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Best Cough Treatment in Jaipur and Antibiotic for COVID-19

If you are searching for Allergy and Chest Specialist in Jaipur or, Saans Doctor then Dr Nishtha Singh is one of those at Asthma Bhawan. She has more than 6 Years of experience in the field of respiratory medicine.

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Best Cough Treatment in Jaipur and Antibiotic for COVID-19

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  1. Antibiotic If secondary infection is suspected Procal > 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.

  2. Anti inflammatories • 1) TOCILIZUMAB (Actemra) • 2)SARILUMAB(Kevzara) • 3)HYDROXYCHLOROQUINE

  3. CYTOKINE STORMThe Coronavirus patients Betrayed by their ownImmune 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

  4. 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

  5. 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

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

  7. 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)

  8. Anecdotal evidence for HCQS • Doctors in Wuhan observed patients with SLE on HCQS did not seem to develop COVID-19 • None of wuhan hospital’s dermatology department’s 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

  9. 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.

  10. 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

  11. 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

  12. 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’’

  13. 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

  14. 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

  15. 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 society’s expected standard’’ Int J Antimicrob Agents

  16. ‘’Let’s put our work into running score proper trials, and see if this effect holds up in well- Conducted studies,’’ Dahly says

  17. ‘’ 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. It’s 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.’’

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