Development of a standard treatment protocol for severe acute respiratory syndrome

Abstract

A series of 31 patients with probable SARS, diagnosed from WHO criteria, were treated according to a treatment protocol consisting of antibacterials and a combination of ribavirin and methylprednisolone. Through experience with the first 11 patients, we were able to finalise standard dose regimens, including pulsed methylprednisolone. One patient recovered on antibacterial treatment alone, 17 showed rapid and sustained responses, and 13 achieved improvement with step-up or pulsed methylprednisolone. Four patients required short periods of non-invasive ventilation. No patient required intubation or mechanical ventilation. There was no mortality or treatment morbidity in this series.

Specific Plant Terpenoids and Lignoids Possess Potent Antiviral Activities against Severe Acute Respiratory Syndrome Coronavirus

“…41,42 In addition, some abietane-type diterpenes were also found to inhibit HIV-1 protease. 41,42 We observed that the specific abietane-type diterpenes (1)(2)(3)(4)(5)(6)(7)(8) possessed potent anti-SARS viral activities, but that these activities apparently did not involve action on 3CL protease because no 3CL protease inhibition was observed (data not shown). The molecular mechanism(s) by which these compounds operate needs to be investigated further.…”

“…Currently, the most frequently administered antiviral and supportive treatment of SARS is a combination of ribavirin and corticosteroids. 4,5 Ribavirin, however, was only marginally effective against the SARS virus, and had serious adverse effects on SARS patients. 6,7 The combination therapy of HIV protease inhibitor drugs (lopinavir/ritonavir) plus ribavirin plus corticosteroids may improve some clinical outcomes, but only when administrated in the early phase of the illness.…”

Inflammatory Cytokine Profile in Children With Severe Acute Respiratory Syndrome

“…The reduction in cytokine levels also correlated with improvement in general clinical condition, pulmonary function, and survival. 13,17 In view of rapid deterioration in lung function in many adult patients during the acute phase of SARS-CoV infection, 3,8 it would be deemed unethical to withhold corticosteroid treatment in any patients who had persistent fever or progressive radiographic changes at the onset of the outbreak. 8 Hence, all except 1 patient in this cohort were treated with corticosteroids.…”

“…Thereafter, a dose-tapering course of oral prednisolone was prescribed in the following 2 weeks. This pediatric treatment regimen was extrapolated from the adult experience, 3,8 and the dose and timing of commencement of these medications were constantly under review during the outbreak.…”

“…Recently, it was proposed that cytolysis may be associated with viral amplification in the early stage of SARS, which is then followed by an adaptive immunologic response with clearance of virus and severe tissue inflammation. 8 The use of immunomodulating drugs, such as corticosteroids or monoclonal antibody to TNF-␣, may be useful in suppressing the host immune response. Thus, knowing the cytokine pattern could assist the clinicians in understanding the disease mechanism and in designing a treatment strategy most effective for the management of this condition.…”