Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection DOI Creative Commons
Mayla Gabriela Silva Borba, Fernando Val, Vanderson de Souza Sampaio

et al.

JAMA Network Open, Journal Year: 2020, Volume and Issue: 3(4), P. e208857 - e208857

Published: April 24, 2020

Importance

There is no specific antiviral therapy recommended for coronavirus disease 2019 (COVID-19). In vitro studies indicate that the effect of chloroquine diphosphate (CQ) requires a high concentration drug.

Objective

To evaluate safety and efficacy 2 CQ dosages in patients with severe COVID-19.

Design, Setting, Participants

This parallel, double-masked, randomized, phase IIb clinical trial 81 adult who were hospitalized acute respiratory syndrome (SARS-CoV-2) infection was conducted from March 23 to April 5, 2020, at tertiary care facility Manaus, Brazilian Amazon.

Interventions

Patients allocated receive high-dosage (ie, 600 mg twice daily 10 days) or low-dosage 450 on day 1 once 4 days).

Main Outcomes Measures

Primary outcome reduction lethality by least 50% group compared group. Data presented here refer primarily outcomes during treatment 13. Secondary end points included participant status, laboratory examinations, electrocardiogram results. will be 28. Viral secretion RNA detection performed days 0 4.

Results

Out predefined sample size 440 patients, enrolled (41 [50.6%] 40 [49.4%] group). Enrolled had mean (SD) age 51.1 (13.9) years, most (60 [75.3%]) men. Older (mean [SD] age, 54.7 [13.7] years vs 47.4 [13.3] years) more heart (5 28 [17.9%] 0) seen high-dose detected 31 (77.5%) 41 (75.6%) groups, respectively. Lethality until 13 39.0% (16 41) 15.0% (6 40). The instance QTc interval greater than 500 milliseconds (7 37 [18.9%]) (4 36 [11.1%]). Respiratory negative only 6 27 (22.2%).

Conclusions Relevance

preliminary findings this study suggest higher dosage should not critically ill COVID-19 because its potential hazards, especially when taken concurrently azithromycin oseltamivir. These cannot extrapolated nonsevere

Trial Registration

ClinicalTrials.gov Identifier:NCT04323527

Language: Английский

Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19) DOI Open Access
Waleed Alhazzani, Morten Hylander Møller, Yaseen M. Arabi

et al.

Critical Care Medicine, Journal Year: 2020, Volume and Issue: 48(6), P. e440 - e469

Published: March 25, 2020

Background: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands people around world. Urgent guidance for clinicians caring sickest these patients needed. Methods: We formed panel 36 experts from 12 countries. All members completed World Health Organization conflict interest disclosure form. proposed 53 questions that are relevant to management COVID-19 in ICU. searched literature direct and indirect evidence on critically ill identified recent systematic reviews most relating supportive care. assessed certainty using Grading Recommendations, Assessment, Development Evaluation (GRADE) approach, then generated recommendations based balance between benefit harm, resource cost implications, equity, feasibility. Recommendations were either strong or weak, form best practice recommendations. Results: Surviving Sepsis Campaign issued 54 statements, which four nine recommendations, 35 weak No recommendation was provided six questions. topics were: 1) infection control, 2) laboratory diagnosis specimens, 3) hemodynamic support, 4) ventilatory 5) therapy. Conclusion: several help support healthcare workers ICU with COVID-19. When available, we will provide new further releases guidelines.

Language: Английский

Citations

1362
COVID‐19 diagnosis and management: a comprehensive review DOI Open Access
Giuseppe Pascarella, Alessandro Strumia, Chiara Piliego

et al.

Journal of Internal Medicine, Journal Year: 2020, Volume and Issue: 288(2), P. 192 - 206

Published: April 29, 2020

Severe acute respiratory syndrome coronavirus (SARS-CoV)-2, a novel from the same family as SARS-CoV and Middle East coronavirus, has spread worldwide leading World Health Organization to declare pandemic. The disease caused by SARS-CoV-2, 2019 (COVID-19), presents flu-like symptoms which can become serious in high-risk individuals. Here, we provide an overview of known clinical features treatment options for COVID-19. We carried out systematic literature search using main online databases (PubMed, Google Scholar, MEDLINE, UpToDate, Embase Web Science) with following keywords: 'COVID-19', '2019-nCoV', 'coronavirus' 'SARS-CoV-2'. included publications 1 January 3 April 2020 focused on treatments. found that infection is transmitted human through contact contaminated environmental surfaces. Hand hygiene fundamental prevent contamination. Wearing personal protective equipment recommended specific environments. COVID-19 are fever, cough, fatigue, slight dyspnoea, sore throat, headache, conjunctivitis gastrointestinal issues. Real-time PCR used diagnostic tool nasal swab, tracheal aspirate or bronchoalveolar lavage samples. Computed tomography findings important both diagnosis follow-up. To date, there no evidence any effective therapies being treat antiviral drugs, chloroquine/hydroxychloroquine therapy. In conclusion, although many have been proposed, quarantine only intervention appears be decreasing contagion rate. Specifically designed randomized trials needed determine most appropriate evidence-based modality.

