Treatment of severe acute respiratory syndrome

Abstract

The best treatment strategy for severe acute respiratory syndrome (SARS) is still unknown. Ribavirin and corticosteroids were used extensively during the SARS outbreak. Ribavirin has been criticized for its lack of efficacy. Corticosteroids are effective in lowering the fever and reversing changes in the chest radiograph but have the caveat of encouraging viral replication. The effectiveness of corticosteroids has only been suggested by uncontrolled observations, and the role of these agents in therapy remains to be established by randomized controlled studies. Both ribavirin and corticosteroids have very significant side effects. The lopinavir/ritonavir combination has been shown to reduce the intubation rate and the incidence of adverse clinical outcomes when used with ribavirin. When patients deteriorate clinically despite treatment with ribavirin and corticosteroids, rescue treatment with convalescent plasma and immunoglobulin may be beneficial. Noninvasive positive pressure ventilation is a sound treatment for SARS patients with respiratory failure if administered with due precaution in the correct environment. Interferons and other novel agents may hold promise as useful anti-SARS therapies in the future. The experience with traditional Chinese medicine is encouraging, and its use as an adjuvant should be further investigated.

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

“…The concentration which was able to inhibit 50% of viral replication (EC 50 ) was calculated and summarized in Table 2. In contrast to compounds 4, 11, 13, 15, and 20 which had EC 50 values higher than 10 µM, the EC 50 values of the four abietane-type diterpenes (1, 5, 6, and 8), one triterpene (14), one lignan (16), and niclosamide (21) were determined to be 1.39, 1.47, 1.15, 1.57, 0.63, 1.13, and <0.1 µM, respectively. These values are similar to or even lower than that of the reference compound valinomycin (22) (EC 50 ) 1.63 µM).…”

“…In addition, the hydroxyl group of C3 of 13 formed a hydrogen bond with the oxygen atom of the carbonyl group of Thr24 located at the N-terminus of domain I (residues 8-101) of the 3CL protease to strengthen the binding. In contrast, betulonic acid (14) did not form additional intermolecular bonds with the enzyme besides the hydrophobic interaction ( Figure 4A). For hinokinin (15) and savinin (16), the computer modeling analyses ( Figure 4B) suggested that savinin fits into the active site cavity better by forming hydrogen bonds with the NHs of Gly143, Ser144, and Cys145 via the O atoms located at C9, and with the NHs of Glu166 and Gln189 via oxygen atoms attached to C3′ and C4′, respectively.…”

How Prepared Are We to Control Severe Acute Respiratory Syndrome in Future

“…Agents that were usually adaptedfor treatment were ribavirin, corticosteroids, human interferons (IFN-β and IFN-γ) and convalescent plasma (Barnard et al, 2004;He et al, 2004;Keyaerts et al, 2004;Wu et al, 2004a;Cinatl et al, 2005;Groneberg et al, 2005;Lai, 2005;Morgenstern et al, 2005;Saijo et al, 2005;Lau et al, 2006;Stockman et al, 2006). However, a systematic review of clinical trials and in vitro studies revealed that although agents such as ribavirin, corticosteroids, lopinavir and type I interferon showed inhibition of SARS-CoV in tissue culture, their usefulness was inconclusive in most patient studies (Stockman et al, 2006).…”

Simultaneous determination of fusidic acid and steroids from bulk drugs and human plasma by reversed phase HPLC

“…1) play an important role in the treatment of asthma [3,4]. Recently, these drugs also play important roles in the treatment of severe acute respiratory syndrome [5][6][7]. Dexamethasone is a potent corti-costeroid with gluconeogenic, immunosuppressive and anti-inflammatory properties.…”