A Descriptive Analysis of the Use of Various Therapeutics in a Cohort of COVID-19 Patients and the Influence of Media Coverage

Authors

DOI:

https://doi.org/10.5195/ijms.2024.2125

Keywords:

COVID-19, SARS-CoV-2, Standard of Care, COVID-19 Treatments, Antiviral Therapy, Media Influence, Remdesivir, Hydroxychloroquine, Hospitalized Patients, Retrospective Study, Clinical Guidelines, Therapeutic Variation, Texas Healthcare

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) impacted the healthcare system immensely throughout 2020-2022. Treatment practices varied in Texas, as guidelines were in flux. As a result, a variety of therapeutics were used. Many verified medications with scientific basis were trialed, while others were implemented despite a lack of scientific consensus. This study aimed to identify how practice patterns to treat and manage COVID-19 changed over time in a cohort of patients in the University of Texas Medical Branch hospital system.

Methods: Ninety participants with a COVID-19 diagnosis were included in the analysis for this study. Data was collected by a retrospective chart review, and included medications administered before and during current admission. Medications were categorized as: antiviral, antibiotic, steroid, supplement, antibody, hydroxychloroquine, and others.

Results: Differences in therapeutic use were identified based on hospitalization status (outpatient or inpatient) and month admitted. The largest difference in the antiviral remdesivir (78%), requiring intravenous administration for up to ten days. In the outpatient setting, antibiotics, primarily azithromycin, were quite common. Additionally, month-to-month variation in steroid use and antibiotic use was observed.

Conclusion: This study shows that adapting medical guidelines and strong media coverage played a role in the clinical management of COVID-19 patients. At times, some ineffective medications were prescribed such as hydroxychloroquine.  Medical leaders and news coverage should collaborate closely in future public health emergencies to prevent the prescription of ultimately ineffective and potentially hazardous treatments.

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References

Monegro AF, Muppidi V, Regunath H. Hospital-Acquired Infections. StatPearls. Treasure Island (FL)2023.

Revelas A. Healthcare - associated infections: A public health problem. Niger Med J. 2012;53(2):59-64.

Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020.

Recovery Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693-704.

Recovery Collaborative Group, Horby P, Mafham M, Linsell L, Bell JL, Staplin N, et al. Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19. N Engl J Med. 2020;383(21):2030-40.

Coronavirus (COVID-19) Update: FDA Issues Emergency Use Authorization for Potential COVID-19 Treatment [press release]. 05/01/2020 2020.

Bhimraj A MR, Shumaker AH, Baden L, Cheng VC, Edwards KM, Gallagher JC, Gandhi RT, Muller WJ, Nakamura MM, O'Horo JC, Shafer RW, Shoham S, Murad MH, Mustafa RA, Sultan S, Falck-Ytter Y. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19: Infectious Diseases Society of America; 2022 [Version 10.0.0:[Available from: https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/.

COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health 2022 [Available from: https://www.covid19treatmentguidelines.nih.gov/.

World Health Organization Communicable Diseases Emergencies Preparedness Emerging Diseases Clinical Assessment and Response Network Guidelines Review Committee. Therapeutics and COVID-19: Living guideline 2022 [Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-therapeutics-2022.5.

Bradley MC, Perez-Vilar S, Chillarige Y, Dong D, Martinez AI, Weckstein AR, et al. Systemic Corticosteroid Use for COVID-19 in US Outpatient Settings From April 2020 to August 2021. JAMA. 2022;327(20):2015-8.

Zhao M. Cytokine storm and immunomodulatory therapy in COVID-19: Role of chloroquine and anti-IL-6 monoclonal antibodies. Int J Antimicrob Agents. 2020;55(6):105982.

Coronavirus (COVID-19) Update: Daily Roundup March 30, 2020 [press release]. 03/30/2020 2020.

Coronavirus (COVID-19) Update: FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine [press release]. 06/15/2020 2020.

Abou-Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management. Thromb Res. 2020;194:101-15.

Coronavirus (COVID-19) Update: FDA Authorizes Monoclonal Antibodies for Treatment of COVID-19 [press release]. 02/09/2021 2021.

Parra-Lara LG, Martinez-Arboleda JJ, Rosso F. Azithromycin and SARS-CoV-2 infection: Where we are now and where we are going. J Glob Antimicrob Resist. 2020;22:680-4.

