Tata Laksana Terapi Pasien dengan COVID-19: Sebuah Kajian Naratif
Abstract
Kasus pneumonia yang disebabkan oleh severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) yang disebut coronavirus diseases 2019 (COVID-19) oleh World Health Organization (WHO) merupakan sebuah tragedi dalam dunia kesehatan secara global. Tata laksana yang tepat dan cepat diharapkan dapat menyelamatkan nyawa pasien. Sampai tulisan ini dibuat, belum terdapat satu jenis obat yang secara resmi diizinkan penggunaannya untuk terapi COVID-19. Kajian literatur ini bertujuan untuk 1) memaparkan tata laksana pengobatan dan 2) mendaftar serta menjelaskan alternatif obat yang dapat digunakan untuk SARS-CoV-2. Proses penelusuran artikel dalam kajian pustaka ini dilakukan pada sebuah database, yakni PubMed dengan kombinasi kata kunci ((“corona virus”) OR (“covid-19”) OR (“SARS-CoV-2”)) AND ((“treatment”) OR (“therapy”)). Hasil kajian ini menunjukkan bahwa tata laksana pasien dengan COVID-19 dapat berbeda antar-setting dan negara dengan mempertimbangkan ketersediaan sumber daya, khususnya obat. Pedoman terapi WHO dan pedoman di Indonesia saat ini merekomendasikan supportive therapy untuk penanganan COVID-19, antara lain: terapi untuk gejala yang terjadi, pemberian oksigen, penggunaan antibiotik, terapi cairan, penggunaan vasopresor, dan tindakan medis (termasuk pemasangan ventilator) untuk menyelamatkan nyawa pasien. Belum terdapat obat khusus yang direkomendasikan untuk menekan replikasi SARS-CoV-2. Beberapa jenis obat yang potensial bermanfaat untuk SARS-CoV-2 antara lain: klorokuin atau hidroksiklorokuin, arbidol, ribavirin, favipiravir, lopinavir/ritonavir, remdesivir, oseltamivir, dan interferon. Namun sampai dengan tulisan ini dibuat, terdapat keterbatasan bukti penelitian dengan desain yang baik yang dapat digunakan untuk menarik kesimpulan terkait superioritas suatu jenis obat tertentu dibandingkan dengan alternatif yang lain. Dalam kondisi menunggu hasil penelitian dengan desain penelitian yang baik, penggunaan obat yang memiliki bukti efektivitas (walaupun belum baik) atau diduga efektif, perlu dioptimalkan untuk menyelamatkan nyawa pasien, khususnya mereka yang dalam kondisi parah.
Kata kunci: COVID-19, tata laksana, terapi
Therapeutic Management of Patients with COVID-19: A Narrative Review
Abstract
Pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—named coronavirus diseases 2019 (COVID-19) by World Health Organization (WHO)—has been a global public health emergency. Timely and effective therapeutic strategies are of importance in saving patients’ lives. However up to now, there is no specific treatment approved for COVID-19. This review aimed 1) to describe the available therapeutic strategies, and 2) to explore options of medications that can be used to treat COVID-19. A search strategy using keywords ((“corona virus”) OR (“covid-19”) OR (“SARS-CoV-2”)) AND ((“treatment”) OR (“therapy”)) was conducted in PubMed database. The review showed that treatment strategies could be different between settings and/or countries considering the availability of resources, particularly medications. The current WHO as well as the Indonesian guidelines mainly recommended supportive therapy to treat COVID-19, including: symptomatic care, oxygen therapy, antibiotics, fluid therapy, vasopressors, and taking medical interventions (including the use of ventilator). Studies conducted so far indicated the potential benefits of some medications, including chloroquine/hydrochloroquine, arbidol, ribavirin, favipiravir, lopinavir/ritonavir, remdesivir, oseltamivir, and interferon; however, the evidences available have been limited and not strong enough to recommend any specific medication for COVID-19. While waiting for quality evidences, optimising the use of medications—reported to have some levels of effectiveness—could be the current best option to save patients, especially those who are critically ill.
Keywords: COVID, medication, therapeutic management
Keywords
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DOI: https://doi.org/10.15416/ijcp.2020.9.1.70
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