Improved Recovery and Survival with Trimethoprim or Cotrimoxazolein Patients with Severe COVID-19: A Retrospective Analysis

Authors

  • Veronica A.Varney Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK Author
  • Rebecca Lawrence Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK Author
  • Amar Sodha Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK Author
  • Chandrashekar Malapanjudi Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK Author
  • Chandrashekar Malapanjudi Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK Author
  • Gopal Chattopadhyay Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK Author
  • Shashikiran Ramanna Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK Author
  • Thomas Samuel Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK Author
  • Thomas John Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK Author
  • Syed R Quadery Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK Author
  • Souvik Dutta Department of Medical Statistics, Peerless Hospital and B.K. Roy Research Centre, Kolkata, India Author

DOI:

https://doi.org/10.47363/JVRR/2020(1)118

Keywords:

Trimethoprim , Cotrimoxazole, COVID-19

Abstract

Background: COVID-19 may become a life-threatening illness as a result of acute respiratory distress syndrome with the mainstay of management supportive, although dexamethasone and serum from recovered patients look helpful in reducing mortality in oxygen dependant patients.


Methods: We retrospectively analysed data from 22 patients with severe COVID-19 treated with trimethoprim (TMP) or cotrimoxazole (CTX) added
to standard therapy antibiotics (ST) and compared this with anonymized data from 22 patients with COVID-19 of similar severity receiving ST alone.

Results: Patients receiving additional TMP or CTX showed clinical improvement within 48 hours with reduced fever (p= 0.001), C-reactive protein levels (p=0.002) and oxygen requirements (SpO2/FiO2, p<0.001). Mortality was reduced (to 5% versus 32% for ST, p=0.022) and the need for ventilatory support (3 versus 16 patients on ST, p<0.001) and hospital length of stay (mean: 9 days versus 22 days on ST p<0.001).


Discussion: This benefit may be due to combined antimicrobial and immunological effects of TMP and CTX. Both drugs block stimulation of the formylpeptide receptors (FPR’s) on the surface of circulating neutrophils and monocytes. When stimulated, FPR’s cause homing of neutrophils to the lung and trigger the release of Reactive Oxygen Series driving cytokine production and therefore a possible cytokine storm. Stressed neutrophils can extrude their nuclear content as ‘external nets’ (NETosis) to trap infectious agents, these nets can block the pulmonary alveolar bed giving severe hypoxia and death as seen in post mortems from COVID-19 patients. Blocking of neutrophil FPR’s by these drugs may be the mechanism by which they protect the lung in COVID-19

Author Biographies

  • Veronica A.Varney, Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

    Veronica A Varney, (ORCID ID 0000-0001-7531-6139), Department of Respiratory Medicine, St Helier Hospital, Wrythe Lane, Carshalton, Surrey, SM5 1AA, United Kingdom

  • Rebecca Lawrence, Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

    Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

  • Amar Sodha, Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

    Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

  • Chandrashekar Malapanjudi, Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

    Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

  • Chandrashekar Malapanjudi, Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK


    Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK 

  • Gopal Chattopadhyay, Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

    Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK 

  • Shashikiran Ramanna, Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

    Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

  • Thomas Samuel, Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

    Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

  • Thomas John, Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

    Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

  • Syed R Quadery, Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

    Department of Respiratory Medicine, Epsom and St Helier University Hospitals NHS Trust, London, UK

  • Souvik Dutta, Department of Medical Statistics, Peerless Hospital and B.K. Roy Research Centre, Kolkata, India

    Department of Medical Statistics, Peerless Hospital and B.K. Roy Research Centre, Kolkata, India

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Published

2020-11-11

Issue

Vol. 1 No. 2 (2020): Volume 1, Issue 2

Section

Articles