Oldenburg CE, Pinsky BA, Brogdon J, Chen C, Ruder K, Zhong L, et al. Effect of Oral Azithromycin vs Placebo on COVID-19 Symptoms in Outpatients With SARS-CoV-2 Infection: A Randomized Clinical Trial. JAMA. 2021;326(6):490-8.

Diyya ASM, Thomas NV. Multiple Micronutrient Supplementation: As a Supportive Therapy in the Treatment of COVID-19. Biomed Res Int. 2022;2022:3323825.

Holford P, Carr AC, Jovic TH, Ali SR, Whitaker IS, Marik PE, et al. Vitamin C-An Adjunctive Therapy for Respiratory Infection, Sepsis and COVID-19. Nutrients. 2020;12(12).

FDA Issues Emergency Use Authorization for Convalescent Plasma as Potential Promising COVID–19 Treatment, Another Achievement in Administration’s Fight Against Pandemic [press release]. 08/23/2020 2020.

FDA In Brief: FDA Updates Emergency Use Authorization for COVID-19 Convalescent Plasma to Reflect New Data [press release]. 02/04/2021 2021.

Gavriatopoulou M, Ntanasis-Stathopoulos I, Korompoki E, Fotiou D, Migkou M, Tzanninis IG, et al. Emerging treatment strategies for COVID-19 infection. Clin Exp Med. 2021;21(2):167-79.

Korley FK, Durkalski-Mauldin V, Yeatts SD, Schulman K, Davenport RD, Dumont LJ, et al. Early Convalescent Plasma for High-Risk Outpatients with Covid-19. N Engl J Med. 2021;385(21):1951-60.

Recovery Collaborative Group. Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial. Lancet. 2021;397(10289):2049-59.

Potter GE, Bonnett T, Rubenstein K, Lindholm DA, Rapaka RR, Doernberg SB, et al. Temporal Improvements in COVID-19 Outcomes for Hospitalized Adults: A Post Hoc Observational Study of Remdesivir Group Participants in the Adaptive COVID-19 Treatment Trial. Ann Intern Med. 2022;175(12):1716-27.

Cohen J. Update: Here's what is known about Trump's COVID-19 treatment. 2020 10/05/2020.

Cathey L. Timeline: Tracking Trump alongside scientific developments on hydroxychloroquine 2020 [Available from: https://abcnews.go.com/Health/timeline-tracking-trump-alongside-scientific-developments-hydroxychloroquine/story?id=72170553.

McCarthy T GJ. Trump is taking hydroxychloroquine, White House confirms 2020 [Available from: https://www.theguardian.com/us-news/2020/may/19/trump-hydroxychloroquine-covid-19-white-house.

Li G, Hilgenfeld R, Whitley R, De Clercq E. Therapeutic strategies for COVID-19: progress and lessons learned. Nat Rev Drug Discov. 2023;22(6):449-75.

Cokljat M, Cruz CV, Carrara VI, Puttaraksa K, Capriglioni C, Insaurralde SM, et al. Comparison of WHO versus national COVID-19 therapeutic guidelines across the world: not exactly a perfect match. BMJ Glob Health. 2024;9(4).

The graph titled "Percentage of Cohort Using Specified Therapeutics Pre-admission (Outpatient) versus During Hospitalization (Inpatient)" compares the use of different treatments in COVID-19 patients. Antivirals (79%) and antibiotics (46%) were more commonly used during hospitalization, while outpatient use was lower. Steroids and supplements also saw increased usage during hospitalization. Less frequent treatments included antibody therapy and hydroxychloroquine, both used minimally in both settings. Overall, therapeutic use was higher during hospitalization compared to pre-admission​.

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Published

2024-07-22 — Updated on 2024-09-30

How to Cite

Mathew, A. A., Mensah, B., Cravero, J. C., Moffatt, D. C., Dongre, R., Giang, T. K., Olvera, S. C., McLellan, S. L., & Levine, C. B. (2024). A Descriptive Analysis of the Use of Various Therapeutics in a Cohort of COVID-19 Patients and the Influence of Media Coverage. International Journal of Medical Students, 12(3), 259–266. https://doi.org/10.5195/ijms.2024.2125

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Vol. 12 No. 3 (2024)

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Copyright (c) 2024 Alfred A. Mathew, Barbara Mensah, John C. Cravero, David C. Moffatt, Roshan Dongre, Thao K. Giang, Samantha C. Olvera, Susan L.F. McLellan, Corri B. Levine

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