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.