Article Type : Case Report
Authors : Hegazy AA and Shouman WM
Keywords : SARS-CoV-2; Treatment; Prophylaxis; Egypt
With the World Health Organization (WHO)
declaring COVID-19 a pandemic, several trials have been proposed to stop or
reduce this unprecedented threat to the health of populations worldwide. From
here, we began to consider available drugs that have been shown to be safe with
the possibility of having an antiviral effect in order to control the
infection. Among these drugs was ivermectin, which is widely used to treat many
parasitic diseases. The first clinical trial in this regard originated from
Zagazig University in Egypt and was registered in May 2020. Great success has
been recorded in preventing infection in family members who are in close
contact with patients. Subsequently, many studies around the world began to use
it in prevention as well as in the treatment of confirmed cases. Despite the
advice of the WHO that ivermectin should only be used in clinical trials, the
results of most previous studies were very encouraging. In this article, we
present our experience regarding the role of ivermectin in prophylaxis and
treatment of early cases of COVID-19.
With the emergence
of Corona infection and the announcement by the WHO of the spread of the COVID-19 pandemic, many attempts
appeared to control
it, including physical
distancing measures, wearing
a face mask, and vaccinations [1]. New mutations of the coronavirus are still
emerging and are mostly resistant to
vaccines. Despite the emergence of many effective vaccines, it is still too early to know the best way to control
the COVID-19 with any of them [2]. In
this regard, several clinical trials
using available drugs to treat COVID-19 patients have been investigated. Among these drugs, ivermectin that has been previously
used as a safe drug to treat several parasitic and skin diseases has been suggested to be effective as a prophylaxis and treatment for the early stages [3]. This
use is built on previous reports indicating broad-spectrum antiviral properties of ivermectin [4]. Despite the apparent effectiveness of ivermectin as an antiviral drug in previous studies,
the WHO has not yet approved its use except in clinical trials
[5].
Our previous study was a prospective, community-based, randomized, controlled-intervention study registered with Clintrials.gov;
NCT04422561 and approved by the IRB, Faculty
of Medicine, Zagazig
University, Code: 6150-31-5-2020 [6,7]. Asymptomatic home family members who were
in close contact with COVID-19 cases
diagnosed at Zagazig University Hospitals,
and a triage and isolation
hospital. It was planned to include contacts of 50 confirmed RT-PCR COVID-19
patients in each arm. But during
recruitment, and since the trial was unblended, the detected high protective efficacy of ivermectin
caused the researchers to stop the no-intervention arm prematurely.
Inclusion criteria included
asymptomatic close family contacts of a confirmed RT-PCR COVID-19 index case,
with age equal to or greater than 16
years. Two arms (or two groups) were designed
according to the use of ivermectin: The first group (the ivermectin group)
received ivermectin on the day of their index case diagnosis. It was administered as a single dose on an empty stomach on the
first day (the day of diagnosis), and repeated again
COVID-19 is a multi-organ disease
that primarily affects
the upper respiratory tract. At neglection of early management, it extends too many other organs [10,11]. In our cases, treatment was started as soon as the diagnosis was
confirmed. This point is very important
for case management. Positive response to treatment
was well marked by mitigation of clinical disturbances. Ivermectin was the main ingredient as an antiviral used in the treatment of our patients. In this regard,
in May 2020 it was the first clinical
trial in the world to use ivermectin to combat the current epidemic registered by Zagazig University. It showed encouraging results in protecting family
members who were in close contact
with patients from transmission of the Corona virus infection [12]. We also suggest high efficacy of ivermectin in
the early stages of the disease with early symptomatic recovery. Ivermectin
is not only beneficial for its antiviral properties, but could also be due to its proposed
anti-inflammatory role in treating
allergic respiratory diseases [13]. In this regard, we also used nasal decongestants to reduce the manifestations of congestion to facilitate breathing. A common mistake
noticed with ivermectin is to use it only after the infection has spread
In conclusion, we suggest the use of ivermectin in the early treatment of COVID-19 infection
in addition to chemoprophylaxis
when exposed to patients. Furthermore, it is
recommended to use an antipyretic and antihistamine in combination
with nasal decongestant tablets for ease of breathing. In this regard, we emphasize in accordance with our previous observations that studies looking at
ivermectin in prevention and early
treatment are neither time consuming nor burdensome to health nor the economy. Therefore, it is easy to verify the
efficacy of ivermectin against
COVID-19 in future studies and at large scales.
We also emphasize that ivermectin is not a substitute for vaccinations. Effective vaccinations are
highly recommended for long-term
protection against the coronavirus. However, the use of ivermectin in parallel with vaccines could help combat the
current epidemic. It may be emergency protection upon exposure or contact with sick people, or medication for
patients who have been infected
in the early stages, even if they have been immunized.
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