Infectious Diseases in Critical Care Medicine

Table 10

Treatment for Adults (

Continued

)

Pathogen

Initial treatment prior to availability of susceptibility

Tick-borne hemorrhagic fever viruses

(Crimean-Congo hemorrhagic fever),Nairovirus

-a Bunyaviridae, Omsk

hemorrhagic fever, Kyasanur forestdisease, and Alkhurma viruses.

Ribavirin.

Multidrug-resistant

M. tuberculosis

See Ref. 97.

SARS virus (SARS-associated

coronavirus)

Supportive care. Interferon alpha, pegylated interferon alpha in small series. Steriods may or may not be of benefit. No randomized

controlled trials with a specific anti-coronavirus agent have been conducted. Reports using historical matched controls havesuggested that treatment with protease inhibitors together with ribavirin, or convalescent plasma-containing neutralizingantibody, could be useful. Ribavirin alone does not appear effective. Presently, no antiviral therapy has proven effective.

West Nile virus (

a Flaviviridae

)

Supportive therapy. Animal trials with monoclonal antibody appear promising. Minocycline has some in vitro antiviral activity.

Pandemic and avian influenza (H5N1

influenza)

Vaccination when vaccine becomes available for control. Osteltamivir 75 mg/kg bid for 5 days or Zanamivir two inhalations bid

(5 mg) b.i.d. for 5 days. Intravenous formulation of zanamivir 10 mg/kg and at 20 mg/kg in the combined prophylactic andtherapeutic groups with both prophylaxis (commencing 12 hr before infection) and therapy (commencing 4 hr after infection)showing similar reductions in viral load in cynomolgus macaque model. Tissue culture studies with chloroquine and IM peramivirin mice appear promising.

Monkeypox virus (

Orthopoxvirus

of the

Poxviridae family)

Supportive therapy. Cidofovir in animal models. See smallpox.

Genetically engineered biological

weapons

Abbreviation

: MIC, minimum inhibitory concentration.

Source

: From Refs. 1, 6, 11, 23, 26, 28, 29, 58–60, and 75–98.

472 Cleri et al.