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Background and Objective: At the beginning of the pandemic, Hydroxychloroquine (HCQ) was one of the most widely used drugs prescribed to patients admitted to hospitals with coronavirus disease 2019 (COVID-19). We try to find the effect of HCQ on the severity and mortality of patients who did not receive corticosteroids. Methods: In this retrospective study, patients with COVID-19 disease were collected from February 20, 2020, to July 21, 2020, at Rouhani Hospital in Babol. Patients were followed up until December 6, 2021. In this study, 170 patients in case and control groups were studied. We used logistic and COX regression models to explore the effects of drugs. Data were analyzed by SPSS version 22. Findings: The use of HCQ did not affect mortality (p=0.46, 95%CI= 0.63 to 2.71, OR= 1.31) and final severity (p= 0.75, 95%CI= 0.59 to 2.06, OR= 1.10) at admission time. However, azithromycin remained in the final model but did not have a significant effect (P= 0.08, HR= 0.28, 95%CI= 0.06 to 0.18). Heparin use was not associated with severity improvement (p= 0.06, 95%CI= 0.97 to 2.81, HR= 1.65), while ceftriaxone remained a factor affecting severity in the model (p = 0.03, 95% CI= 0.29 to 0.95, HR = 0.52). Conclusion: In this study, HCQ harmed mortality admission time and was ineffective in the long term. The use of ceftriaxone compared to other drugs showed protective effects against the mortality hospitalization time. Heparin is not recommended without considering the risk of bleeding in COVID-19 patients.
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Background: There exists a treatment dilemma regarding the optimal and effective use of therapeutic drugs (hydroxychloroquine/chloroquine/azithromycin) for COVID-19. Furthermore, with changing guidelines, the data on drug utilization patterns across India are limited. Hence, this study was conducted to assess the prescription pattern and drug utilization trends in COVID-19 patients with the aim to study the drug utilization pattern in patients affected with COVID-19 in a dedicated COVID-19 hospital. Aims and Objectives: The objectives of the study are as follows: (1) To study drug utilization patterns according to the severity of the disease. (2) To study the prevalence of adverse drug reactions (ADRs). Materials and Methods: Data were collected retrospectively from 100 medical records of patients 18 years irrespective of sex admitted in the COVID ward and ICU of a dedicated COVID hospital from May to August 2020. Pregnant and lactating women were excluded from the study. ADRs reported were also analyzed. Results: About 71% were mild in this study, 18% were moderate, and 11% were severe COVID-19 patients. Overall, the most common drugs prescribed were multivitamins, followed by pantoprazole, paracetamol, and azithromycin. Hydroxychloroquine was prescribed in 22%, favipiravir in 7%, and remdesivir in 3% of cases. The majority of moderate COVID patients received injectables piperacillin-tazobactam, methylprednisolone, and enoxaparin. The mean number of medications, duration of admission, and number of days on oxygen were higher and significant in moderate compared to mild and severe COVID patients. Overall, ADRs were encountered in 9% of cases. Conclusion: The prescribed pattern of drugs was by the national standard guidelines. Multivitamins, followed by pantoprazole, paracetamol, and azithromycin dominated the prescription pattern. Polypharmacy was encountered, which needs to be addressed for the rational use of drugs.
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The coronavirus disease 2019 (COVID-19) has become a global pandemic. It is urgent to find treatments to control the infection and improve symptoms. Homologous modeling and clinical analyses suggest that histamine receptor antagonists have broad prospects in the treatment of COVID-19. This article introduces the research progress of histamine H1 receptor antagonist combined with azithromycin, histamine H2 receptor antagonist famotidine alone or combined with aspirin, and histamine H1 and H2 receptor antagonists used in combination in the treatment of COVID-19. Finally, the possible mechanism of histamine receptor antagonists in the treatment of COVID-19 was introduced and the application prospect of histamine receptor antagonists in the treatment of COVID-19 was analyzed.
