US, WASHINGTON (ORDO NEWS) — There are a lot of them. But there are a few basic ones.
COVID-19 is a new disease, and there are no specialized medicines for it yet, they are only being developed. In this regard, doctors have to experiment, trying various treatment regimens and various drugs intended for other diseases.
At the same time, you need to understand that far from always there is a universal recipe that will allow absolutely all patients to recover. Everything depends too much on the state of the person – someone has diabetes, someone doesn’t have a heart condition, a special approach is needed for pregnant women. All these nuances can even be fatal if the drug was chosen incorrectly.
But since the current situation in the world can only be called force majeure, it is necessary to act quickly, including by scientists. And with regard to the development of vaccines, and in clinical trials of existing drugs on patients with COVID-19. Permits to use have to be issued quickly, as the situation requires it.
The result is a huge amount of experimental treatment methods. WHO, for example, is counting drugs used worldwide. As of April 28, their number far exceeded a hundred.
There is even a rather convenient and intuitive “cove” -base , where data about all the studies of various treatment methods flock. While there are 506.
“Anti-malarial” therapy leads with a noticeable margin, then there are antiviral and antiretroviral drugs, then a blood transfusion with antibodies that have been taken. There are many related combinations.
It all depends on the severity of the patient. If the patient is “average”, according to general statistics, he is often prescribed antiviral and antiretroviral drugs – as a rule, this is a combination of lopinavir and ritonavir, the standard drug for HIV-infected people. For patients with COVID-19, the dosage is 400 mg of lopinavir + 100 mg of ritonavir every 12 hours for 14 days.
There are also quite popular now favipiravir, ribavirin, umifenavir. And the most talked about right now is remdesivir, a licensed American anti-Ebola drug that is nowhere to be found. It has been tested since the beginning of the year, and on April 29 intermediate results appeared , which were quite promising. They were given weight by the words of the head of the National Institute of Allergy and Infectious Diseases of the USA, Anthony Fauci – speaking at a briefing in the White House, he said that the drug really seriously accelerates the recovery of patients. So what is now expectedthat the FDA, the local Food and Drug Administration, will issue a license for the use of remdesivir. In the critical situation in which the United States finds itself with its million infected, this may be a justifiable step.
In general, while the standard procedures for the medical treatment of patients with COVID-19 are not very different in different countries – even though the borders between experimental and proven methods are now somewhat erased due to the elementary absence of the latter. In Russia, the scheme recommended by the Ministry of Health looks like this.
What is given to patients with mild symptoms
Hydroxychloroquine and chloroquine are the two main antimalarial drugs. But they have many side effects, such as sleep disturbance, anorexia. They are also contraindicated in patients with renal and hepatic insufficiency, pregnant women, and “cores”.
Hydroxychloroquine is given 200-400 mg twice a day for six days. Here is how the Ministry of Health describes their choice: “Among the drugs that seem promising for the treatment of COVID-19, a group of antimalarial drugs should be noted: chloroquine, hydroxychloroquine, mefloquine. These drugs are used to treat malaria and some other protozoal infections. The mechanism of action of antimalarial drugs against some viral infections has not been fully studied; published data indicate several variants of their effect on COVID-19, which impede the penetration of the virus into the cell and its replication. In small clinical trials, the combination of azithromycin with hydroxychloroquine has been shown to enhance the antiviral effect of the latter. ”
Azithromycin, by the way, is an antibiotic. Studies on the effectiveness of its connection with hydroxychloroquine first appeared in mid-March, they were studied by a group led by the famous French virologist Didier Raoul. It is believed that it was his work that inspired Donald Trump to declare the benefits of hydroxychloroquine in the fight against COVID-19. After the president’s words, several people in the USA decided to self-medicate after drinking some of these pills. And in the end they died. As for the works of the Raul group, the scientific community did not accept them – somewhere there was too small a sample, somewhere – mixed results.
But it is not easy to refuse even this kind of therapy on the general lack of effective treatment methods, so in Russia it is used.
What give with moderate to severe symptoms
The same anti-malarial drugs. Azithromycin, by the way, is already added right at the stage of the appearance of more serious symptoms.
If the patient had contraindications or his condition still worsens, the Ministry of Health recommends switching to other drugs. In particular, to lopinavir / ritonavir, which, according to several studies, prevent the spread of SARS-CoV-2 particles in the body. They are supplemented with interferon beta-1b, which is usually used for multiple sclerosis, and in some cases – baricitinib, a drug against arthritis.
What gives in critical condition
Everything is the same, only tocilizumab or sarilumab is added to all schemes, it replaces baricitinib if necessary – they are all used in the treatment of arthritis.
The main option here is hydroxychloroquine + azithromycin +/- tocylizumab (sarilumab).
Spare: mefloquine + azithromycin +/- tocilizumab (sarilumab) or
lopinavir / ritonavir + recombinant interferon beta-1b +/- tocilizumab (sarilumab).
And finally, if nothing helps at all, the Ministry of Health recommends trying lopinavir / ritonavir with hydroxychloroquine and tocilizumab.
At the same time, the same recommendations of the department say that it is not worth mixing lopinavir / ritonavir with hydroxychloroquine.
It is also possible to use the blood plasma of those who have been ill, but no specific indications for its use have yet been developed in Russia.
Do all of these treatments work
Not at all a fact. For almost every study with positive findings, one or more disproving these data can be found. For example, despite all the laudations regarding remdesivir, based, by the way, mainly on the publications of its direct developer, there is also the opinion of Chinese scientists who did not notice the difference between him and placebo.
April 29 was published the work of an international group of scientists who tried to analyze the effectiveness of the 19 most commonly used drugs against COVID-19. Among them were remdesivir, and hydroxychloroquine, and mefloquine, and lopinavir / ritonavir. Only remdesivir proved to be more or less good, 68% of patients after taking it went on the mend. Hydroxychloroquine was noted to have a positive effect, but only when taken an hour before infection and at practically lethal doses. The remaining drugs could not protect the cells of the body from death after infection with SARS-CoV-2.
In general, scientists did not recommend the use of any of the drugs; the risks to the health of patients were too great. But there seems to be no choice yet. The American Institute of Health, for example, scolds a technique based on hydroxychloroquine and lopinavir / ritonavir, but offers no alternatives.
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