U.S. Pharmacists Share Insights about Ebola Treatment

By Sederstrom, Jill | Drug Topics, January 2015 | Go to article overview

U.S. Pharmacists Share Insights about Ebola Treatment


Sederstrom, Jill, Drug Topics


With few patients and no approved medications for the treatment of Ebola virus in the United States, caring for those who develop the disease may seem like uncharted territory to many. Pharmadsts who have already worked with these patients can help provide a road map for others in the profession.

During a session at ASElP's 2014 midyear meeting in Anaheim, Calif., pharmadsts who treated patients with Ebola virus disease in hospitals across the United States shared their dinical insights, nutritional considerations, and experiences working with investigational medications.

Impact in the United States

While most confirmed cases of Ebola virus have been in West Africa, the United States also has played a role in the 2014 Ebola outbreak by conduding trials, caring for patients with the disease in America, and sending officers of the U.S. Public Health Service Commissioned Corps to lend a hand in Liberia.

According to Robert DeChristoforo, RPh, MS, FASHP, chief of the National Institutes of Health (NIH) Clinical Center Pharmacy, the NIH is currently conducting two Ebola vaccine trials at its campus in Maryland. The first will assess the safety and immunogenidty of the NIH/GSK cAd3-EBO vaccine, while the second will seek to establish the maximum safe and tolerated dose of a two-dose prime boost IM VSV EBOV vacdne.

The United States also has begun to see cases of patients infected with the Ebola virus disease within its own borders, and healthcare teams across the country are preparing to treat this complicated and potentially deadly disease.

Clinical presentation

Clinical pharmacists can play a valuable role throughout the treatment of patients with Ebola virus disease. They can determine drug distribution, serve as coordinators of pharmaceutical care, and participate in daily patient meetings, although since pharmacists are not typically numbered among the personnel essential to the patient room, they may need to communicate by means of such alternative methods as short-wave radio or walkie-talkie.

Andrew Faust, PharmD, BCPS, is a critical care pharmacy specialist at the Texas Health Presbyterian Hospital, where two of the first Ebola cases to arise in the United States - both nurses at the hospital -were treated.

Experts agree that early detection of Ebola virus disease is critical to providing the best patient outcome; however, said Faust, the difficulty with the early stage of the disease is that it looks like many other viral illnesses. Early disease symptoms that occur between days one and four include fever, myalgias, malaise, and cramping.

"Really, what you need to do with these people is draw labs, and the hallmark labs here are going to be leukopenia, thrombocytopenia, and transaminitis," he said. "If you see those in conjunction with the travel history and it all seems to fit, you need to start thinking 'Ebola virus/"

Faust recommends consideration of alternative infectious diseases, such as malaria or bacterial gastroenteritis, and the use of empiric antibiotics, if needed, until EVD is confirmed.

Fluid loss

The acute phase, which is said to begin about day five, consists of severe gastrointestinal symptoms, hypotension, coagulopathies, electrolyte derangements, and renal failure.

"The amount of GI output in these patients is profound - I mean eight to 10 liters of diarrhea a day. Even as an ICU dinical spedalist, having seen people who are really, really sick, I've never seen diarrhea like that before," Faust said.

Supportive care is an essential part of caring for these patients.

To compensate for the large volume of diarrhea patients can discharge, fluid resuscitation is particularly important. Faust said that when teams at Texas Health Presbyterian Hospital were treating patients, they tried to ensure that the amount of fluid going in matched the amount of fluid going out.

"Your rates on fluids may exceed things like 300 or 400 cc an hour, especially if your patients have GI loss of diarrhea and vomiting at the same time," he said. …

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