Treating with ivermectin in patients with COVID-19

Treating with ivermectin in patients with COVID-19

Blog Article

Ivermectin Dosage For Humans is an oral drug approved in copyright for the treatment of certain parasitic infections (e.g. strongyloidiasis and onchocerciasis)Footnote1. In vitro data have demonstrated that ivermectin has antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and can prevent viral proteins from binding to and entering cellsFootnote2.

This has contributed to the view that ivermectin may have antiviral effects in vivo. However, the plasma concentrations that are required to achieve antiviral effect are significantly higher than the maximum achievable plasma concentrations with tolerable doses in humansFootnote3.

Ivermectin is currently not recommended for prophylaxis or treatment of coronavirus disease 2019 (COVID-19)Footnote4, as current evidence does not show clinical benefitFootnote5. In the absence of evidence showing a clinical benefit for ivermectin in the treatment of COVID-19, there are compelling reasons to conserve limited national and provincial supplies of Buy Ziverdo kit by only using it for evidence-based indications. It is important to note that the primary and approved use of ivermectin is as an antiphrastic agent. One parasite of interest is Strongyloidiasis stercoralis.

Strongyloidiasis infection ranges in presentation from asymptomatic intestinal infection to hype infection and severe disseminated disease. Patients with chronic asymptomatic S. stercoralis infection and impaired immunity may develop "accelerated auto-infection", known as hype infection. These patients may also experience disseminated disease secondary to larval migration outside their usual anatomic reservoir, with varying presentations (e.g. pneumonia, central nervous system infection, recurrent gram-negative or polymicrobial bacteremia and sepsis). Immunosuppression, in particular corticosteroid use, has been associated with increased risk of hyperinfection syndrome in patients with chronic Strongyloides infection. Clinicians can refer to the Ontario Science Advisory Table Science Brief "Ivermectin as Empiric Treatment for Strongyloides in Patients with COVID-19 Disease" for full details to further support the recommendations submitted in this article. The Science Table full brief is available online.

In patients with strongyloidiasis (including asymptomatic Strongyloides infection), immunosuppression can lead to a worsening of the parasitic infection including hyperinfection and disseminated disease, which is a devastating illness with mortality rates approaching 90% if left untreatedFootnote6Footnote7.
Although most reports of hyperinfection syndrome implicate corticosteroids as the main risk factor, there are also reports with other immunosuppressive or immunomodulatory agents including tumour necrosis factor (TNF), interleukin-1 (IL-1) and other non-steroid lymphocyte depleting agentsFootnote6Footnote7.
A recent European Society of Clinical Microbiology and Infectious Diseases review on the safety of biological therapies did not identify Strongyloides as a major infectious risk with IL-6 inhibitors (including tocilizumab)Footnote8.
However, there have been case reports of Strongyloides hyperinfection developing in patients who received concomitant corticosteroid therapy with tocilizumabFootnote9Footnote10Footnote11.
Dexamethasone and tocilizumab, two evidence-based therapies for the treatment of moderately and critically-ill patients with COVID-19, are both anti-inflammatory agents with immunosuppressive effects. There is no clear relationship between a threshold dose and duration of immunosuppression at which the risk of disseminated Strongyloides infection may occur.
It is also currently not well described how concomitant immunosuppressive medications may interact to affect hype infection risk, or whether those who receive multiple immunosuppressive therapies are at additional risk for disseminated disease.

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