Several therapeutic agents including antivirals, monoclonal antibodies, antiparasitic drugs, steroid and plasma therapy have been tried in COVID-19 patients during early part of COVID-19 pandemic without any scientific evidence based on their efficacy on other viral infections or similar clinical conditions. Over the span of one and half year of COVID-19 pandemic, based on the results of various clinical trials, currently only a few therapeutic agents are recommended for use in COVID-19 patients. Based on the line of management guided by WHO and CDC, Ministry of Health and Family Welfare (MOHFW), India has come up with a management guideline. The below mentioned management of COVID-19 is in line with MOHFW, India.

In asymptomatic patients on home isolation: No medication is recommended for this group of patients. Advised to take healthy balanced diet with adequate fluid.

In mild patients: Antipyretic, antitussive and inhalational budesonide are advised for symptomatic relief.

In patients with moderate and severe COVID-19, oxygen support to maintain SpO2 92–95% and steroid, antiviral, immunomodulator and anticoagulant are to be given as indicated based on the results of relevant parameters.

Remdesivir: This is an adenosine analog of adenosine triphosphate, inhibits the viral RNA dependent RNA polymerase. It has been shown broad antiviral activity against RNA viruses including Ebola virus, SARS-CoV and middle east respiratory syndrome coronavirus (MERS-CoV). In non-human primate infected with MERS-CoV, it has shown prophylactic and therapeutic effects by decreasing the pulmonary lesions. The safety profile of remdesivir in patients who received for Ebola was favorable. Based on the limited scientific evidence globally, remdesivir presently approved for use in hospitalized patients in many countries including USA, European Union, India. It is to be used only in hospitalized patient with moderate to severe category who are on supplemental oxygen within 10 days of disease onset. It is given intravenously, 200 mg/day on day 1 followed by daily maintenance with 100 mg/day up to 10 days.

Tocilizumab: This is a humanized monoclonal antibody against IL-6 receptor. It has been approved for use in severe and critically ill COVID-19 patients who (i) show no signs of improvement in oxygen requirement after 24 48 hours of treatment, (ii) has significantly increased level of inflammatory markers with C-reactive protein ³75 mg/L. As this is an immunosuppressive agent, it should be ensured that there is no secondary bacterial, fungal or tubercular infection in the patient. It is administered as a single dose of 8 mg/kg body weight in 100 mL normal saline over 1 hour.

Steroid: Steroids are not indicated in asymptomatic or patients with mild COVID-19 infection and it may be harmful in these patients as it may delay the clearance of virus and increase the viral load. It is indicated only in hospitalized patients when the oxygen saturation goes below 92%. Dexamethasone or methylprednisolone or hydrocortisone can be given initially for 10 days or till the time of discharge either orally or intravenous. Monitoring of blood glucose is mandatory to keep a check on hyperglycemia.

Anticoagulants: Prophylactic anticoagulant is indicated in moderate and severe COVID-19 patients with low molecular weight heparin or unfractionated heparin. Therapeutic dose is indicate, if evidence of thromboembolism is there.

Monoclonal antibodies: Before COVID-19, several monoclonal antibodies have been developed for many viral infections such as HIV, Ebola, respiratory syncytial virus, influenza, Zika virus, etc. Monoclonal antibody (mAb) against RSV is the only one which have FDA approval, whereas mAb against Ebola has shown promising results. Several mono clonal antibodies got the emergency use authorization of FDA for use in COVID-19 patients.

Bamlanivimab: Also known as LY-CoV555, or LY3819253 was originally derived from the blood of one of the first US patients who recovered from COVID-19. It is a recombinant neutralizing monoclonal antibody directed against the receptor binding domain (RBD) of SARS-CoV-2 spike protein.

Etesivumab: Also known as LY-CoV016 or JS016, or LY3832479 is a monoclonal antibody directed against the overlapping but different epitopes of RBD of SARS-CoV-2 spike protein.

Casirivimab (previously REGN10933) and imdevimab (previously REGN10987) are recombinant human monoclonal antibodies that bind to non-overlapping epitopes of the S protein RBD of SARS-CoV-2.

The combination products of bamlanivimab plus etesevimab and casirivimab plus imdevimab have got the FDA, EUA approval.

Recommendation of NIH (National Institute of Health) guideline as of July 2021: Use of bamlanivimab 700 mg plus etesevimab 1,400 mg OR casirivimab 1,200 mg plus imdevimab 1,200 mg are recommended for non-hospitalized COVID-19 patients with mild to moderate severity who are at high-risk of clinical progression to severe disease. Treatment should be started as soon as possible of symptom within 10 days of symptom onset.

NIH recommends against the use of mono clonal antibodies in patients who are hospitalized because of COVID-19, who are on oxygen therapy due to COVID-19 or non-COVID-19 underlying comorbidity or who require increase oxygen flow than baseline. However, the combination may be used for persons with mild to moderate COVID-19 who are hospitalized for a reason other than COVID-19 but who otherwise meet the EUA criteria.

SARS-CoV-2 variant having mutation E484K or L452R or K417N have shown decreased activity to bamlanivimab, combi nation of bamlanivimab plus etesevimab and also to casirivimab.

اخر الاخبار

اخبار العتبة العباسية المقدسة

مؤتمر السيد المجاهد يشهد عرض فيلم وثائقي عن سيرته العلمية ومشروع إحياء تراثه

بحث حوزوي يتناول التمييز بين المعجزة والسحر عند السيد المجاهد

بحث يناقش أثر القواعد العقلية في استنباط الأحكام الشرعية عند السيد محمد المجاهد

بحث علمي يناقش ردود السيد المجاهد على اللغويين والنحويين في كتابه (مفاتيح الأصول)

المزيد

الآخبار الصحية

هل توقيت نشاطك اليومي يؤثر على صحة دماغك؟.. العلماء يجيبون

"مشروب محبوب" يخفي فوائد لا يعرفها كثيرون

طبيب يكشف 5 أنواع للسعال.. بعضها خطير

نقص فيتامينات "خفي".. قد يفسّر التعب والتنميل وقلة التركيز

المزيد

الآخبار التكنلوجية

دراسة: تغيّرات في أسلوب القيادة قد تكشف مبكرا عن الخرف !

عمرها 773 ألف سنة.. اكتشاف أقدم أحافير بشرية في المغرب

"اختراق علمي".. اختبار دم في منزلك قد يكشف ألزهايمر

ماذا يحدث للجسم عند قطع الكافيين فجأة؟

المزيد

مواضيع ذات صلة

Antiviral Chemotherapy

Antivirals of Influenza virus

Agents Used to Treat Viral Infections

Entry and Integrase Inhibitors

Protease Inhibitors

Non-nucleoside Reverse Transcriptase Inhibitors

Nucleoside and Nucleotide Reverse Transcriptase Inhibitors

Introduction to Antiretroviral Drugs

Neuramidase Inhibitors

Anti-Cytomegalovirus Agents

Anti-Herpes Simplex Virus and Varicella-Zoster Virus Agents

Introduction to Antiviral Drugs