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).