Best Cough Treatment in Jaipur and Antibiotic for COVID-19

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Antibiotic

• If secondary infection is suspected Procal gt 0.2
• T. Azithromycin 500mg OD x 5 Days
• Or
• T. AmoxClav 625 TDS x 5 days
• Or
• Injection Ceftrioxone 1 gram twice a day if
  admitted in
• Moderate to severe case.

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Anti inflammatories

• 1) TOCILIZUMAB (Actemra)
• 2)SARILUMAB(Kevzara)
• 3)HYDROXYCHLOROQUINE

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CYTOKINE STORMThe Coronavirus patients Betrayed
by their own Immune systemsA cytokine storm
becomes an all-too-frequent phenomenon ,
particularly among the young. But treatments are
being tested.

• The immune system keeps raging after the virus is
  no longer a threat 15 of all severely ill
  COVID-19 patients younger patients more often- -
  Diagnosed by elevated Interleukin -6, interferon
  gamma, TNF alpha Elevated Ferritin levels may be
  the most simple and specific test Tocilzumab ,
  Sarilumab in severe cases
• HCQS in milder cases

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Anti-Inflammatory Drugs

• 1. Tocilzumab -
• Anti-inflammatory drug tocilizumab is also being
  investigated as a treatment for coronavirus. The
  drug is most commonly used to treat rheumatoid
  arthritis
• Dose -a. Injectable Solution
• 20mg/ml (4,10 and 20 ml single dose
  vials )
• b. Injection, single-use autoinjector
  (ACTPen ) for SC
• 162mg /0.9 ml
• c. Injection, single use prefilled
  syringe for SC
• 162mg/0.9 ml

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Tocilizumab / Actemra (Roche)

• An IL-6 receptor antagonist
• FDA approved treatment in
• Severe , active ,RA
• CAR T cell induced cytokine release storm - -
• IL-6 drives overactive inflammatory response in
  lungs of severely ill COVID-19 patients

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Chloroquine / HCQS

• CHLOROQUINE a widely used anti-malarial
• HYDROXYCHLOROQUINE less toxic analogue
• Both have immunomodulatory effects
• Old drugs in use over gt 50 years
• Safe drugs In WHO list of safe and essential
  medicines.
• Widely used gt 5 million prescriptions / year in
  U.S alone (2018)

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Safety

• Whilst majority of patients require no special
  caution - -
• Dangerous hemolysis in patients with G6PD
  deficiency
• Gastric side effects
• Caution in diabetics
• Significant drug interactions
• Risk of cardiac arrhythmias (by QTc prolongation)

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Anecdotal evidence for HCQS

• Doctors in Wuhan observed patients with SLE on
  HCQS did not seem to develop COVID-19
• None of wuhan hospitals dermatology departments
  80 lupus patients were infected
• They hypothesized that this may be due to
  long-term use of HCQS
• Anecdotal case reports of its use in the previous
  SARS outbreak in 2002-2003

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• 1.Chloroquine is effective in preventing the
  spread of SARS Co V in cell culture.
• 2.Favourable inhibition of virus spread observed
  when cells were treated with chloroquine either
  prior to or after SARS Co V infection.

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Cellular evidence for HCQS

• I) pH related
• An acidic pH at the surface of the host cell
  facilitates coronavirus entry
• HCQS alters pH at cell membrane surface thus
  inhibiting fusion of virus to cell membrane ie
  inhibiting endocytosis
• II) Other antiviral mechanisms
• Inhibits nucleic acid replication
• Glycosylation of viral proteins
• Inhibits virus assembly, virus particle
  transport, virus release
• III) Other receptor mechanisms
• May involve ACE2 cellular receptor inhibition

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Clinical Infectious Diseases

• PK study which showed
• 1) HCQS more effective than Chloroquine in
  inhibitory effect on COVID-19
• 2) Reaches high lung concentration
• 3) Optimal dose 400mg bid on Day 1, than
  200mg Day 2 - 5

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Results after 5 days of HCQS

• Overall faster TTCR
• Faster improvement in cough
• Faster improvement in temperature
• Faster imp
• None progressed to severe disease (4 in the non-
  HCQS group)

Our results confirm the short- term efficacy of
HCQS in the treatment of COVID-19 pneumonia
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• ACTUALITES ARTICLES SCIENTIFIQUES Int J
  of Antimicrobial Agents 2020
• Clinical and microbiological effect of a
  combination of hydroxychloroquine and
  azithromycin in 80
• COVID-19 patients with at least a six-day follow
  up
• an observational study
• 28 mars 2020
• Source Mediterranee Infection
• Auteur Philippe Gautret and AI.
• Corresponding author Didier Raoult
• 80 hospitalized COVID-19 patients
• Rx with HCQS 200 mg TDS for 10 days
• Azithromycin for 5 days

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Results too good to be true?

• Clinical improvement in all but 2 of the 80
  patients
• Rapid decline in nasopharyngeal viral PCR load by
  Day 8 93
• Viral cultures from resp samples negative by Day
  5 97
• Allowed rapid discharge from contagious wards
  after mean stay of 5 Days

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Criticism

• Small size
• No control limb
• Physicians not blinded
• Milder cases only
• Selection bias could have skewed data
• 6 patients dropped out their data excluded from
  analysis- -
• PCR tests not consistently performed
• Conflicts of interest
• Promoted on YouTube, Fox News by
  author/colleagues before
• review

A deeply flawed study The article does not
meet the societys expected standard Int J
Antimicrob Agents
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• Lets put our work into running score proper
  trials, and see if this effect holds up in well-
• Conducted studies, Dahly says

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To those who say we need 30 multi center
studies and 1000 patients I say when you have a
Rix that works against zero others, this should
become a benchmark. It is unethical not to
administer it. Its that simple
The evidence is anecdotal. The president is
talking abut hope .My job, as a scientist, is to
prove, without a doubt, that a drug is not only
safe by that it actually works.