Ebola medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Marjan Khan M.B.B.S.[2]

## Overview[edit | edit source]

No specific antiviral drug has demonstrated effectiveness against Ebola infection. Management is primarily supportive and symptomatic. The following basic interventions, when used early, may improve the chances of survival: administration of intravenous fluids and correction of electrolyte abnormalities, maintenance of stable vital signs, and treatment against other co-infections or super-infections by antimicrobial agents. It is common practice to administer prophylactic broad-spectum antimicrobial agents, such as antibiotics and antimalarial agents, due to the high risk of co-infection or super-infection.

## Medical Therapy[edit | edit source]

* Ebola virus treatment[1][2]

* Preferred regimen: supportive therapy. There is no specific antiviral drug available for Ebola thus far. For information of investigational therapies including Favipiravir, Brincidofovir, ZMapp, TKM-Ebola, AVI-6002, and BCX4430, see here.

* Isolate patient
* Provide intravenous fluids (IV) (patients need large volumes in some cases) and maintain electrolytes at normal levels
* Maintain oxygen saturation and blood pressure
* Administer blood products if coagulopathy or bleeding, antiemetics if vomiting , antipyretics if fever, analgesics, anti-motility if severe diarrhea, total parenteral nutrition if patient has poor oral intake and dialysis if there's renal failure
* Treat other infections if they occur. Provide adequate Gram-negative coverage and gram-positive if the patient has any catheter or hospital-acquired pneumonia.
* If there's respiratory failure, invasive mechanical ventilation may be the best option to offer respiratory support

* Note (1): Recovery from Ebola depends on good supportive care and the patient’s immune response.
* Note (2): While there is no proven treatment available for Ebola virus disease, human convalescent whole blood has been used as an empirical treatment with promising results in a small group of EVD cases.[3][4]
* Note (3): People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer. It is not known if people who recover are immune for life or if they can become infected with a different species of Ebola.
* Note (4): Some people who have recovered from Ebola have developed long-term complications, such as joint and vision problems.

## Pregnant Women with Ebola Virus Disease[edit | edit source]

* Healthcare providers caring for pregnant women in U.S. hospitals should be prepared to screen patients for EVD and have a plan in place to triage these patients.
* Obstetric management of pregnant women with EVD, particularly decisions about mode of delivery for women in labor, needs to consider risks to the woman, risks of exposure for healthcare providers, and potential benefits to the neonate.
* Healthcare workers who are pregnant should not care for patients with EVD.
* Pregnant PUIs or patients with confirmed EVD should be hospitalized, and CDC guidance for hospitalized PUIs or patients with confirmed EVD should be followed.
* There is no evidence currently exists to suggest that pregnant women are more susceptible to infection from Ebola virus (EBOV) than the general population.
* limited evidence does suggest that pregnant women are likely to be at increased risk of severe illness and death when infected with EBOV.
* Pregnant women with EVD also appear to be at an increased risk of fetal loss and pregnancy-associated hemorrhage.
* EBOV can cross the placenta, and pregnant woman infected with the virus will likely transmit it to the fetus.

## Prophylaxis Against Co-infections or Super-infections[edit | edit source]

Overwhelming sepsis is associated with the majority of deaths due to Ebola virus disease.[5] Thus, it is common practice to administer antibiotics and antimalarial agents for patients with Ebola virus disease due to the high risk of co-infection or super-infection with Malaria and bacterial organisms.[6] In contrast, the administration of antiviral agents, such as acyclovir or ribavirin, has not demonstrated efficacy.[5]

## Nutritional Support[edit | edit source]

* When both the lactating woman and child are positive for EVD, and where replacement feeding with liquid ready-to-use infant formula (RUIF) is acceptable, feasible, and provision is guaranteed, suspend breastfeeding until breast milk tests are negative.
* When the lactating woman is positive for EVD and child negative for EVD suspend breastfeeding.
* When the lactating woman is negative for EVD and child positive for EVD suspend breastfeeding.
* The nutritional needs and approach to nutritional care in any individual will be determined by the patient’s preceding nutritional status, severity of illness and age.
* Intake of high nutrient-dense foods may be important in patients in the early phase of the disease who still have appetite and no eating difficulties.
* In patients who are ill for longer time period in the convalescence phase; and following discharge.

## References[edit | edit source]

1. ↑ "Ebola virus treatment".
2. ↑ Feldmann H, Geisbert TW (2011). "Ebola haemorrhagic fever". Lancet. 377 (9768): 849–62. doi:10.1016/S0140-6736(10)60667-8. PMC 3406178. PMID 21084112.CS1 maint: PMC format (link)
3. ↑ interim
4. ↑ Mupapa K, Massamba M, Kibadi K, Kuvula K, Bwaka A, Kipasa M; et al. (1999). "Treatment of Ebola hemorrhagic fever with blood transfusions from convalescent patients. International Scientific and Technical Committee". J Infect Dis. 179 Suppl 1: S18–23. doi:10.1086/514298. PMID 9988160.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
5. ↑ 5.0 5.1 Parkes-Ratanshi R, Ssekabira U, Crozier I (2014). "Ebola in West Africa: be aware and prepare". Intensive Care Med. 40 (11): 1742–5. doi:10.1007/s00134-014-3497-z. PMID 25253023.CS1 maint: Multiple names: authors list (link)
6. ↑ Kreuels B, Wichmann D, Emmerich P, Schmidt-Chanasit J, de Heer G, Kluge S; et al. (2014). "A Case of Severe Ebola Virus Infection Complicated by Gram-Negative Septicemia". N Engl J Med. doi:10.1056/NEJMoa1411677. PMID 25337633.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)

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