ABSTRACT
Background: Severe COVID-19 has been attributed to a hyperimmune response mediated by cytokines. The mainstay of therapy remains largely supportive along with steroids. Co-trimoxazole in addition to having antimicrobial properties has immunomodulatory and anti-inflammatory properties and could potentially improve outcomes in patients with severe COVID-19 . Hypothesis: We hypothesised that Co-trimoxazole given to patients with severe COVID-19 could prevent progression to critical illness, mortality and reduce time to recovery. Method(s): We conducted an interim analysis in our single center open-label randomised control trial, in which hospitalised patients with severe COVID-19 requiring supplemental oxygen via non-rebreathe mask between 10 -15 Litres per minute and maintaining saturations between 92-96% were assigned in a 1:1 ratio to receive either oral Cotrimoxazole in addition to standard therapy or standard therapy alone. Result(s): 111 patients were recruited into the study, of which 56 patients received Co-trimoxazole and 55 received standard therapy alone. The mean age was 50 years in the Co-trimoxazole group versus 53 years in the standard therapy group (p=0.083). In-hospital mortality was 11% in the Co-trimoxazole group vs 29% in the standard therapy group (p=0.020). Mechanical ventilation was offered to 9% of the patients in the Co-trimoxazole group versus 13% of the patients in the standard therapy group. Time to recovery was 6 days in the Co-trimoxazole group versus 7 days in the standard therapy group (p=0.466). Conclusion(s): In this interim analysis oral Co-trimoxazole reduces mortality in patients with severe Covid-19. Further recruitment is underway.