Treatment options for COVID-19: The reality and challenges
Journal
Journal of Microbiology, Immunology and Infection
Journal Volume
53
Journal Issue
3
Pages
436-443
Date Issued
2020
Author(s)
Abstract
An outbreak related to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, China in December 2019. An extremely high potential for dissemination resulted in the global coronavirus disease 2019 (COVID-19) pandemic in 2020. Despite the worsening trends of COVID-19, no drugs are validated to have significant efficacy in clinical treatment of COVID-19 patients in large-scale studies. Remdesivir is considered the most promising antiviral agent; it works by inhibiting the activity of RNA-dependent RNA polymerase (RdRp). A large-scale study investigating the clinical efficacy of remdesivir (200 mg on day 1, followed by 100 mg once daily) is on-going. The other excellent anti-influenza RdRp inhibitor favipiravir is also being clinically evaluated for its efficacy in COVID-19 patients. The protease inhibitor lopinavir/ritonavir (LPV/RTV) alone is not shown to provide better antiviral efficacy than standard care. However, the regimen of LPV/RTV plus ribavirin was shown to be effective against SARS-CoV in vitro. Another promising alternative is hydroxychloroquine (200 mg thrice daily) plus azithromycin (500 mg on day 1, followed by 250 mg once daily on day 2–5), which showed excellent clinical efficacy on Chinese COVID-19 patients and anti-SARS-CoV-2 potency in vitro. The roles of teicoplanin (which inhibits the viral genome exposure in cytoplasm) and monoclonal and polyclonal antibodies in the treatment of SARS-CoV-2 are under investigation. Avoiding the prescription of non-steroidal anti-inflammatory drugs, angiotensin converting enzyme inhibitors, or angiotensin II type I receptor blockers is advised for COVID-19 patients. ? 2020
SDGs
Other Subjects
antiinfective agent; azithromycin; chloroquine; favipiravir; glycopeptide; herbaceous agent; hydroxychloroquine; interferon; lopinavir plus ritonavir; monoclonal antibody; polyclonal antibody; remdesivir; ribavirin; teicoplanin; adenosine phosphate; alanine; amide; antivirus agent; favipiravir; lopinavir; lopinavir-ritonavir drug combination; pyrazine derivative; remdesivir; ritonavir; RNA directed RNA polymerase; antiviral therapy; coronavirus disease 2019; drug efficacy; herbal medicine; human; mixed infection; nonhuman; plasma transfusion; prescription; Review; Betacoronavirus; Coronavirus infection; drug combination; drug effect; pandemic; passive immunization; procedures; virus pneumonia; Adenosine Monophosphate; Alanine; Amides; Antiviral Agents; Azithromycin; Betacoronavirus; Coronavirus Infections; Drug Combinations; Humans; Hydroxychloroquine; Immunization, Passive; Lopinavir; Pandemics; Pneumonia, Viral; Pyrazines; Ritonavir; RNA Replicase; Teicoplanin
Type
review