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.