Ebola medical therapy: Difference between revisions
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:::*Treat other infections if they occur. Provide adequate Gram-negative coverage and gram-positive if the patient has any catheter or hospital-acquired pneumonia. | :::*Treat other infections if they occur. Provide adequate Gram-negative coverage and gram-positive if the patient has any catheter or hospital-acquired pneumonia. | ||
:::*If there's respiratory failure, invasive mechanical ventilation may be the best option to offer respiratory support | :::*If there's respiratory failure, invasive mechanical ventilation may be the best option to offer respiratory support | ||
::*Note (1): Recovery from Ebola depends on good supportive care and the patient’s immune response. | |||
::*Note (2): While there is no proven treatment available for Ebola virus disease, human convalescent whole blood has been used as an empirical treatment with promising results in a small group of EVD cases.<ref>[http://apps.who.int/iris/bitstream/10665/135591/1/WHO_HIS_SDS_2014.8_eng.pdf interim]</ref><ref name="pmid9988160">{{cite journal| author=Mupapa K, Massamba M, Kibadi K, Kuvula K, Bwaka A, Kipasa M et al.| title=Treatment of Ebola hemorrhagic fever with blood transfusions from convalescent patients. International Scientific and Technical Committee. | journal=J Infect Dis | year= 1999 | volume= 179 Suppl 1 | issue= | pages= S18-23 | pmid=9988160 | doi=10.1086/514298 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9988160 }} </ref> | |||
==Prophylaxis Against Co-infections or Super-infections== | ==Prophylaxis Against Co-infections or Super-infections== | ||
Revision as of 00:19, 5 May 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Marjan Khan M.B.B.S.[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
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- Preferred regimen: supportive therapy. There is no specific antiviral drug available for Ebola thus far. For information of investigational therapies including Favipiravir, Brincidofovir, ZMapp, TKM-Ebola, AVI-6002, and BCX4430, see here.
- Isolate patient
- Provide intravenous fluids (IV) (patients need large volumes in some cases) and maintain electrolytes at normal levels
- Maintain oxygen saturation and blood pressure
- Administer blood products if coagulopathy or bleeding, antiemetics if vomiting , antipyretics if fever, analgesics, anti-motility if severe diarrhea, total parenteral nutrition if patient has poor oral intake and dialysis if there's renal failure
- Treat other infections if they occur. Provide adequate Gram-negative coverage and gram-positive if the patient has any catheter or hospital-acquired pneumonia.
- If there's respiratory failure, invasive mechanical ventilation may be the best option to offer respiratory support
- Note (1): Recovery from Ebola depends on good supportive care and the patient’s immune response.
- Note (2): While there is no proven treatment available for Ebola virus disease, human convalescent whole blood has been used as an empirical treatment with promising results in a small group of EVD cases.[3][4]
Prophylaxis Against Co-infections or Super-infections
Overwhelming sepsis is associated with the majority of deaths due to Ebola virus disease.[5] 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.[6] In contrast, the administration of antiviral agents, such as acyclovir or ribavirin, has not demonstrated efficacy.[5]
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
- ↑ "Ebola virus treatment".
- ↑ Feldmann H, Geisbert TW (2011). "Ebola haemorrhagic fever". Lancet. 377 (9768): 849–62. doi:10.1016/S0140-6736(10)60667-8. PMC 3406178. PMID 21084112.
- ↑ interim
- ↑ Mupapa K, Massamba M, Kibadi K, Kuvula K, Bwaka A, Kipasa M; et al. (1999). "Treatment of Ebola hemorrhagic fever with blood transfusions from convalescent patients. International Scientific and Technical Committee". J Infect Dis. 179 Suppl 1: S18–23. doi:10.1086/514298. PMID 9988160.
- ↑ 5.0 5.1 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.
- ↑ 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.