Severe acute respiratory syndrome medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
Antibiotics are ineffective. Treatment of SARS so far has been largely supportive with antipyretics, supplemental oxygen and ventilatory support as needed.
Suspected cases of SARS must be isolated, preferably in negative pressure rooms, with full barrier nursing precautions taken for any necessary contact with these patients.
There was initially anecdotal support for steroids and the antiviral drug ribavirin, but no published evidence has supported this therapy. Many clinicians now suspect that ribavirin is detrimental.
Researchers are currently testing all known antiviral treatments for other diseases including AIDS, hepatitis, influenza and others on the SARS-causing coronavirus.
There is some evidence that some of the more serious damage in SARS is due to the body's own immune system overreacting to the virus. There may be some benefit from using steroids and other immune modulating agents in the treatment of the more acute SARS patients. Research is continuing in this area.
In December 2004 it was reported that Chinese researchers had produced a SARS vaccine. It has been tested on a group of 36 volunteers, 24 of whom developed antibodies against the virus. [1]
A 2006 systematic review of all the studies done on the 2003 SARS epidemic found no evidence that antivirals, steroids or other therapies helped patients. A few suggested they caused harm.[2]
- Preferred regimen: supportive therapy
- Note: New therapies were studied for SARS during the last outbreaks which concluded:
- Ribavirin ineffective and probably harmful due to haemolytic anaemia
- Lopinavir PLUS Ritonavir is still controversial and need further investigation
- Interferon has no benefit and its studies are inconclusive
- Corticosteroids increases risk of fungal infections, some studies showed a higher incidence of psychosis, diabetes, avascular necrosis and osteoporosis
- Inhaled Nitric oxide potent mediator of airway inflammation, its has improved oxygenation in some studies
References
- ↑ First SARS vaccine trials a success China Daily January 15, 2005
- ↑ SARS: Systematic Review of Treatment Effects PLoS Medicine September 2006 URL Accessed 13 September 2006
- ↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
- ↑ Stockman LJ, Bellamy R, Garner P (2006). "SARS: systematic review of treatment effects". PLoS Med. 3 (9): e343. doi:10.1371/journal.pmed.0030343. PMC 1564166. PMID 16968120.
- ↑ Groneberg DA, Poutanen SM, Low DE, Lode H, Welte T, Zabel P (2005). "Treatment and vaccines for severe acute respiratory syndrome". Lancet Infect Dis. 5 (3): 147–55. doi:10.1016/S1473-3099(05)01307-1. PMID 15766649.