Middle East Respiratory Syndrome (MERS) Treatment & Management

Updated: Jun 22, 2015
  • Author: Diana M Salazar, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Treatment

Approach Considerations

Rapid development of effective therapeutic options is a high priority since no antivirals are approved for the treatment of coronavirus infection nor vaccines available for prevention. Management of Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV) infection is supportive; this includes hydration, antipyretic, analgesics, respiratory support, and antibiotics if needed for bacterial superinfection.

Experience during the SARS outbreak showed inconsistent results when antiviral therapy was used. One randomized trial compared ribavirin versus interferon1 alpha in SARS and showed no advantage of ribavirin over interferon. [32]

A recent study demonstrated activity of mycophenolic acid against the novel MERS-CoV; its potent in vitro activity may allow it to be used as monotherapy. [33]

Ribavirin and interferon alfa have synergistic in vitro effects against the virus, but their role (if any) in the treatment of MERS remains unknown.

One small observational study of 5 patients with MERS-CoV infection receiving ribavirin in combination with interferon alfa 2b in Saudi Arabia failed to show any benefit. These patients were all critically ill and on mechanical ventilation, and the median time from admission to therapy was 19 days, perhaps too late to demonstrate any benefit.

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Consultations

Infection control and the local Health department should be notified immediately if a case of MERS-CoV infection is suspected. Proper infection-control measures, including standard contact and airborne precautions, should be implemented while managing patients with suspected MERS-CoV infection. Consultation with an infectious disease specialist is strongly recommended, and consultation with a pulmonologist should be considered if severe respiratory complications develop.

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