Article
Early treatment of patients with COVID-19 in ambulatory care – a case report
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Authors
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Gesine Friederike C. Weckmann
- European University of Applied Sciences, Deutschland
| Published: | September 15, 2022 |
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Outline
Text
Hintergrund: COVID-19 has vastly different risks depending on age and comorbidities. Since the start of the COVID-19 pandemic, several vaccinations and medications have been developed to modify disease severity. The arrival of monoclonal antibodies (Mabs) and antiviral medications against COVID-19 allow general practitioners to treat high-risk patients prophylactically or in early-stage infection.
Fragestellung: Which options are feasable in post-exposure prophylaxis and early treatment of COVID-19 infections in high-risk patients in ambulatory care? What are the facilitators and barriers to early intervention in these cases?
Methoden: We analyze 2 treatment situations to address early treatment options for COVID-19 in ambulatory care as well as facilitators and barriers to the application of these options.
Ergebnisse: In December 2021, a caretaker tested positive for SARS-Cov-19. She reported fatigue and muscle pain since the previous day and close contact with 2 unvaccinated patients aged 95 (patient 1) and 79 (patient 2). Because of age and comorbidities, post-exposure prophylaxis was indicated. Mabs were obtained from the local university hospital pharmacy, but ordering the recommended inline-filter was problematic. After i.v. application of the mAbs at home <48 hours after contact, both patients remained negative.
In June 2022, patient 1 showed upper respiratory symptoms and was tested positive for SARS-Cov-19. Ordering medication was delayed by holidays. On day 2, the patient developed fever and generalized symptoms. Treatment with nirmatrelvir/ritonavir and sotrovimab was started and by day 4 all symptoms had vanished.
Diskussion: Delays in obtaining medication were mainly caused by weekends and holidays, as well as unfamiliarity with the procedures for prescription and use of these novel medications.
Take Home Message für die Praxis: Early treatment for COVID-19 of high-risk patients with oral antiviral medication can be performed at home, but drug interactions should be considered. Ambulatory treatment with Mabs can be performed at home or doctor's office, depending on patient condition and patient and physician preference.