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Background: The COVID-19 pandemic has caused many economic problems worldwide, in Iran as well, causing Hospitals to face many financial problems. Objectives: Based on documented data on pharmacotherapy, costs, and its effectiveness, this study aimed to analyze the costs and outcomes of hospitalized patients with COVID-19 under pharmacotherapy in Iran. Methods: This research was a retrospective analytical descriptive study. Relevant data of the COVID-19 hospitalized patients' were extracted from the Hospital's Medical Records Department. All items of direct medical costs, such as visits, nursing services, consuming materials, laboratories, imaging, medical operations, medications, and beds, were extracted by reviewing COVID-19 hospitalized patients' files in different wards of the Shohada Ashayer Hospital in Khorramabad city in 2021. Results: A total of 399 patients were examined in this study. The total direct medical costs per patient was 338.63 US$. Of note, the highest cost was related to medicine (32.56%), more than the cost of bed (22.77%). The most commonly used drugs were Lopinavir (95%) and Azithromycin (90%), and the highest medicine cost per patient was related to Immunoglobulin (64.32 US$) and Remdesivir (46.91 US$). Conclusion: Medicine and hospitalization costs accounted for the largest share of the total treatment costs of patients. Therefore, reducing bed costs requires home treatments and outpatient injections. Furthermore, due to rising drug costs, prescriptions should be based on standard treatment protocols.
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Children are usually affected by pneumonia, which is a common ailment caused by Pathogenic Streptococcus pneumoniae. This study's objective was to isolate and identify S. pneumoniae, which was recovered from blood samples of suspected paediatric pneumonia patients using conventional techniques, such as antibiotic sensitivity profiles and molecular approaches. In this study, forty (40) samples from three major hospitals in the Dinajpur region of Bangladesh were collected and assessed using various bacteriological, biochemical, antibiotic susceptibility test, and molecular techniques. 37.5% of the 40 samples tested positive for pneumonia, and 15 isolates were discovered. In terms of age, pneumonia was more common in children aged 3-5 years (50%) than in those aged 6 to 8 (33.33%), 9 to 11 (25%) and 12 to 15 (20%). According to the results of the current study, the study area had no statistically significant impact (P > 0.05), while age and socioeconomic status had a significant impact on the prevalence of pneumonia in patients with pneumonia (P 0.05). The age group for which pneumonia was most prevalent (at 50%) was that for children between the ages of 3-5. Poor socioeconomic status was associated with the highest prevalence of pneumonia (54.54%). By sequencing the 16S rRNA gene, S. pneumoniae was identified as S. pneumoniae NBRC102642. In the antibiotic investigation, S. pneumoniae was found to be extremely resistant to ciprofloxacin, amikacin, vancomycin, and cefexime, but responsive to erythromycin and azithromycin, as well as neomycin, kanamycin, streptomycin, and bacitracin. S. pneumoniae causes serious complications in paediatric patients, and this scenario requires prevention through vaccination and the development of new, efficient antibiotic therapies for pneumonia. If specific laboratory features of paediatric patients with pneumonia are understood, sepsis will be easier to detect early, treat, and reduce mortality.
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Background: The increased risk of cardiovascular events in patients prescribed macrolides has been subject to debate for decades. Methods: Medline, EMBASE databases and ClinicalTrials.gov were searched from inception until August 31, 2022 for studies investigating the link between macrolides and cardiovascular risk. A meta-analysis was performed using a random-effects model. Results: A total of 80 studies involving 39,374,874 patients were included. No association was found between macrolides and all-cause death. However, compared with the non-macrolide group, macrolides were associated with a significantly increased risk of ventricular arrhythmia or sudden cardiac death (VA or SCD) (azithromycin, relative ratio [RR]: 1.53; 95% confidence interval [CI]: 1.19 to 1.97; clarithromycin, RR: 1.52; 95% CI: 1.07 to 2.16). Besides, administration of macrolides was associated with a higher risk of cardiovascular disease (CVD) death (azithromycin, RR: 1.63; 95% CI: 1.17 to 2.27) and a slightly increased risk of myocardial infarction (MI) (azithromycin, RR: 1.08; 95% CI: 1.02 to 1.15). Interestingly, no association was observed between roxithromycin and adverse cardiac outcomes. Increased risk of VA or SCD was observed for recent or current use of macrolides, MI for former use, and CVD death for current use. Conclusion: Administration of macrolide antibiotics and timing of macrolide use are associated with increased risk for SCD or VTA and cardiovascular death, but not all-cause death.
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Objective: There is currently no drug that is effective against the coronavirus disease-2019 (COVID-19) and no consensus was present regarding the treatment. In this cross-sectional study, we aimed to evaluate the progress of the treatment process of patients with COVID-19 since the first day of pandemic in our country and the changes in the process. Method: This single-center cross-sectional study was conducted from March 11 through November 30, 2020, in University of Health Sciences Turkey, Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, a 400-bed tertiary care hospital in Izmir, Turkey. Treatment options in all hospitalized children with COVID-19 were evaluated.
