Treating Ebola: 14 Symptomatic and Experimental Options

Ebola is treated in ICU settings using symptomatic and experimental approaches.

Most treatment of the deadly Ebola virus is symptomatic and focuses on the relief of symptoms as they develop.  Much treatment targets both bleeding and shock, which are among the most worrisome complications of Ebola.  Patients with Ebola should be isolated and treated in the intensive care unit with barrier precautions in place—gowns, gloves, masks and goggles for all healthcare personnel in contact with the patient.  Although most treatment of Ebola is symptomatic, there exists certain experimental interventions that target the Ebola virus itself and have shown some promise in animal models and a handful of people with the disease.

1
Fluid and electrolyte management (symptomatic treatment)

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In order to prevent dehydration, fluids are given to the patient with Ebola both intravenously and, if tolerated, by mouth, too.  Furthermore, electrolytes or body salts are regulated intravenously in order to keep the body in proper homeostasis or balance.  Finally, intravenous lines serve as routes of administration for drugs like antibiotics which help combat secondary infections.

2
Analgesics (symptomatic treatment)

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Ebola is painful thus heavy-hitting analgesics (drugs like morphine) are given for pain relief.

3
Antipyretics (symptomatic treatment)

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Antipyretics (drugs like Tylenol) are given to reduce very high fevers caused by the Ebola virus.  (Ebola isn't called a viral hemorrhagic fever for nothing!).

4
Antiemetics (symptomatic treatment)

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Antiemetics are used to combat nausea and vomiting.  (Emesis means vomiting.)

5
Antidiarrheal agents (symptomatic treatment)

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Antidiarrheal agents (drugs like Lomotil) are used to help with diarrhea that usually sets in a few days after infection with Ebola.

6
Blood and blood products (symptomatic treatment)

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Blood and blood products help with the bleeding caused by the Ebola virus.

7
Pressors (symptomatic treatment)

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Pressors, a class of drugs that helps maintain blood pressure and cardiac output (the volume of blood pumped by the heart), are routinely administered to help fight shock.  Along with bleeding, shock is a major concern in the patient with Ebola.

8
Dialysis and mechanical ventilation (symptomatic treatment)

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In case the patient with Ebola experiences end-organ damage (failure of the kidneys or lungs), dialysis and respirators can be life saving.

9
Convalescent blood and blood products (experimental treatment)

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In September 2014, the World Health Organization (WHO) released “interim guidance” which suggested using convalescent blood and plasma, a blood component, from recovered patients with Ebola as a means of immunization. 

10
Monoclonal antibodies (experimental treatment)

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Zmapp, a cocktail of monoclonal antibodies which fight proteins that constitute the Ebola virus, has shown promise in a handful of people.   Other monoclonal antibodies such as HB-003 and ZMab have shown antiviral effects in macaques, a type of primate.  (Keep in mind that animal models aren’t human, so, although encouraging, such findings must be taken with a grain of salt.)

11
Plasmapheresis (experimental treatment)

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Plasmapheresis is a treatment which removes blood plasma from the body, treats it and returns it to the body.

12
siRNAs (experimental treatment)

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Small interfering RNAs or siRNAs (TMK-100201 and TMK-100802), phosphorodiamidate morpholino antisense oligomers, polyinosinic-polycytidylic acid stabilized with polylysine and carboxymethylcellulose are molecules that interfere with viral replication and are currently all in clinical trials.

13
BCX4430 (experimental treatment)

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Nucleoside-analog BCX4430 also interferes with viral replication and has shown promise in macaques.    Additionally, nucleotide-analog favipiravir has shown clinical efficacy in mice (which are even less like humans than macaques).

14
SERMs (experimental treatment)

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Selective estrogen receptor modulators (SERMs) including clomiphene and toremifene have also proved effective in combating Ebola in mice.

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