Macrolides in critically ill patients with Middle East Respiratory Syndrome

Arabi, Yaseen M.; Deeb, Ahmad M.; Al-Hameed, Fahad; Mandourah, Yasser; Almekhlafi, Ghaleb A.; Sindi, Anees; Al‐Omari, Awad; Shalhoub, Sarah; Mady, Ahmed; Alraddadi, Basem; Almotairi, Abdullah; Khatib, Kasim Al; Abdulmomen, Ahmed; Qushmaq, Ismael; Solaiman, Othman; Al‐Aithan, Abdulsalam M.; Al‐Raddadi, Rajaa; Ragab, Ahmad; Harthy, Abdulrahman Al; Kharaba, Ayman; Jose, Jesna; Dabbagh, Tarek Al; Fowler, Robert; Balkhy, Hanan H.; Merson, Laura; Hayden, Frederick G.

doi:10.1016/j.ijid.2019.01.041

Cited by 111 publications

(94 citation statements)

References 32 publications

(47 reference statements)

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“…Very sick patients with coronavirus develop critical illness myopathy or polyneuropathy. [10][11][12][13] A risk factor for developing critical illness myopathy is use of nondepolarizing neuromuscular blocking agents. Nevertheless, this has not been reported in patients with other coronavirus receiving short courses of these medications.…”

Section: Risk Of Infection Causing a New Nmdmentioning

confidence: 99%

COVID-19 and neuromuscular disorders

2020

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The coronavirus 2019 pandemic has potential to disproportionately and severely affect patients with neuromuscular disorders. In a short period of time, it has already caused reorganization of neuromuscular clinical care delivery and education, which will likely have lasting effects on the field. This article reviews (1) potential neuromuscular complications of COVID-19, (2) assessment and mitigation of COVID-19-related risk for patients with preexisting neuromuscular disease, (3) guidance for management of immunosuppressive and immunomodulatory therapies, (4) practical guidance regarding neuromuscular care delivery, telemedicine, and education, and (5) effect on neuromuscular research. We outline key unanswered clinical questions and highlight the need for team-based and interspecialty collaboration. Primary goals of clinical research during this time are to develop evidence-based best practices and to minimize morbidity and mortality related to COVID-19 for patients with neuromuscular disorders.

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Section: Risk Of Infection Causing a New Nmdmentioning

confidence: 99%

COVID-19 and neuromuscular disorders

2020

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“…were not associated with improved survival in critically ill patients with influenza A(H1N1)pdm09 [23]. In patients with MERS (n = 349), macrolide therapy is not associated with a reduction in 90-day mortality or improvement in MERS-CoV RNA clearance [24]. A study of clarithromycin combined with the cyclooxygenase inhibitor flufenamic acid in hospitalized patients with influenza is underway (NCT03238612).…”

Section: Macrolidesmentioning

confidence: 99%

Critical care management of adults with community-acquired severe respiratory viral infection

2020

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With the expanding use of molecular assays, viral pathogens are increasingly recognized among critically ill adult patients with community-acquired severe respiratory illness; studies have detected respiratory viral infections (RVIs) in 17-53% of such patients. In addition, novel pathogens including zoonotic coronaviruses like the agents causing Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and the 2019 novel coronavirus (2019 nCoV) are still being identified. Patients with severe RVIs requiring ICU care present typically with hypoxemic respiratory failure. Oseltamivir is the most widely used neuraminidase inhibitor for treatment of influenza; data suggest that early use is associated with reduced mortality in critically ill patients with influenza. At present, there are no antiviral therapies of proven efficacy for other severe RVIs. Several adjunctive pharmacologic interventions have been studied for their immunomodulatory effects, including macrolides, corticosteroids, cyclooxygenase-2 inhibitors, sirolimus, statins, anti-influenza immune plasma, and vitamin C, but none is recommended at present in severe RVIs. Evidence-based supportive care is the mainstay for management of severe respiratory viral infection. Non-invasive ventilation in patients with severe RVI causing acute hypoxemic respiratory failure and pneumonia is associated with a high likelihood of transition to invasive ventilation. Limited existing knowledge highlights the need for data regarding supportive care and adjunctive pharmacologic therapy that is specific for critically ill patients with severe RVI. There is a need for more pragmatic and efficient designs to test different therapeutics both individually and in combination.

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“…A retrospective study of 136 patients with MERS found that macrolide therapy is not associated with a reduction in mortality or improvement in MERS-CoV RNA clearance. 43 Currently there is an ongoing randomized controlled trial in progress in the Kingdom of Saudi Arabia comparing lopinavir/ritonavir, recombinant IFN-b1b, and standard supportive care against placebo and standard supportive care in patients with laboratory-confirmed MERS requiring hospital admission. 44 Systemic corticosteroids were shown to delay viral clearance in critically ill patients with MERS-CoV infection.…”

Section: Clinical Management Of Middle East Respiratory Syndrome Casesmentioning

confidence: 99%

The Middle East Respiratory Syndrome (MERS)

Azhar

Hui

Memish

et al. 2019

Infectious Disease Clinics of North America

228

201

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KEYWORDS Middle East respiratory syndrome coronavirus MERS-CoV Epidemiology diagnosis Treatment KEY POINTSThe Middle East respiratory syndrome (MERS) is a novel lethal zoonotic disease of humans endemic to The Middle East, caused by the MERS coronavirus (MERS-CoV). Humans are thought to acquire MERS-CoV though contact with camels or camel products. MERS carries a 35% mortality rate. There is no specific treatment for MERS. Person-toperson spread causes hospital and household outbreaks of MERS-CoV. Millions of visitors travel to Saudi Arabia each year from across the world, thus watchful surveillance and a high degree of clinical awareness and early diagnosis with rapid implementation of infection control measures in returning travelers is important.Infect Dis Clin N Am 33 (2019) 891-905

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Macrolides in critically ill patients with Middle East Respiratory Syndrome

Cited by 111 publications

References 32 publications

COVID-19 and neuromuscular disorders

COVID-19 and neuromuscular disorders

Critical care management of adults with community-acquired severe respiratory viral infection

The Middle East Respiratory Syndrome (MERS)

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