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Background: COVID-19 is an infectious disease caused by a new type of virus named SARS-CoV-2. There is still no specific treatment for COVID-19;the antibiotic is used for therapy and to prevent severe disease, so the increasing use of antibiotics in COVID-19 patients will lead to a detrimental impact and the risk of antibiotic resistance. Purpose: This study aims to analyze antibiotic use frequency and determine the number of DDD per 100 bed-days in July - December 2020 at Bhayangkara Hospital Surabaya.
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Objectives: To examine the clinical characteristics, drug resistance, and factors influencing development of a pulmonary fungal infection in patients with severe respiratory diseases in order to provide a reference for clinical treatment.
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Objectives: To investigate pathogenic bacteria, their drug resistance, and changes in levels of cytokines in patients with a puerperal infection after a Cesarean section.
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The study of the presence of antibiotics in the aquatic environment is a preliminary step to analyse their possible harmful effects on aquatic ecosystems. In order to monitor their occurrence in the aquatic environment, the European Commission established in 2015, 2018, and 2020 three Watch Lists of substances for Union-wide monitoring (Decisions (EU) 2015/495, 2018/840, and 2020/1161), where some antibiotics within the classes of macrolides, fluoroquinolones and penicillins were included. In the Basque coast, northern Spain, three macrolide antibiotics (erythromycin, clarithromycin, azithromycin) and ciprofloxacin were monitored quarterly from 2017 to 2020 (covering a period before and after the COVID19 outbreak), in water samples collected from two Waste Water Treatment Plants (WWTPs), and three control points associated with receiving waters (transitional and coastal water bodies). This work was undertaken for the Basque Water Agency (URA). The three macrolide antibiotics in water showed a frequency of quantification >65 % in the Basque coast, with higher concentrations in the WWTP emission stations than in receiving waters. Their frequency of quantification decreased from 2017 to 2020, as did the consumption of antibiotics in Spanish primary care since 2015. Ciprofloxacin showed higher frequencies of quantification in receiving waters than in wastewaters, but the highest concentrations were observed in the WWTP emission stations. Although consumption of fluoroquinolones (among which is ciprofloxacin) in primary care in the Basque Country has decreased in recent years, this trend was not observed in the waters sampled in the present study. On the other hand, concentrations of clarithromycin, azithromycin, and ciprofloxacin in receiving waters exceeded their respective Predicted No-Effect Concentrations, so they could pose an environmental risk. These substances are widely used in human and animal medicine, so, although only ciprofloxacin is included in the third Watch List, it would be advisable to continue monitoring macrolides in the Basque coast as well.
Subject(s)
COVID-19 , Water Pollutants, Chemical , Anti-Bacterial Agents/analysis , Azithromycin , Ciprofloxacin/analysis , Clarithromycin , Ecosystem , Environmental Monitoring , Fluoroquinolones/analysis , Humans , Penicillins , Risk Assessment , Spain , Waste Disposal, Fluid , Wastewater/analysis , Water Pollutants, Chemical/analysisABSTRACT
COVID-19 is a deadly disease;at the time of the first COVID-19 wave (January 2020 to November 2020), so many deaths were reported worldwide. There were no standard conventional treatments and vaccines, so the whole world turned to traditional medicine. Siddha system of medicine is one of the traditional medicines practiced in the southern part of India. Shailam is a polyherbal formulation (licence no. 1189/25D) which was analyzed by molecular docking, with AutoDockVina software, against SARS-CoV-2 Spike Protein (PDB ID 7DDD). Absorption, distribution, metabolism, and excretion (ADME) properties were also recorded for Shailams phytocompounds using the online SwissADME tool. The results of the molecular docking study showed that the phytocompounds, like Caryophyllene, Aspidospermidin-17-ol, N,N Dibenzylidene-3,3-dichlorobenzidine, Beta-selinene, Curzerene, Germacrene B, Spathulenol, had the highest docking scores: -6.6 Kcal/mol, -8.8 Kcal/mol, -8.7 Kcal/mol, -6.2 Kcal/mol, -6.0 Kcal/mol, -6.6 Kcal/mol, -6.5 Kcal/mol, respectively, and the scores fall within the docking score range of the four standard conventional drugs;Azithromycin, Hydroxychloroquinone, Ivermectin, and Remdesivir which had binding energies of 7.7 Kcal/mol, -5.9 Kcal/mol, -9.2 Kcal/mol, and -7.5 Kcal/mol, respectively. ADME analysis predicted that all of Shailams phytocompounds met four Lipinskis rule of five and have a higher bioavailability score (0.55) as compared to standard conventional drugs, Azithromycin, Hydroxychloroquinone, Ivermectin, and Remdesivir (0.17). Twelve of Shailams phytochemical compounds have high GIT absorption and can cross the blood-brain barrier (BBB). In conclusion, Shailams phytocompounds show a good docking score and ADME property against SARS-CoV-2 Spike Protein (PDB ID 7DDD) as compared to standard conventional drugs.
