[india-drug] DSPRUD Recommendations on the treatment of SARS patients

[DSPRUD.dsprud@satyam.net.in]

DSPRUD Recommendations on the treatment of  SARS patients
------------------------------------------------------------

Dear India drug participants,

Enclosed below please find DSPRUD Recommendations on the treatment of 
SARS patients. It has been put up on the DSPRUD website
<www.dsprud.org> as well.


SUPPORTIVE TREATMENT

Ensure adequate hydration.
If fever, give paracetamol 500 ? 1000 mg 6 ? 8 hourly.
If severe myalgia, give ibuprofen 400 ? 800 mg 8 hourly.
If the patient has a blocked nose, give Xylometazoline HC1 .1% 1 ? 2
nasal drops in each nostril 1 ? 2 times daily Or Oxymetazoline .05% 1 ?
2 nasal drops in each nostril 1 ? 2 times daily.

If there are signs of respiratory failure i.e., oxygen saturation less
than 90%, PAO2
less than 60 mmHg give oxygen inhalation.

In case of severe respiratory distress, intubation and mechanical
ventilation may be required.


SPECIFIC THERAPY


The following antibiotics could be administered along the lines of the
treatment used for community-acquired pneumonia.

Inj Levofloxacin 50 mg twice daily IV for 10 days.
			Or
Inj Azithromycin 500 mg IV loading dose followed by a 250 mg single
daily dose for 10 days.
			Or
Inj Clarithromycin 500 mg loading dose then 250 mg twice daily orally.


No specific drug has so far been identified for treating SARS. 
However, if the patient is seriously afflicted with the disease in an
advanced stage, if the patient has lymphopenia, has increased
neutrophil counts, hyponatraemia and has an elevated LDH, the
antibiotics can be administered


Inj Ribavirin 33 mg/Kg (max 2 g IV loading dose then 16 mg/Kg (max 1 g)
every 6 hours for 4 days then 8 mg/Kg (max 0.5 g) every 8 hours for 3 ?
6 days depending on clinical response and tolerance.
			Or
If injection ribavirin is not available,
Tab Ribavirin 2 g loading dose po then 4 g/day po in four divided doses
for 4 days then 2 g/day po for 6 days.

If the clinical condition deteriorates and the patient develops acute
respiratory distress syndrome, then administer Inj Hydrocortisone 100
mg IV 6 ? 8 hourly.


Some Don?ts

·	Chest physiotherapy
·	Nebulization
·	Suction
·	Non invasive ventilation or any other procedure which generates
aerosols

Procedures like bronchoscopy and endoscopy should be carried out under
strict infection control measures as mentioned under hospital infection
control measures.




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