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Do not take for prevention: what you need to know about dexamethasone, which reduces mortality from COVID-19

There is a lot of enthusiasm among doctors in the US and Europe for an inexpensive drug that seems to help save the lives of people with severe COVID-19. What you need to know about dexamethasone, tells The Healthy.

Photo: Shutterstock

When enthusiasm for hydroxychloroquine decreased because the risks of drug treatment outweighed the benefits, a new study found that an inexpensive, widely used steroid may help patients with the most severe forms of COVID-19.

And although this was just one promising study, many doctors cautiously hope that this steroid (dexamethasone) can save the lives of patients who require hardware help for breathing.

“So far, this is the most potentially important result we have in the treatment of severe forms of COVID-19. Dexamethasone is the first drug that appears to reduce mortality, ”said Charles Hennekens, MD, professor and senior scientific adviser at the University of Atlantic in Florida.

Dexamethasone is often used in emergency

Dexamethasone is a steroid that is often used to reduce inflammation and treat certain types of arthritis. It is used in the emergency department when a patient comes with swelling or swelling of the throat, tongue or lips, notes Robert Glatter, an emergency doctor in New York.

Researchers at Oxford University in England found that dexamethasone can reduce mortality by one third in people with COVID-19 who needed mechanical ventilation, and one fifth in those who needed oxygen. Researchers note that the drug will prevent one death for every 8 patients on the ventilator, and for every 25 patients who need only oxygen.

These are the most severe patients among all with coronavirus infection. According to a study in April 2020, which became one of the largest reviews of COVID-19 patients hospitalized in the United States, up to 88% of people who need mechanical breathing devices will die.

“The utility is obvious and great in those patients who are so sick that they need oxygen treatment, so dexamethasone should now become the standard for their treatment,” said Peter Horby, professor of infectious diseases at Oxford University. He is one of the leading research scientists.

This widely available treatment may have saved Scott Krackover's life. The 40-year-old doctor, head of the psychiatry department at Zucker Hillside Hospital in Glen Oaks, NY, got COVID-19 in April. At first, he lost his sense of taste and smell, during the week he felt worse.

“I coughed up blood, my throat was swollen to the point where I could not breathe, and I was admitted to the hospital,” he recalls. Krakover received IV dexamethasone along with supplemental oxygen.

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Dexamethasone is inexpensive, fast and long

The UK government has approved the use of dexamethasone for standard treatment of COVID-19 after the publication of the results of the study.

Dexamethasone is inexpensive, affordable, and can be used immediately, says Dr. Horby. This is a generic drug, therefore, is cheaper than branded drugs, the production of which costs hundreds of millions of dollars. The cost of treatment with dexamethasone for 8 people will be about $ 50.

Dexamethasone acts quickly, Glatter explains. Dr. Krackover felt this effect on himself.

“I felt a change right after I got steroids,” he said. “After an hour, I stopped coughing, and the intensity of the symptoms was not as strong as before the intravenous steroid was injected.”

Krackover was discharged from the hospital a few days later. He is now taking steroids to treat a cough that later returned.

According to Glatter, after the onset of the drug, its effect lasts more than 50 hours.

Dexamethasone has side effects

“We have to see what the full data shows,” Glatter cautions. "This is all encouraging, but we need to be careful when we promote treatment as the standard for COVID-19 patients as things change and evolve very quickly."

Some possible side effects include indigestion, vomiting, headache, anxiety and / or sleep problems, according to the American Society of Pharmacists.

How dexamethasone works

This drug does not stop the reproduction of SARS-CoV-2 coronavirus.

“Dexamethasone reduces inflammation in the lungs, so they are less damaged and less prone to irreparable changes that can cause respiratory distress and death,” says Dr. Hennekens.

According to him, other treatment methods are needed that attack the virus and reduce the likelihood of death. He notes that the antiviral drug remdesivir, designed to fight Ebola and its viruses, considered promising. The Food and Drug Administration (FDA) has approved the emergency use of remdesivir for the treatment of COVID-19. Israel also recently approved the use of remdesivir for the treatment of coronavirus infections.

“This is still not proven, and we do not know if this drug reduces the risk of death from COVID-19,” notes Dr. Hennekens.

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Do not take dexamethasone for the prevention of COVID-19

Steroids have known side effects, and doctors should not prescribe dexamethasone for the prevention of coronavirus infection, says Neil Miner, MD, professor of medicine, pulmonology, intensive care and sleep medicine at Mount Sinai Hospital in New York.

“Steroids are not helpful at the first sign of infection. You have to be very sick to take this drug and potentially benefit, ”he added.

Dexamethasone is also not recommended as a first-line treatment for those who have just become infected. Dr. Shakhtar says that for most people, the first 5-10 days of illness are not so difficult.

“Don't rush to the hospital if you are feeling well and your condition is not getting worse,” he advises. - Stay home and watch out for possible complications. Drink plenty of fluids, get some rest, and take medications to reduce your fever. ”

Other steroids may aggravate the symptoms of COVID-19

It is still not clear whether other types of steroids will help fight inflammation. Some studies have shown that people taking moderate to high doses of steroids are more likely to suffer from the severe course of COVID-19 disease, says Dr. Shakhtar. According to him, these patients often take steroids to treat the underlying disease, and they can suppress the immune system and make a person more vulnerable to infection.

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