Smallpox medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Tecovirimat is the only FDA-approved antiviral treatment for smallpox. However, the effectiveness of tecovirimat for treatment of smallpox disease has not been determined in humans because adequate and well-controlled field trials have not been feasible, and inducing smallpox disease in humans to study the drug’s efficacy is not ethical. Additional management is supportive and includes hydration, antipyretics, pain medications, and treatment of superimposed bacterial infections.

Medical Therapy

In case of a suspicious case of smallpox infection, the patient should be treated in a negative-pressure room whenever available. He should also be vaccinated, particularly if still in an early stage of the disease, in an attempt to minimize morbidity and mortality. In the presence of multiple patients with suspected or confirmed disease, a special facility or the whole hospital should be isolated and reserved for treating those patients.

So far Tecovirimat is the only antiviral drug that has been approved by the FDA for the treatment of patients with smallpox disease. The investigation for additional suitable drugs has been impaired by:

• Absence of human disease
• Difficulty in finding an animal host/model
• Reserved access to the virus

Apart from Tecovirimat, the main form of treatment is to keep the patient comfortable throughout the disease and prevent concomitant infections. This can be achieved by:

• Supportive care is the mainstay of therapy.
• Currently, Tecovirimat is the only FDA-approved anti-viral drug for the treatment of patients with smallpox disease.
• Recently, animal studies suggest that cidofovir and its cyclic analogues, given at the time of or immediately after exposure, have promise for the prevention of cowpox, vaccinia, and monkeypox.
• Patients need adequate hydration and nutrition, because substantial amounts of fluid and protein can be lost by febrile persons with dense, often weeping lesions.

• 1. Secondary bacterial infection

• Penicillinase-resistant antimicrobial agents should be used

• If smallpox lesions are secondarily infected,

• If bacterial infection endangers the eyes

• Daily eye rinsing is required in severe cases.

• Topical idoxuridine should be considered for the treatment of corneal lesions, although its efficacy is unproved for smallpox.

• If the eruption is very dense and widespread.