Ebola medical therapy: Difference between revisions
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Supplemental oxygen, including intubation and mechanical ventilation, may be necessary for patients with severe dyspnea, pulmonary edema, severe hemorrhage, and acute respiratory distress syndrome (ARDS). | Supplemental oxygen, including intubation and mechanical ventilation, may be necessary for patients with severe dyspnea, pulmonary edema, severe hemorrhage, and acute respiratory distress syndrome (ARDS). | ||
===Superimposed Infections=== | ===Superimposed Infections=== | ||
Close monitoring for possible superimposed infections is necessary given the high association between Ebola virus disease and overwhelming sepsis. | Close monitoring for possible superimposed infections is necessary given the high association between Ebola virus disease and overwhelming sepsis. Aggressive empirical administration of antimicrobial agents is necessary to treat infectious complications of Ebola virus disease.<ref name="pmid25337633">{{cite journal| author=Kreuels B, Wichmann D, Emmerich P, Schmidt-Chanasit J, de Heer G, Kluge S et al.| title=A Case of Severe Ebola Virus Infection Complicated by Gram-Negative Septicemia. | journal=N Engl J Med | year= 2014 | volume= | issue= | pages= | pmid=25337633 | doi=10.1056/NEJMoa1411677 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25337633 }} </ref> Infectious agents should be isolated and cultured for appropriate continuation of targeted antimicrobial therapy. | ||
==Prophylaxis Against Co-infections or Super-infections== | ==Prophylaxis Against Co-infections or Super-infections== | ||
Revision as of 21:08, 27 October 2014
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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. Administration of whole blood and plasma products from convalescent patients using standard procedures have been administered empirically with promising results and is currently recommended as empirical treatment during outbreaks by the World Health Organization (WHO).[1]
Bleeding
- Repletion of coagulation factors with fresh frozen plasma (FFP) if available, and transfuse with packed red blood cells and platelets may be required. 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
Supplemental oxygen, including intubation and mechanical ventilation, may be necessary for patients with severe dyspnea, pulmonary edema, severe hemorrhage, and acute respiratory distress syndrome (ARDS).
Superimposed Infections
Close monitoring for possible superimposed infections is necessary given the high association between Ebola virus disease and overwhelming sepsis. Aggressive empirical administration of antimicrobial agents is necessary to treat infectious complications of Ebola virus disease.[2] Infectious agents should be isolated and cultured for appropriate continuation of targeted antimicrobial therapy.
Prophylaxis Against Co-infections or Super-infections
Overwhelming sepsis is associated with the majority of deaths due to Ebola virus disease.[3] Thus, 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.[2] In contrast, the administration of antiviral agents, such as acyclovir or ribavirin, has not demonstrated efficacy.[3]
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.
References
- ↑ "Use of convalescent whole blood or plasma collected from patients recovered from Ebola virus disease for transfusion, as an empirical treatment during outbreaks" (PDF). 2014.
- ↑ 2.0 2.1 Kreuels B, Wichmann D, Emmerich P, Schmidt-Chanasit J, de Heer G, Kluge S; et al. (2014). "A Case of Severe Ebola Virus Infection Complicated by Gram-Negative Septicemia". N Engl J Med. doi:10.1056/NEJMoa1411677. PMID 25337633.
- ↑ 3.0 3.1 Parkes-Ratanshi R, Ssekabira U, Crozier I (2014). "Ebola in West Africa: be aware and prepare". Intensive Care Med. 40 (11): 1742–5. doi:10.1007/s00134-014-3497-z. PMID 25253023.