.25590.1
5
Patterns of disease progression response to
different corticosteroid doses in 3 patients
Source So, et al. Lancet 20033611615-6 http//w
ww.thelancet.com/journal/vol361/iss9369/full/llan.
361.9369.original_research.25590.1
6
A standardized treatment protocol for adult SARS
in Hong Kong

• Standard corticosteroid regimen
• for 21 days
• Methylprednisolone 1mg/kg q8h (3mg/kg daily) IV
  for 5d
• Then methylprednisolone 1mg/kg daily) IV for 5d
• Then prednisolone 0.5mg/kg BID (1mg/kg daily) PO
  for 5d

Source So, et al. Lancet 20033611615-6 http//w
ww.thelancet.com/journal/vol361/iss9369/full/llan.
361.9369.original_research.25590.1
7
A standardized treatment protocol for adult SARS
in Hong Kong

• Standard corticosteroid regimen
• for 21 days
• Then prednisolone 0.5mg/kg daily PO for 3d
• Then prednisolone 0.25mg/kg daily PO for 3d
• Then off

Source So, et al. Lancet 20033611615-6 http//w
ww.thelancet.com/journal/vol361/iss9369/full/llan.
361.9369.original_research.25590.1
8
A standardized treatment protocol for adult SARS
in Hong Kong

• Ribavirin regimen for 10-14 days
• Ribavirin 400mg q8h (1200mg daily) IV for at
  least 3d (or until condition becomes stable)
• Then ribavirin 1200mg BID (2400mg daily) PO

Source So, et al. Lancet 20033611615-6 http//w
ww.thelancet.com/journal/vol361/iss9369/full/llan.
361.9369.original_research.25590.1
9
A standardized treatment protocol for adult SARS
in Hong Kong

• Pulsed methylprednisolone
• Give pulsed methylprednisolone if clinical
  condition, CXR, or SaO2 worsens (at least two of
  these), lymphopenia persists
• Give as methylprednisolone 500mg IV BID for 2d,
  then back to standard corticosteroid regimen

Source So, et al. Lancet 20033611615-6 http//w
ww.thelancet.com/journal/vol361/iss9369/full/llan.
361.9369.original_research.25590.1
10
A standardized treatment protocol for adult SARS
in Hong Kong

• Ventilation
• Consider non-invasive ventilation or mechanical
  ventilation if SaO2 lt96 while on gt6 L per min
  O2 or if patient complains of increasing
  shortness of breath

Source So, et al. Lancet 20033611615-6 http//w
ww.thelancet.com/journal/vol361/iss9369/full/llan.
361.9369.original_research.25590.1
11
Treatment regimen for SARS in Guangzhou, China

• Levofloxacin 200mg BID plus azithromycin 600mg
  daily IV
• Recombinant interferon a 3,000,000 U daily IM
  (for 75 of their cases).
• If patients failed to respond, with pulmonary
  infiltrates involving more than one pulmonary
  segment, or an expanding area of consolidation
  was observed, they were treated with high-dose
  methylprednisolone for 5-14d.

Source Zhao Z, et al. J Med Microbiol 2003
52715-20 http//jmm.sgmjournals.org/cgi/content/f
ull/52/8/715
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Treatment regimen for SARS in Guangzhou, China

• Methylprednisolone
• 160-1000mg daily depending on symptoms and X-ray
  results
• 160mg daily if one lobe was involved
• 320mg daily if gt1 lobe
• 25 needed an increase in dosage from 160 to
  320-720mg daily to maintain respiratory
  physiological parameters to control temperature

Source Zhao Z, et al. J Med Microbiol 2003
52715-20 http//jmm.sgmjournals.org/cgi/content/f
ull/52/8/715
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Treatment regimen for SARS in Guangzhou, China

• Oxygen 3-5 L per min was given by mask if SaO2
  lt95 or, if patients felt short of breath,
  non-invasive CPAP ventilation was used.
• If CPAP failed (SaO2 lt90), mechanical
  ventilation was used.
• Immunoglobulins, thymic peptides or recombinant
  human thymus proteins were given to some
  critically ill patients.

Source Zhao Z, et al. J Med Microbiol 2003
52715-20 http//jmm.sgmjournals.org/cgi/content/f
ull/52/8/715