Ebola medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Guillermo Rodriguez Nava, M.D. [2]

Overview

No specific antiviral drug has demonstrated effectiveness against Ebola infection. Management is primarily supportive and symptomatic. The following basic interventions, when used early, may improve the chances of survival: administration of intravenous fluids and correction of electrolyte abnormalities, maintenance of stable vital signs, and treatment against other co-infections or super-infections by antimicrobial agents. It is common practice to administer prophylactic broad-spectum antimicrobial agents, such as antibiotics and antimalarial agents, due to the high risk of co-infection or super-infection.

Medical Therapy

There are no targeted antiviral therapies currently in use. Supportive care is the mainstay of medical management. where hemodynamic and respiratory support are the two most important interventions.

Bleeding

Replete coagulation factors with fresh frozen plasma if available, and transfuse with packed red blood cells and platelets as needed. Invasive procedures should be avoided to prevent further bleeding.

Dehydration and Shock

• Patients with Ebola virus disease should be considered high-risk for development of shock.
• Intravenous fluids should be aggressively administered with careful consideration of electrolyte imbalances.
• Hypokalemia and hypocalcemia are common and repletion of potassium levels and calcium may be necessary.
• A combination of intravenous fluids, vasopressors, and blood products may be necessary as needed.

Hypoxia

Treat with supplemental oxygen including intubation if deemed necessary.

Superimposed Infections

Treating any complicating infections with empiric antimicrobial agents.

Prophylaxis Against Co-infections or Superinfections

It is common practice to administer antibiotics and antimalarial agents for patients with Ebola virus disease due to the high risk of co-infection or super-infection with Malaria and bacterial organisms.

Nutritional Support

• Although preferred, enteral nutrition may not be tolerated due to vomiting or paralytic ileus.
• Parental nutrition should be administered to patients who cannot tolerate oral food intake.
• Enteral nutrition should be resumed as soon as it is tolerated.