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Introduction: COVID-19, the life-threatening disease caused by the pathogenic SARS-CoV-2 virus, has limited treatment or measures for curing the infected persons. However, many antibiotics have been tried with varied results.
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At the end of 2019 in December, a bunch of deadly pneumonia cases were found in Huanan sea food market in city of Wuhan in Hubei province, china. They were caused by a previously unknown corona virus. All patients had been associated with the Wuhan Whole food market, where seafood and live animals are sold. The virus spread at an alarming speed and lead authorities in China to initiate effort and investigation. However, by that time, the great row of travelers had carried the virus to many countries, sparking memories of the previous corona virus epidemics, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), and causing widespread media attention and panic. Based on clinical criteria and available serological and molecular information, the new disease was called corona virus disease of 2019 (COVID-19), and the novel corona virus was called SARS Corona virus -2 (SARS-CoV-2), emphasizing its close relationship to the 2002 SARS virus (SARS-CoV). The scientific community raced to uncover the origin of the virus, understand the pathogenesis of the disease, develop treatment options, define the risk factors, and work on vaccine development. In this manuscript we portray the causes, mechanisms and possible treatments for corona virus.
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Introduction. Hypertension, as a medical problem, is one of the most common disorders in cardiovascular disease. High blood pressure has been identified as one of the most familiar risk factors for the ongoing COVID-19 pandemic. We planned to explore the possible interactions between antihypertensive agents and drugs targeting SARS-CoV-2 with broad investigations in the mechanism of action and adverse effects of these medications. Methods. The electronic databases (PubMed, Scopus, and Google scholar) were searched by two of the coauthors to collect the papers relevant to the subject. The keywords searched were angiotensin converting enzyme inhibitors (ACEI), angiotensin-II receptor blockers (ARBs), sympatholytic drugs (alpha-1 blockers, beta blockers), vasodilators (calcium channel blockers, nitrates, hydralazine), diuretics, chloroquine, hydroxychloroquine, lopinavir/ritonavir, remdesivir, favipiravir, interferons, azithromycin, anti-cytokine agents, glucocorticoids, anticoagulant agents, nitric oxide and epoprostenol. Results. QT prolongation, hypokalemia, arrhythmia and increase the serum level of drugs are the most risky adverse effects of medications in patients with COVID-19 on anti-hypertensive drugs. Conclusion. Interaction of the drugs used for COVID-19 patients with anti-hypertensive drugs is an important issue that this review addresses.
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A 45-year-old man presented to the Medicine Outdoor with chief complaints of tingling sensation of lower limbs followed by weakness of both lower and upper limbs of 5 days duration. His complaints started with tingling sensation on the dorsum of feet that progressed upwards and within 12 hours he developed weakness of both lower limbs that progressed to affect both upper limbs within 24 hours. About 15 days prior to this event, he had fever for 5 days with cough, sneezing, myalgia without anosmia and ageusia. He got relief of these symptoms with azithromycin and paracetamol without testing for Covid-19. On examination, he was afebrile, pulse rate of 80/min, Blood Pressure-130/80mm of Hg. In right arm supine posture, respiration rate-18/minute, oxygen saturation-97% at room air. In view of acute onset lower motor neuron type of quadriparesis without sensory deficit and sphincter involvement with a preceding history suggestive of upper respiratory tract infection (URTI) 2 weeks before, a clinical diagnosis of Post-infectious Gullain-Barre syndrome (GBS) was made. The detection of serum IgG to SARSCoV-2 which is in accordance with the time interval of antibody appearance i.e., within 13 median days of clinical onset suggested the antecedent Covid-19 that was limited to upper respiratory tract. Hence, final diagnosis of GBS after Covid-19 infection has been made and he was treated with intravenous Immunoglobin at a dose of 0.4g/kg/day for 5 days with a total dose of 2g/kg. He improved symptomatically and could walk without support and was discharged after 7 days.
