r suggested
drugs 5,8.
Moreover, an Egyptian expat in KSA with SARS CoV-2 PCR positive test
results of a combined nasopharyngeal and oropharyngeal swab was also a
hypertensive and type 2 diabetic patient and managed, upon advice, to
receive diclofenac potassium to replace the prescribed paracetamol. This
patient has already received amoxicillin/clavulanate potassium and thus,
we decided not to administer any further antibiotics as no fever was
detected. Interestingly, his troublesome fortnight dyspnea and dry cough
were reported to dramatically improve from the first day diclofenac
potassium 50 mg, postprandial b.i.d., was administered and he became
mostly symptom-free in three days. The patient continued further two
days and later he was discharged. Notably, he was advised, similar to
our other COVID-19 patients, not to take antitussives for his mild to
moderate cough episodes, and to use warm beverages e.g. boiled mint to
soothe their sore throat and this approach has proved beneficial in all
our cases, it’s been a recommendation basing on a clinical sense that
trusted the body natural reflexes and was not basing on a scientific
evidence based evidence, which is currently lacking and might not be
promptly available. For the second isolated expat, we prescribed
diclofenac potassium/azithromycin to manage his persistent 20 days
fluctuating fever. Notably, this patient managed to get azithromycin
with a help from an Egyptian pharmacist as antibiotics are not allowed
to be purchased without a prescription in KSA and he reported that his
persistent diarrhea started to improve immediately after ceasing to use
the previously prescribed antitussive dextromethorphan even before
managing to purchase the other newly prescribed drugs from outside the
quarantine facility. Furthermore, he has also used ibuprofen 600 mg
tablets that were available with him and reported a better clinical
experience than diclofenac potassium regarding headache, fatigue and
pain control and later he was discharged. Importantly, we preferred to
give NSAIDs twice daily aiming at improving the natural immune response
if the patients recorded temperature less than 38°C in between the two
doses but they were allowed to take them t.d.s if the temperature
exceeded 38°C before the next dose. Similarly, we prescribed diclofenac
potassium/azithromycin to safely manage a third expat patient, also
confirmed by PCR, who complained of 39°C fever associated with his SARS
CoV-2 infection and a fourth COVID-19 expat patient also confirmed by
PCR, suffered from fluctuating fever up to 39°C with marked dry cough to
which he was prescribed azithromycin 500 mg daily for three days and
paracetamol. We, contacted on the third day, instructed him to continue
azithromycin for 2 more days and to replace paracetamol with diclofenac
potassium t.d.s. for two days and b.i.d. for three days and he felt
marked improvement in his clinical condition with normal temperature and
gradual significant improvement of cough during the five days course.
Notably, nitazoxanide is not commercially available in KSA pharmacies
but is readily available in Egyptian pharmacies. Some patients have also
complained of severe malaise, anorexia, moderate diarrhea, anosmia,
dysgeusia, ageusia, moderate to severe flank and back pain which have
been totally improved in two weeks. Most of the patients who received
the protocol early in COVID-19 have improved during the its five-day
duration. Notably, some young individuals were close contacts to
positive COVID-19 cases with no or very mild symptoms e.g. mild cough
without fever and for those suspected silent carriers, only isolation
+/- zinc and vitamins was advised and reassurance was granted with their
smooth follow up.