Keywords
medications
mortality rate
COVID-19
Abstract
There are many treatment modalities for COVID-19 – with varied outcome. Therefore, authors designed this study to assess prescribing patterns and the clinical outcome for hospitalized patients with severe and critical COVID-19 so as to determine the most effective approach. Authors conducted a retrospective observational study on 346 adult patients with either severe or critical COVID-19, who were admitted to public hospitals in Al-Najaf city, Iraq from June to September 2020. Patients’ information, medications and outcomes were collected from their medical records in the registered office of the hospital.A total of 346 patients were enrolled, with a majority of patients being adults above 35 years old and male (70.2%). Most patients (81%) received corticosteroid as dexamethasone, and about 45% of all patients were given convalescent plasma therapy, while a few patients were prescribed antiviral favipiravir (23%) and lopinavir/ritonavir (19%). As supportive care medications, anticoagulant such as enoxaparin was administered to most of the patients (93%) and more than half of all patients received the broad-spectrum antibiotic, meropenem. The majority of the patients recovered and were discharged alive (66%), however, the in- hospital mortality rate was 26%. Interestingly, patients treated with enoxaparin alone or in combination with hydroxychloroquine were associated with better outcome.The prescribing pattern of COVID-19 specific medications and supportive care is aligned with guideline recommendations and associated with a beneficial therapeutic outcome.
References
1. Phelan AL, Katz R, Gostin LO. The Novel Coronavirus Originating in Wuhan, China: Challenges for Global Health Governance. JAMA. 2020;323(8):709-10.
2. Al-Malkey MK, Al-Sammak MA. Incidence of the COVID-19 in Iraq – Implications for travellers. Travel Med Infect Dis. 2020;38:101739.
3. WHO; 2021. [https://covid19.who.int/] (access: 04 June 2021)
4. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
5. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323(20):2052-9.
6. Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic treatments for Coronavirus Disease 2019 (COVID-19): A review. JAMA. 2020;323(18):1824-36.
7. Bajwah S, Wilcock A, Towers R, Costantini M, Bausewein C, Simon ST, et al. Managing the supportive care needs of those affected by COVID-19. Eur Respir J. 2020;55(4):2000815.
8. Campos DM de O, Fulco UL, de Oliveira CBS, Oliveira JIN. SARS-CoV-2 virus infection: Targets and antiviral pharmacological strategies. J Evid Based Med. 2020;13(4):255-60.
9. Sahebnasagh A, Avan R, Saghafi F, Mojtahedzadeh M, Sadremomtaz A, Arasteh O, et al. Pharmacological treatments of COVID-19. Pharmacol Rep. 2020;72:1446-78.
10. Chappell L, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in hospitalized patients with COVID-19 – preliminary report. N Engl J Med. 2021;384(8):693-704.
11. Kewan T, Covut F, Al-Jaghbeer MJ, Rose L, Gopalakrishna KV, Akbik B. Tocilizumab for treatment of patients with severe COVID-19: A retrospective cohort study. E Clinical Medicine. 2020;24:100418.
12. WHO; 2021.[https://www.who.int/] (access: 28 June 2021)
13. Best JH, Kong AM, Kaplan‐Lewis E, Brawley OW, Baden R, Zazzali JL, et al. Treatment patterns in US patients hospitalized with COVID‐19 and pulmonary involvement. J Med Virol. 2021;93:5367-75.
14. Chibber P, Haq SA, Ahmed I, Andrabi NI, Singh G. Advances in the possible treatment of COVID-19: A review. Eur J Pharmacol. 2020;883:173372.
15. Lin KJ, Schneeweiss S, Tesfaye H, D’Andrea E, Liu J, Lii J, et al. Pharmacotherapy for hospitalized patients with COVID-19: Treatment patterns by disease severity. Drugs. 2020;80(18):1961-72.
16. Centers for Disease Control and Prevention. Guidance for COVID-19. [https://www.cdc.gov/coronavirus/2019-ncov/communication/guidance.html] (access: 27 June 0 2021).
17. Watanabe JH, Kwon J, Nan B, Abeles SR, Jia S, Mehta SR. Medication use patterns in hospitalized patients with COVID-19 in California During the pandemic. JAMA Netw Open. 2021;4(5):e2110775.
18. Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the treatment of COVID-19 – Final Report. N Engl J Med. 2020;383(19):1813-26.
19. Wang Y, Zhang D, Du G, Du R, Zhao J, Jin Y, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 2020;395(10236):1569-78.
20. Rattanaumpawan P, Jirajariyavej S, Lerdlamyong K, Palavutitotai N, Saiyarin J. Real-world experience with favipiravir for treatment of COVID-19 in Thailand: Results from a multi-center observational study. MedRxiv. 2020. [https://doi.org/10.1101/2020.06.24.20133249]
21. Salazar E, Christensen PA, Graviss EA, Nguyen DT, Castillo B, Chen J, et al. Treatment of Coronavirus Disease 2019 patients with convalescent plasma reveals a signal of significantly decreased mortality. Am J Pathol. 2020;190(11):2290-303.
22. Alsharidah S, Ayed M, Ameen RM, Alhuraish F, Rouheldeen NA, Alshammari FR, et al. COVID-19 convalescent plasma treatment of moderate and severe cases of SARS-CoV-2 infection: A multicenter interventional study. Int J Infect Dis. 2021;103:439-46.
23. Arshad S, Kilgore P, Chaudhry ZS, Jacobsen G, Wang DD, Huitsing K, et al. Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19. Int J Infect Dis. 2020;97:396-403.
24. Freedberg DE, Conigliaro J, Wang TC, Tracey KJ, Callahan MV, Abrams JA, et al. Famotidine use is associated with improved clinical outcomes in hospitalized COVID-19 patients: A propensity score matched retrospective cohort study. Gastroenterol. 2020;159(3):1129-31.e3.
25. Padhy BM, Mohanty RR, Das S, Meher BR. Therapeutic potential of ivermectin as add on treatment in COVID 19: A systematic review and meta-analysis. J Pharm Pharm Sci. 2020;23:462-9.
26. Zanasi A, Mazzolini M, Kantar A. A reappraisal of the mucoactive activity and clinical efficacy of bromhexine. Multidiscip Respir Med. 2017;12(1):1-14.
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