Dexamethasone during COVID-19 as prophylaxis!

Updated: Jun 20, 2020

Coronaviruses are ribonucleic acid viruses. Significantly, in humans, the viruses can infect the respiratory, gastrointestinal, hepatic, and central nervous systems. The current pandemic caused by severe acute respiratory syndrome (SARS) coronavirus type 2 (SARS-CoV-2, also known as COVID-19) has caused an unprecedented strain on the global healthcare system, causing thousands of deaths worldwide.


There are symptoms of infection are associated with this virus they are usually non-specific, and comprise fever, cough, and myalgia, with diarrhea, with or without the following development of dyspnea. Severe cases that include respiratory distress, sepsis, and septic shock have been progressively reported.



In 2003 during the SARS-CoV epidemic, therapeutic systemic corticosteroids were administered in patients who were infected and developed the severe respiratory disease, in a meta-analysis of corticosteroid use in patients with SARS, only four studies provided conclusive data, all indicating higher mortality.

Also when the corticosteroids are given to a patient with covid19 (SARS COV2) it may lead to failure and death too because many reports have shown that infection with SARS-CoV-2 causes reduction of B- and T-lymphocytes, including CD4 and CD8 T-cells, and it is associated with severe illness and death and that patients with higher lymphocyte levels may have better results, Dexamethasone, a widely prescribed antiemetic for acute and delayed nausea and vomiting from a variety of cancer drugs, causes B and T cell depletion, which may amplify immunosuppression, but it decreases the rate of mortality when it is given to a patient with sever state as ARDS ( acute respiratory distress syndrome) but it isn’t given to a patient in a mild state as it will harm him instead of treating him but he needs rest and vitamins instead.


Finally, the literature existing so far does not fully encourage the routine use of corticosteroids in COVID-19, but some findings suggest that methylprednisolone could decrease the mortality rate in more severe forms of this condition, such as in ARDS. Findings from future clinical trials that are ongoing are needed to better understand the role of corticosteroids in COVID-19.


Citations:

(1) Veronese, N., Demurtas, J., Yang, L., Tonelli, R., Barbagallo, M., Lopalco, P., Lagolio, E., Celotto, S., Pizzol, D., Zou, L., Tully, M. A., Ilie, P. C., Trott, M., López-Sánchez, G. F., & Smith, L. (2020). Use of Corticosteroids in Coronavirus Disease 2019 Pneumonia: A Systematic Review of the Literature. Frontiers in medicine, 7, 170. https://doi.org/10.3389/fmed.2020.00170.

(2) Marinella, M. A. (2020). Routine antiemetic prophylaxis with dexamethasone during COVID-19: Should oncologists reconsider?. Journal of Oncology Pharmacy Practice, 1078155220931921.‏

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