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CoViD-19: Pharmaceutical care during early disease

Dear Editor

Coronavirus may likely stay with us forever [1] and you have rightly mentioned in your recent editorial [2] that it is the time to shift the focus on living with the disease. An approved drug or vaccine to treat or prevent the disease is still far and may not be readily available across the world in the near future, particularly in the low and middle-income countries. Therefore, a comprehensive pharmaceutical care during early CoViD-19 is invaluable in supporting patients under self-isolation or in quarantine to help with their symptoms and preventing them from getting a severe disease needing hospitalisation. A recent preprint [3] provides a pharmaceutical care plan for the early CoViD-19 as an alternative approach to manage the pandemic in the absence of a ‘breakthrough’ drug or a fully established coronavirus vaccination program. The given approach aims to hit the coronavirus hard within the upper respiratory tract before it goes down to cause a severe disease.

The pharmaceutical care during early CoViD-19 may include inhaling steam infused with essential oils such as those in over-the-counter VapoRubs, for instance, Vicks®. The essential oils have previously shown broad-spectrum activity against various microorganisms to include a range of viruses [3, 5] and may help in attenuating the coronavirus within the upper respiratory tract in conjunction with the inhaled steam.

In addition, antiseptic mouthwashes such as chlorhexidine digluconate (Corsodyl®) can be used as a throat rinse (gargle) to sanitise the oropharynx. Chlorhexidine has been effectively used in dental practice since long and provides a broad-spectrum antimicrobial activity against various pathogenic bacterial, yeasts, fungi and viruses [6]. Moreover, benzydamine containing throat rinse can provide analgesic and anti-inflammatory properties to ameliorate pharyngitis by inhibiting pro-inflammatory cytokines [7]. This is to support the recommendation from Venning et al [4] in response to your editorial on using low dose aspirin during early disease. Benzydamine throat rinse may provide a substitute offering a more localised effect in managing cytokine storm during early CoViD-19. Another alternative approach could be a throat rinse (gargle) using an aspirin solution that can be freshly prepared in-situ by adding dispersible aspirin tablets in a glass of water.

Antiseptic lozenges such as those containing 2,4-dichlorobenzyl alcohol and amylmetacresol (such as Strepsils®) can further help with the oral and pharyngeal sensitisation. The combination of dichlorobenzyl alcohol with amylmetacresol offers wide spectrum antiseptic properties against a range of bacteria, fungi and viruses including respiratory syncytial virus, cytomegalovirus, influenza and the coronavirus (SARS-CoV-1) [8,9].

There have been reports of gastrointestinal symptoms in CoViD-19 patients in recently published studies [10-12] which can be controlled by various over-the-counter remedies for diarrhoea or constipation, such as Senokot®, lactulose, activated charcoal, ispaghula husk, Movicol®, as the case may be. This will not only help in regulating the bowel but may also facilitate in clearing the virus from the gut via surface adsorption (charcoal, ispaghula). In case of patients complaining gastrointestinal spasm, an antispasmodic agent such as hyoscine or mebeverine may also be offered.

The aforementioned pharmaceutical care plan is in addition to the currently recommended support in early CoViD-19, such as paracetamol, ibuprofen, antihistamines, antitussives, bronchodilators and offering empirical antibiotics if a secondary bacterial infection is suspected.

A comprehensive pharmaceutical care and early intervention can, therefore, prevent the virus to get down the lower respiratory tract, and potentially reduce the number of cases with severe disease involving pneumonia, and consequent reduction in CoViD-19 associated hospitalisation. To the least, it can provide a comprehensive management of symptoms and may give the body the time to produce antibodies and recover naturally from the disease. The author, therefore, reiterates your notion of shifting the focus to provide the care and support to CoViD-19 patients, particularly, during the early disease to help them recover and significantly reduce the disease burden on healthcare systems.

[3] https:/

Competing interests: No competing interests

29 May 2020
Hamid A. Merchant
Subject Leader in Pharmacy
University of Huddersfield, UK