It has almost been two weeks now.

Is it still true that the early drug cocktail of choice is Plaquenil/ZPAK? Are there any other options coming on line? Two weeks ago my CCP recommended Plaquinil/ZPak to me if I showed any COVID19 symptoms. Would you expect other alternatives drugs for early use to counter COVID19?

Are the drugs of choice giving later to a critically ill patient (like day 9, 10, 11 and is either Toculizumab or Remdesivir? As above, any alternative drugs coming on line to. Help a critical I'll patient?

Last question. Has there ever been a previous drug that had become so politically charged as Plaquinil? It has to be irritating?

Thank you for all that you do during this time!

Azithromycin has never really been "in favor" by most experts because the pharmacological logic behind it was always so poor. Same with zinc. They were popularized by anecdotes, poor study data and to some degree (in the case of zinc) long standing pseudoscience. Both are becoming utilized less and less as this information is disseminated to other providers such as outpatient PCPs and hospitalists. These "cocktails" were always bad science driven by fear and the urge to "do something".

HCQ is being taken out of many institutions algorithms as more less encouraging data emerges, especially given how even the most ardent supporters have been forced to acknowledge it at least is ineffective once patients are really sick. Given I work in the hospital setting and many of the patients I see are sick I'm using it less and less, and if the large early treatment and prophylaxis studies are equally as meh I'll stop using it altogether.

Remdesivir is more promising but it effects viral replication so it's effects are diminished later in the disease process. The IL-6 inhibitors are encouraging as well for more severe disease. Big trials for all these are pending.

Are doctors concerned about ACE inhibitors?

No, ACEI ok to continue to use.

Listened to a NYC nephrologist this AM. Keep taking your ACEs and ARBs. They are seeing a wide variety of renal issues caused by the virus. Not all ATN or prerenal.

queso1 said:

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Are doctors concerned about ACE inhibitors?

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No

Infection_Ag11 said:

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queso1 said:

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Are doctors concerned about ACE inhibitors?

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No

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Isn't there some data emerging that ACE inhibitors and ARBs might actually help?

How about the HCQ and risk of heart failure? What are people seeing on that end?