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BACKGROUND: Lung is the primary organ affected by the Coronavirus Disease-2019 (COVID-19) virus, which causes pneumonia, an acute respiratory distress syndrome (ARDS). Lung computed tomography (CT) is a very useful and practical modality in diagnosing COVID-19 due to its speed and high sensitivity in determining the severity. When visiting patients with suspected COVID-19 in hospitals, general practitioners are usually the first medical staff to visit these patients. Therefore, sufficient knowledge in the interpretation of the patients' lung CT scan is essential for general practitioners. CASE REPORT: A 28-year-old male patient referred to a physician at the hospital. He had only the symptoms of shortness of breath and mild chest pain during deep breathing. The general practitioner requested a CT scan of the patient;in addition, the physician diagnosed that the lungs were healthy and prescribed azithromycin and diphenhydramine syrup. Since the patient was a medical staff and was fully acquainted with CT scans, he became suspicious of the stereotype of his lung image and referred to an infectious disease specialist. Upon seeing the CT, the specialist immediately became suspicious of COVID-19 and referred the CT to a radiologist. CONCLUSION: In order to prevent misdiagnosis and spread of COVID-19 in the examinations, it is necessary to enhance the general practitioners' knowledge of the CT scan of lungs of suspected patients and patients with low lung infection, which can be difficult for general practitioners, by infectious disease specialists and radiologists.
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COVID-19 is a potentially fatal disease, considers that effective therapy is urgently needed necessary. Chloroquine and hydroxychloroquine have been tested for this in tested in China and France, respectively. Based on good efficacy data obtained from more than 100 patients, chloroquine was included in the guidelines for the treatment of COVID-19 pneumonia. These data are yet to be disclosed to the scientific community. Hydroxychloroquine alone or in combination with azithromycin has also been shown to be effective in a small, uncontrolled group. French study. The wide publicity of this dubious data but hopefully deficiency of these drugs, causing consequences for patients with dependent rheumatism. The description of the sample size calculation also reflects the original single branch design studies, because of the assumptions for combination control and treatment groups are completely omitted, suggesting that the inclusion of these groups was decided somewhere in the research process. They hope that more randomised controlled trials are ongoing demonstrate the effectiveness and safety of CLQ and HCQ in the treatment of COVID-19, as well as in preventive treatment. However, credit should not go to erroneous studies are published hastily. At this point, all necessary measures must made to facilitate access to these drugs for patients taking them for approved indications and protect them fall victim to science hype.
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Covid-19 is caused by SARS-CoV-2, which is responsible for the pandemics state declared in March 2020, leading to more than 500 thousand deaths in Brazil until June 2021. It is believed the severe cases are related to cytokines storm and to ACE2 receptor gene expression increasement. The present study aims to bring a review on the current types of medicines used for Covid-19 treatment in Brazil, highlighting the importance of deeper therapeutical studies for the disease. The qualitative bibliographical review was performed between June 2020 and June 2021, based on 32 articles about the topic and found on the PUBMED, MEDLINE, Scielo e Google Scholar databases. Scientific research and studies enabled the vaccines development as a prophylactic tool against Covid-19. However, the medicines used for treatment are still unclear. One of the first drugs for new coronavirus treatment cited in the literature was the chloroquine (CQ) and hydroxychloroquine (HCQ). Moreover, azithromycin (AZI), nitazoxanide (NTZ) e methylprednisolone (MPDN) are also consideredas therapeutic alternatives in Brazil. In the case of already infected individuals, the vaccine is not efficient for treatment anymore. Thus, it is necessary to identify an efficient treatment against Covid-19, being necessary deeper research about the medicines to combat SARS-CoV-2.
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In the context of the current SARS-CoV-2 pandemic, associations of drugs which interfere with specific steps of the viral infectious cycle are currently being exploited as therapeutic strategies since a specific treatment by vaccination is still unavailable. A widespread association of repurposed agents is the combination of the antimalarial drug Hydroxychloroquine and the macrolide antibiotic Azithromycin in the setting of clinical trials. But a closer analysis of their mechanism of action suggests that their concomitant administration may be impractical, and this is supported by experimental data with other agents of the same classes. However a sequential administration of the lysosomotropic antimalarial with the addition of the macrolide proton pump inhibitor after the first has reached a certain threshold could better exploit their antiviral potential.