4- Treatment of complications mediated by virus replication
As the cytokine storm develops through the body, it causes shock and
hypoxemia. Also, Antimicrobial and antifungal agents could be
administered for elongated illness course. Application of prebiotics and
Resolving nutritional deficiencies could be used alongside the main
therapeutics. ARDS and difficulty in breathing are COVID-19 symptoms in
which nitric oxide could help in regulating the function of the airways
and inhibiting the synthesis of viral protein and RNA (8). An effective
way is to administer a combination, including anti-shock, antivirus,
anti-secondary infection, anti-hypoxemia, and maintenance of water,
electrolyte and acid-base balance, and micro ecological balance and
immune enhancement. It could effectively reduce the mortality rate in
COVID-19 patients. (72).
Azithromycin , a macrolide and an erythromycin derivative, with
unique pharmacologic properties and prolonged half-life, has been a part
of the treatment options for community-acquired pneumonia. It can be
used alone or in combination with other antimicrobial agents, depending
on the history and severity of the disease(29). However, like other
macrolides, through affecting potassium ion channels, prolongation of QT
interval may happen and recent studies revealed an association of
increased risk of cardiac death (28). Taking azithromycin may cause
increased lactate dehydrogenase, thrombocythemia, lymphocytopenia (37).
In a retrospective study of 85 fatal cases, most patients received
antibiotics (Meropenem), antiviral (Arbidol), and glucocorticoid
treatments. The administration of multiple antibiotics did not decrease
the mortality rate. This article did not mention azithromycin(73).