Pharmacological and Therapeutic Features of COVID - 19 Infection in Hodeidah, Yemen

Background: The symptoms and signs of coronavirus diseases 2019 (COVID-19) present at illness onset vary, but over the course of the disease, most persons with COVID-19 will experience the following: fever, cough, fatigue, anorexia, shortness of breath, hypoxia, sputum production, and myalgia. During the first year (2020), there was no effective cure for COVID-19 infection and the most common treatment for patients was supportive therapy. Ministry of Public Health and Population in Yemen presented national guideline that is extracted from other countries and World Health Organization (WHO).

Objective: Therefore, in this research, we discuss the pharmacological and therapeutic approaches for management of COVID-19 during its early period of rampage, using availability of medicines in Yemeni local pharmaceutical marketing. On the other hand, the efficacy of therapeutic was monitored.

Methodology: 505 patients with COVID-19 from Hodeidah showed that respiratory infection illness can range from mild to critical. Mild to moderate was 386 case (78.93 %), severe cases was 73 cases (15.13 %) and critical cases was 28 cases (5.93 %). The major criteria for cases admission namely clinical examination, case definition, clinical investigation, radiological finding, hematological and biochemical finding and molecular biology assay namely real – time - polymerase chain reaction (RT- PCR). The pharmacological and therapeutic properties of supportive therapy of COVID-19 included" antipyretic agent, antiviral (oseltamivir) analgesic agent, glucocorticoid (dexamethasone), anticoagulant agent (enoxaparin), anti-cough (acetylcysteine), antibiotics broad spectrum to treat the secondary infection namely azithromycin, ceftriaxone, ceftazidime, piperacillin and tazobactam, meropenam, and moxifloxacin. In addition, oxygen therapy is the major treatment that used in treatment of severe and critical cases. Also, vitamins (C and D) and mineral namely zinc were prescribed and proton pump inhibitor (PPI) (pantaprazol), anti-emetic (Ondansetron). Fluid therapy namely ringer lactate or normal saline were used in management of COVID -19.

Results: The results showed that the age of the patients included in this study between 3- 92 years with 4.0 to 1.0 males: females. 49 patients were admitted in COVID-19 isolation department of Hodeidah, Yemen. 25/49 cases (54.34% ) were recovered with national guideline, the average of RR pre - treatment was 30 ± 5 breath / minute and reduced to 23 ± 2 breath / minute post – treatment with significantly statistically different (p < 0.05). On the other hand, the clinical symptoms namely difficult in breathing, cough, fever, and headache reduced to absent absolutely (100 %). In addition, the results showed that the average of WBC pre - treatment was 20 ± 4 (×109/L) and reduced to 7 ± 2 (×109/L) post – treatment with significantly statistically different (p < 0.05). Also, lymphocytes decreased with COVID -19 infection to 2 % with average (10±5%) and improved post - treatment to 20 %. In addition, neutrophil increased to 95 % with average (80±15%) and improved to 70 % post-treatment. the average of WBC pre - treatment was 20 ± 4 (×109/L) and reduced to 7 ± 2 (×109/L) post-treatment with significantly statistically different (p < 0.05). The outcome finding of management that 19 cases (3.88 %) of severe and 6 cases (1.22 %) of critical were recovered. On the other hand, 1 case of severe and 21 cases of critical COVID-19 were died.

Conclusion: In spite of lack of specific antiviral drugs, the approach of pharmacology and therapeutics had good impact at level of mild to moderate cases, and severe cases while the critical cases needs to develop at level critical cases in intensive care unit (ICU) with mechanical ventilation (MV) procedure.