Conclusion:
In December 2019, several cases of pneumonia were reported in Wuhan,
Hubei province, in China. The agent responsible for this respiratory
illness was named SARS-CoV-2. COVID 19 is transmitted to humans through
bats and the intermediate host is unknown. People having potential risk
factors for this disease are particularly susceptible to this disease.
Some develop COVID 19 complications, including acute respiratory
distress syndrome, shock, acute renal injury, acute cardiac injury,
secondary infection, and death. This disease has reached almost 213
countries /territories/ areas around the world, and it has disturbed the
socio-economic status of many countries. This is declared by the World
Health Organization(WHO) as a pandemic in March 2020. It has become a
public health emergency of international concern (PHEIC) as declared by
the World health organization (WHO). Early reported cases had the
contact history of the Huanan seafood market. Human to human
transmission occurs via respiratory droplets. Social distancing is the
only way to reduce the spread of COVID-19. Symptomatic and supportive
treatment can help reduce the severity of the disease. They are thus
raising the primary concern for controlling this infection. Vaccine for
COVID 19 has to go through a vigorous trial process. Potential
therapeutic drugs and plasma could help manage patients with mild,
moderate, and severe coronavirus disease.
Our article summarizes case reports, case series, randomized control
trials, in vitro studies, and prospective drug reviews. Therapeutic
strategies are considered for the treatment of COVID 19. As many
diseases involve the same molecular basis, investigating the already
existing drugs for therapeutic purposes can help us to develop drugs
within a short period for COVID 19. This core approach is one strategy
to deal with this worldwide pandemic. Due to the slow pace of newly
discovered drugs, we consider those drugs with already established
pharmacokinetic profile and efficacy in drug reprofiling. Our article
covers the repurposed drugs suggested in various journals and the
methodological framework suggested by them. The detailed study of their
mechanism of action shows that they act by one of these mechanisms,
i.e., blocking viral entry, inhibiting endocytosis, decreasing cytokine
storm, reducing viremia, by modulating the inflammatory response and
viral replication.
Various drugs have been identified for treating SARS CoV 2 infection
previously used for other coronavirus diseases. Although the efficacy of
these drugs is not established, multiple clinical trials and in vitro
studies are being carried out to check the safety profile of these
drugs. Combination therapy of various antivirals like
lopinavir/ritonavir with ribavirin shows promising results. Little
information about convalescent plasma is there, and more clinical trials
are needed. Angiotensin-converting enzyme inhibitors or angiotensin
receptor blockers show promising results in decreasing the mortality
rate as compared to those not taking these drugs. In critically ill
patients, tocilizumab use may prove life-saving. Clinical trials on
remdesivir suggest that it has in vitro activity and can act as a potent
drug in COVID 19 patients. Possible side effects of chloroquine and
hydroxychloroquine limit its use. The combined use of azithromycin and
hydroxychloroquine shows promising results. Severe SARS-CoV-2 infection
can be managed by steroids, but its routine administration is not
recommended. Clinical evidence of these drugs can be established by
further studies on animals, cells, and humans.
Among the 50 articles included in our review, most of them are RCT and
in vitro studies. Our review provides information on understanding the
potential therapeutic strategies and clinical outcomes of using several
drugs. Although no specific treatment is available, various strategies
are used for managing COVID patients, including antivirals,
antibacterial drugs, steroids, oxygen mask, invasive, and non-invasive
ventilation. Studies in this domain are needed to control the pandemic.