臨床感染症: オープンアクセス

Background: The emerging SARS-CoV-2 infection has been associated with moderate and severe disease in patients with a weaker cellular immunity which might result in prolonged period of hospitalizations. Viusid^® has shown recognized immunoregulator properties, including an important modulation on IFN-δ, TNF-α, IL-1β and IL-6 levels in patients with infectious diseases. Our observational study was aimed to evaluate the effectiveness of Viusid^® along with Asbrip^®, an upper respiratory antiseptic, in patients with mild to moderate symptoms related with SARS-COV-2 infection.

Methods: An observational study was conducted to evaluate the efficacy of Viusid and Asbrip^® in patients with mild to moderate symptoms of respiratory disease caused by the emerging SARS-CoV-2 infection in 2019 at the Teodoro Maldonado Carbo University Hospital in Guayaquil, Ecuador. A total of 53 subjects were enrolled in our observational study. Of them, 44 were non-responders to the protocolized standard therapy for 46 ± 23 days. All of them received the protocolized standard therapy along with Viusid^® 30 ml and Asbrip^® 10 ml every 8 h for 21 days and assessed clinically until the hospital discharge.

Results: The results of the trial show that non-responders to the protocolized COVID-19 therapy patients taking Viusid^® and Asbrip^® experienced a significant improvement in their symptoms over a relatively shorter period of time. The average length of stay in the hospital with no changes was reduced once they were assigned to Viusid^® and Asbrip^® (15 ± 5 days). New hospitalizations were protocolized with the adjuvant therapy with an average length of stay in the hospital of 14 ± 6 days.

Conclusions: Viusid^® in conjunction with Asbrip^® might reduce the length of patient hospitalization in patients with SARS-COV-2 infection.

Ceftriaxone is a broad-spectrum antibiotic used to treat or prevent bacterial infections. It has a wide range of gram-negative activity and some gram-positive activity, making it one of the most widely used antibiotics. This study is a prospective study evaluating the use of ceftriaxone in the medical wards. It was the first drug evaluation conducted on ceftriaxone in medical wards of UKMMC. Inpatient records were screened for patients receiving ceftriaxone between August 2018 to December 2018. The appropriateness of ceftriaxone was assessed on the basis of 5 parameters: according to type of therapy (empirical, prophylactic, targeted), indication based on source of infection, total daily dose, dosing frequency, and culture & sensitivity tests. Therapy was deemed appropriate if all 5 criteria were met by the study participants according to local and international antibiotic protocols. Deviation in any of the criteria was considered inappropriate. Patients were followed-up until discharge. Clinical success was considered when there is resolution of signs and symptoms. Clinical failure was considered when there is escalation of antibiotics due to clinical worsening. 325 patients were included. Ceftriaxone use was empirical in 92.9% of patients and one third was indicated for pneumonia (35.4%). The majority of patients were prescribed a total daily dose of 2 g (94.5%) and once daily (96%). Median duration of treatment was 5.0 (IQR 4.0 - 7.0) days. Blood culture and sensitivity test was done in 97.8% of patients. Overall, inappropriate use of ceftriaxone was 55.7%, mostly attributed by inappropriate type of therapy and indication. Factors associated with appropriateness are: concomitant antibiotics, (AOR 2.73, 95% CI (1.55-4.80), P<0.001), length of stay (P<0.023) and duration of therapy (P<0.026).59.7 % of patients had a good clinical outcome, but 13.2% had clinical failure and 1.2% had bacteraemia-related mortality. Inappropriate use of ceftriaxone was high and almost half had no indication to initiate antibiotic. Measures such as diagnostic stewardship must be taken to improve the practice of antibiotics.