Alam Mohammud M, Mahmud Saborny, Rahman Mohammad M, Simpson JoAnn, Aggarwal Sandeep, Ahmed Ziauddin
Department of Medicine and Infectious Diseases, Northwell University Hospital, Plainview, USA.
Department of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Cureus. 2020 Aug 11;12(8):e9658. doi: 10.7759/cureus.9658.
Rationale Due to the cluster and associated comorbidities in residents of long-term care facilities (LTCFs), COVID-19-associated morbidity and mortality are significantly increased. Multiple therapeutic options, including hydroxychloroquine (HCQ) and azithromycin (AZI), were tried initially to treat moderate to severe COVID-19 and high-risk patients in LTCFs, but they were abandoned due to unfavorable reports. As a less toxic option, we initiated treatment with doxycycline (DOXY) very early in the course of illness. DOXY has antiviral, cardioprotective, immunomodulatory, and anti-inflammatory properties, but the efficacy of early intervention with DOXY in high-risk COVID-19 patients in LTCFs is unknown. Objective The goal of this retrospective study is to describe the clinical outcomes of high-risk COVID-19 patients with moderate to severe symptoms in LTCFs after early intervention with DOXY. Design Case-series analysis Setting LTCFs in New York Participants This observational study examines 89 patients who were diagnosed with COVID-19 from March 18 to May 13, 2020. Exposure All patients who were diagnosed with COVID-19 received DOXY and regular standard of care within 12 hours of the onset of symptoms. Additionally, four patients received meropenem, three patients received Zosyn, two patients received linezolid, and two patients received Bactrim DS. Four patients were on chronic ventilator support. No patients received any steroids or any other antiviral or immunomodulatory agents. The majority of the patients received zinc and calcium supplements as well. Main outcomes and measures Assessed measures were patients' characteristics, fever, shortness of breath (SOB), cough, oxygen saturation/pulse oximetry (POX), radiologic improvements, laboratory tests, DOXY side effects, hospital transfers, and death. Results Eighty-nine (89) high-risk patients, who developed a sudden onset of fever, cough, SOB, and hypoxia and were diagnosed with COVID-19, were treated with DOXY (100 mg PO or intravenous (IV) for seven days) and regular standard of care. Eighty-five percent (85%) of patients (n=76) demonstrated clinical recovery that is defined as resolution of fever (average 3.7 days, Coeff = -0.96, p = 0.0001), resolution of SOB (average 4.2 days), and improvement of POX: average 84% before treatment and average 95% after treatment (84.7 ± 7% vs. 95 ± 2.6%, p = 0.0001). Higher pre- and post-treatment POX is associated with lower mortality (oxygen saturation (Spo2) vs. Death, Coeff = -0.01, p = 0.023; post-Spo2 vs. Death, Coeff = -0.05, p = 0.0002). Within 10 days of symptom onset, 3% of patients (n=3) were transferred to hospital due to clinical deterioration and 11% of patients (n=10) died. The result was followed for 30 days from the onset of symptoms in each patient. Conclusion Early treatment with DOXY for high-risk patients with moderate to severe COVID-19 infections in non-hospital settings, such as LTCFs, is associated with early clinical recovery, decreased hospitalization, and decreased mortality.
理论依据 由于长期护理机构（LTCF）中的居民存在聚集性及相关合并症，与新型冠状病毒肺炎（COVID-19）相关的发病率和死亡率显著增加。最初尝试了多种治疗方案，包括羟氯喹（HCQ）和阿奇霉素（AZI），用于治疗LTCF中的中度至重度COVID-19患者和高危患者，但由于不良报告而被放弃。作为毒性较小的选择，我们在疾病早期就开始用强力霉素（DOXY）进行治疗。DOXY具有抗病毒、心脏保护、免疫调节和抗炎特性，但在LTCF的高危COVID-19患者中早期干预使用DOXY的疗效尚不清楚。目的 这项回顾性研究的目的是描述在LTCF中，高危的中度至重度症状COVID-19患者在早期接受DOXY干预后的临床结局。设计 病例系列分析 地点 纽约的LTCF 参与者 这项观察性研究检查了2020年3月18日至5月13日期间被诊断为COVID-19的89名患者。暴露 所有被诊断为COVID-19的患者在症状出现后12小时内接受DOXY和常规标准治疗。此外，4名患者接受了美罗培南，3名患者接受了哌拉西林他唑巴坦，2名患者接受了利奈唑胺，2名患者接受了复方磺胺甲恶唑。4名患者接受慢性呼吸机支持。没有患者接受任何类固醇或任何其他抗病毒或免疫调节药物。大多数患者还接受了锌和钙补充剂。主要结局和指标 评估的指标包括患者特征、发热、呼吸急促（SOB）、咳嗽、氧饱和度/脉搏血氧饱和度（POX）、影像学改善、实验室检查、DOXY副作用、转院和死亡。结果 89名高危患者突然出现发热、咳嗽、SOB和缺氧，并被诊断为COVID-19，接受了DOXY（100 mg口服或静脉注射（IV），持续7天）和常规标准治疗。85%（n=76）的患者表现出临床康复，定义为发热消退（平均3.7天，系数=-0.96，p=0.0001）、SOB消退（平均4.2天）以及POX改善：治疗前平均84%，治疗后平均95%（84.7±7%对95±2.6%，p=0.0001）。治疗前后较高的POX与较低的死亡率相关（氧饱和度（Spo2）与死亡，系数=-0.01，p=0.023；治疗后Spo2与死亡，系数=-0.05，p=0.0002）。在症状出现后10天内，3%（n=3）的患者因临床恶化转院，11%（n=10）的患者死亡。从每位患者症状出现开始随访30天。结论 在非医院环境（如LTCF）中，对高危的中度至重度COVID-19感染患者早期使用DOXY治疗与早期临床康复、住院率降低和死亡率降低相关。
