by James Lyons-Weiler, PhD, Popular Rationalism, ©2024
(Aug. 22, 2024) — In an unusual move, the CDC is holding a monopoly on access to drugs that might be useful in treating a contagious virus. Here, we explore standard-of-care options for treating monkeypox.
Physicians in the field have found that care primarily focuses on alleviating symptoms and preventing complications, as no specific antiviral treatment has been approved specifically for monkeypox.
Potential (proposed) guidelines for managing the condition:
1. Symptomatic Treatment:
– Pain and Fever Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage pain and fever.
– Hydration: Ensuring adequate fluid intake to prevent dehydration is crucial.
– Skin Care: Keep the skin lesions clean and dry. Calamine lotion or antihistamines might be used to alleviate itching.
2. Isolation and Prevention:
Isolation: Patients should be isolated to prevent the spread of the virus, especially when they are symptomatic and have active lesions.
– Hygiene: Regular handwashing and disinfecting surfaces can help reduce transmission.
3. Antiviral Treatments:
Tecovirimat (TPOXX) is an antiviral medication approved for the treatment of smallpox. Due to its activity against orthopoxviruses, it is sometimes used under compassionate use or in clinical trials for monkeypox.
Cidofovir and Brincidofovir are antiviral drugs sometimes used to treat severe orthopoxvirus infections. Their use for monkeypox is not well established, but it is generally considered when other options are unavailable.
4. Supportive Care:
– Monitoring for Complications: Patients should be monitored for potential complications, such as bacterial infections of skin lesions, pneumonia, or encephalitis, especially in immunocompromised individuals.
– Hospitalization: Severe cases may require hospitalization for supportive care and treatment of complications.
5. Counseling and Mental Health Support:
– Psychological Support: Patients with monkeypox may require psychological support due to the stigma and isolation associated with the disease.
Most Recent Knowledge on Treatment Options
Recent studies on antiviral treatments for monkeypox have provided new insights, though challenges remain. Tecovirimat (TPOXX), initially developed for smallpox, is the most studied antiviral for monkeypox. A study conducted in the Democratic Republic of the Congo observed lower overall mortality rates: the study’s 1.7% overall mortality among enrollees, regardless of whether they received the drug or not, was much lower than the monkeypox mortality of 3.6% or higher reported among all cases in the DRC (NIH). Supportive care alongside TPOXX might contribute to better outcomes. In the study, Tecovirimat did not significantly reduce the duration of monkeypox lesions in patients infected with the clade I strain.
Other antivirals being explored include Brincidofovir and Cidofovir, both of which are DNA polymerase inhibitors. These drugs show varying levels of effectiveness against monkeypox in laboratory settings, though they are generally considered when Tecovirimat is unavailable or ineffective. These antivirals are more commonly used for treating other DNA viruses, but their role in monkeypox treatment is still under investigation, especially concerning safety and dosage optimization.
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