Language: Английский

Citations

1353
Coronavirus disease 2019 (COVID-19) pandemic and pregnancy DOI Creative Commons
Pradip Dashraath,

Jing Lin Jeslyn Wong,

Karen Lim

et al.

American Journal of Obstetrics and Gynecology, Journal Year: 2020, Volume and Issue: 222(6), P. 521 - 531

Published: March 24, 2020

The current coronavirus disease 2019 (COVID-19) pneumonia pandemic, caused by the severe acute respiratory syndrome 2 (SARS-CoV-2) is spreading globally at an accelerated rate, with a basic reproduction number (R0) of 2-2.5, indicating that 2-3 persons will be infected from index patient. A serious public health emergency, it particularly deadly in vulnerable populations and communities which healthcare providers are insufficiently prepared to manage infection. As March 16, 2020, there more than 180,000 confirmed cases COVID-19 worldwide, 7000 related deaths. SARS-CoV-2 virus has been isolated asymptomatic individuals, affected patients continue infectious weeks after cessation symptoms. substantial morbidity socioeconomic impact have necessitated drastic measures across all continents, including nationwide lockdowns border closures. Pregnant women their fetuses represent high-risk population during outbreaks. To date, outcomes 55 pregnant 46 neonates reported literature, no definite evidence vertical transmission. Physiological mechanical changes pregnancy increase susceptibility infections general, when cardiorespiratory system affected, encourage rapid progression failure gravida. Furthermore, bias toward T-helper (Th2) dominance, protects fetus, leaves mother viral infections, effectively contained Th1 system. These unique challenges mandate integrated approach pregnancies SARS-CoV-2. Here we present review pregnancy, bringing together various factors integral understanding pathophysiology susceptibility, diagnostic real-time reverse transcription polymerase chain reaction (RT-PCR) assays, therapeutic controversies, intrauterine transmission, maternal-fetal complications. We discuss latest options antiviral therapy vaccine development, novel use chloroquine management COVID-19. Fetal surveillance, view predisposition growth restriction special considerations labor delivery, addressed. In addition, focus on keeping frontline obstetric care safe while continuing provide essential services. Our clinical service model built around principles workplace segregation, responsible social distancing, containment cross-infection providers, judicious personal protective equipment, telemedicine. aim share framework can adopted tertiary maternity units managing flux pandemic maintaining safety patient provider its core.

Language: Английский

Citations

1259
RETRACTED: Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis DOI Creative Commons
Mandeep R. Mehra, Sapan S. Desai, Frank Ruschitzka

et al.

The Lancet, Journal Year: 2020, Volume and Issue: unknown

Published: May 1, 2020

Language: Английский

Citations

1212
Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence DOI Open Access
Lisheng Wang, Yiru Wang, Dawei Ye

et al.

International Journal of Antimicrobial Agents, Journal Year: 2020, Volume and Issue: 55(6), P. 105948 - 105948

Published: March 19, 2020

Language: Английский

Citations

1198
Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19 DOI Creative Commons
Peter Horby, Marion Mafham, Louise Linsell

et al.

New England Journal of Medicine, Journal Year: 2020, Volume and Issue: 383(21), P. 2030 - 2040

Published: Oct. 8, 2020

Hydroxychloroquine and chloroquine have been proposed as treatments for coronavirus disease 2019 (Covid-19) on the basis of in vitro activity data from uncontrolled studies small, randomized trials.

Language: Английский

Citations

1183
A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19 DOI Open Access
Andrea Cortegiani,

Giulia Ingoglia,

Mariachiara Ippolito

et al.

Journal of Critical Care, Journal Year: 2020, Volume and Issue: 57, P. 279 - 283

Published: March 10, 2020

Language: Английский

Citations

1144
New insights on the antiviral effects of chloroquine against coronavirus: what to expect for COVID-19? DOI Creative Commons
Christian Devaux, Jean‐Marc Rolain, Philippe Colson

et al.

International Journal of Antimicrobial Agents, Journal Year: 2020, Volume and Issue: 55(5), P. 105938 - 105938

Published: March 12, 2020

Language: Английский

Citations

1103
Insights into SARS-CoV-2 genome, structure, evolution, pathogenesis and therapies: Structural genomics approach DOI Open Access

Ahmad Abu Turab Naqvi,

Kisa Fatima,

Taj Mohammad

et al.

Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease, Journal Year: 2020, Volume and Issue: 1866(10), P. 165878 - 165878

Published: June 13, 2020

Language: Английский

Citations

1051
SARS-CoV-2: an Emerging Coronavirus that Causes a Global Threat DOI Creative Commons
Jun Zheng

International Journal of Biological Sciences, Journal Year: 2020, Volume and Issue: 16(10), P. 1678 - 1685

Published: Jan. 1, 2020

An ongoing outbreak of pneumonia caused by a novel coronavirus, currently designated as the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was reported recently.However, SARS-CoV-2 is an emerging virus, we know little about it.In this review, summarize key events occurred during early stage outbreak, basic characteristics pathogen, signs and symptoms infected patients well possible transmission pathways virus.Furthermore, also review current knowledge on origin evolution SARS-CoV-2.We highlight bats potential natural reservoir pangolins intermediate host but their roles are waiting for further investigation.Finally, advances in development chemotherapeutic options briefly summarized.

Language: Английский

Citations

1027