ABSTRACT
We would like to draw attention to the potential of immunomodulatory tetracyclines for severe COVID-19. The COVID-19 pandemic is having a devastating impact on developing countries. A successful approach to manage the scarcity of cost-effective therapies worldwide is drug repurposing. Predictions of direct anti-viral activity of tetracyclines against SARS-CoV2 have been confirmed experimentally. Furthermore, their effectiveness in experimental ARDS has been proven extensively, counteracting the overt inflammatory reaction and fibrosis sequelae due to a synergic combination of pharmacological activities. Finally, a few clinical reports have confirmed their potentiall in COVID-19 patients, encouraging the development of this novel indication. We believe that the benefits of their multi-target pharmacology and their safety profile place immunomodulatory tetracyclines as gold repurposing candidates for COVID-19.
Subject(s)
COVID-19ABSTRACT
Clinical assessment of possible infection with SARS-CoV-2, the novel coronavirus responsible for the outbreak of COVID-19 respiratory illness, has been a major activity of infectious diseases services in the UK and elsewhere since the first report of cases in December 2019. We report our case series of 68 patients, reviewed by Infectious Diseases Consultants at a Regional Infectious Diseases Unit in the UK. We prospectively evaluated our service between the 29th Jan 2020 and 24th Feb 2020. Demographic, clinical, epidemiological and laboratory data were collected. We have compared clinical features and subsequent diagnosis between well patients not requiring admission for clinical reasons or antimicrobials with those assessed as needing either admission or antimicrobial treatment. Final microbiological diagnoses included SARS-CoV-2 (COVID-19), Mycoplasma pneumonia, influenza A, RSV, non SARS/MERS coronaviruses, rhinovirus/enterovirus. 9/68 were treated with antimicrobials, 15/68 were admitted to a negative pressure room of whom 5/68 were admitted solely due to an inability to isolate at home. Patients requiring either admission on clinical grounds or antimicrobials (14/68) were similar to those not requiring admission or antimicrobials, with modestly more fever and shortness of breath in the clinically admitted / antimicrobial group. The most commonly prescribed antimicrobials were doxycycline, moxifloxacin and oseltamivir. The majority of patients had mild illness which did not require a clinical intervention to manage. This finding supports a community testing approach supported by clinicians to review the proportion of more unwell patients.