PMC:7074432 / 7325-11877 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7074432","sourcedb":"PMC","sourceid":"7074432","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7074432","text":"Treatment of 2019-Novel Coronavirus: Evidence from China\nThe details of treatment reported in case of 2019-nCoV are presented in Table 1. The antiviral agents which are used in the management of 2019-nCoV episodes are lopinavir, ritonavir, arbidol,[28] oseltamivir,[12] i.v. ganciclovir.[29] Among immunomodulators, the commonly used agents are systematic corticosteroids,[1230] and i.v. immunoglobulin was used in more serious cases who were refractory to initial therapy.[28] Among herbal medicines, Chinese herbal medicinal products Tanreqing i.v. gtt,[31] shufeng jiedu capsule (a traditional Chinese medicine) was used.[28] The WHO has specified that at this present time there is no high level evidence is available, which favous use of a single specific antiviral agent for the treatment of patients with suspected or confirmed 2019nCoV infection.[27] Although many of the death cases were in higher age group[32] and many were smokers and had bilateral disease,[29] lack of appropriate control group is the main hindrance in interpreting these prognostic factors.\nTable 1 Details of reported therapeutic strategies to counter 2019-nCoV infection\nStudy details Sample size Therapeutic agents Outcome\n[28] 4 patients All patients received oxygen therapy and mechanical ventilation. All patients were treated with antibiotic, lopinavir, ritonavir, arbidol, and SFJDC (a traditional Chinese medicine). However, only one seriously ill patient received i.v. immunoglobulin. All patients were treated with antivirals for 6-15 days 3 patients improved, last patient still on ventilator (but improved)\n[12] 41 patients Antibiotic therapy was administered in 100% cases (n=41). 93% (n=38) patients received oseltamivir. 22% (n=9) patients received systematic corticosteroids Discharged=68% (n=28)\nAntiviral therapy: Overall 38 (93%), ICU setting 12 (92%), non-ICU care 26 (93%) Death=6 patients\nAntibiotic therapy: Overall 41 (100%), ICU setting 13 (100%), non-ICU setting 28 (100%) Death: Overall 6/41, ICU 5/13, non-ICU 1/28\nUse of corticosteroid: Overall 9 (22%), ICU settings 6 (46%), non-ICU settings 3 (11%)\n[32] Clinical data from 137 2019-nCoV- infected patients Patients were treated symptomatically and given respiratory support. Immunoglobulin was given to few patients depending upon clinical severity and response. No benefit was observed from systematic corticosteroid. Notably, early respiratory support facilitated disease recovery and improved prognosis. The risk of death was primarily associated with age, underlying chronic diseases, and median interval from the appearance of initial symptoms to dyspnea Patients with higher age at presentation and concomitant disease were more likely to show features of respiratory failure and had poorer outcome\n[30] 138 patients 90% of patients received oseltamivir. The most commonly used antibiotics were ceftriaxone (25%), moxifloxacin (64%), and azithromycin (18%). Around 45% of patients received additional glucocorticoid therapy Still admitted=61.6% (n=85)\n9.4% of patients required additional vasopressor and 1.44% of patients required renal replacement therapy Discharged=34% (n=47)\nSeverity of disease was an important determinant of antiviral and corticosteroid therapy. However, no effective outcomes were observed Death=4.3% (n=6)\n[29] 99 patients All patients were treated in isolationAntiviral therapy given to 76% patients (n=75). The antivirals used were oral oseltamivir, i.v. ganciclovir and lopinavir/ritonavir tablets. The duration of antiviral therapy ranged from 3 to 14 days70 patients received antibiotic treatment. In case of secondary bacterial infection, culture and sensitivity were used as a guide for antibiotic therapy. The duration of antibiotic therapy ranged from 3 to 17 days19 (19%) patients were also treated with additional corticosteroids for a duration of 3-15 daysNoninvasive ventilator=13, invasive ventilator=4, ECMO=3, and requirement of RRT=9 Discharged=31% (n=31)Died=11 (11%)Details of death patients:7/11 deaths age \u003e60 yearsLong history of smoking=3MuLBSTA score could predict outcomeLymphopenia=8Bilateral pneumonia=7Hypertension=3\n[31] 2 patients Both the patients were treated with i.v. corticosteroid, human gamma globulin, antibiotics (moxifloxacin), antiviral (oseltamivir and abidol hydrochloride) and Chinese herbal medicine Tanreqing i.v. gtt Both patients recovered\nSFJDC=Shufeng Jiedu Capsule, ICU=Intensive care unit, i.v.=Intravenous, ECMO=Extracorporeal membrane oxygenation, RRT=Renal replacement 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