The Pharmaceutical Journal
Vol 270 No 7249 p673
17 May 2003

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SARS treatment protocol published

A standard treatment protocol for severe acute respiratory syndrome (SARS) has been published by doctors in Hong Kong.

Dr Loletta K.-Y. So, Pamela Youde Nethersole Eastern Hospital, Hong Kong, and colleagues treated a series of 31 patients with SARS. Following experience with the first 11 patients, the standard treatment protocol was finalised. It involves:

• Antibacterial treatment Standard treatment with levofloxacin (Tavanic) 500mg once daily intravenously or orally, or alternative regimen with clarithromycin (Klaricid) plus co-amoxiclav (Augmentin) in certain circumstances.
• Antiviral treatment Antiviral treatment should be added when there is evidence of extensive or persistent chest radiographic involvement or a worsening condition. Treatment with ribavirin 400mg every eight hours intravenously for at least three days until the condition stabilises then 1,200mg orally twice a day.
• Corticosteroid treatment Corticosteroids should be added under the same circumstances as antivirals. Initially intravenous methylprednisolone 1mg/
  kg every eight hours for five days, then 1mg/kg every 12 hours for five days. Then change to oral prednisolone (0.5mg/kg twice daily for five days) followed by gradual dose reduction.
• Pulsed corticosteroid If the clinical condition, chest radiograph or oxygen saturation worsens then intravenous methylprednisolone 500mg twice daily for two days should be given.

After using this protocol for the 31 patients, the researchers report that one patient recovered on antibacterial treatment alone, 17 showed rapid and sustained responses and 13 improved with pulsed methylprednisolone. Four patients additionally required short periods of non-invasive ventilation. They add that there was no mortality or morbidity associated with this treatment protocol (Lancet 2003;361:1615).

Another group of researchers in Hong Kong suggest that the latter stages of the clinical pattern of SARS are caused by an excessive response by the immune system. Week one is characterised by fever, myalgia and other systemic symptoms that generally improve after a few days. An increasing viral load suggests that symptoms are associated with the effects of viral replication. In week two, many patients have a recurrence of fever, onset of diarrhoea and worsening lung condition. At the same time, viral load is decreasing. To lessen progression to this chronic phase, an effective antiviral to reduce the viral load may be important, they add. “At the time of writing, no antiviral is reported to be clinically effective for the treatment of this novel coronavirus.” The study is published online at The Lancet’s website (www.thelancet.com).

Researchers in Singapore have found that the SARS coronavirus does not mutate rapidly. This genetic stability means it is unlikely to change to a benign infection, but also makes the possibility of a vaccine more achievable. This research is also published at The Lancet’s website.