Dear Editor
Currently, we are dealing in Africa as elsewhere globally, with a tripledemic of SARS CoV-2 Omicron numerous sub-variants, respiratory syncytial virus (RSV), and several influenza viruses including novel
1
and potential reassortment influenza subtypes’ infection 2
, 3
, 4
. The clinical manifestations of these and other respiratory viral infections are mostly similar 5
especially when the patients are seeking an early medical advice as we highly recommended and continue to recommend, to be noted that the vast majority of our African patients can't afford to perform any investigations due to economic reasons and again we had to adjust our practice to best serve all patients.Interestingly, though the above mentioned viruses might share in sore throat, rhinitis, cough and fever. I suggest that influenza virus infection in adults is more characterized by the sudden onset of severe body ache, marked physical exhaustion (loss of energy as described by many patients), as well as the sudden troublesome nausea, while RSV infection in young children is more common to be associated with otalgia, and conjunctivitis. Similarly, diarrhea was a predominant GIT manifestation that accompanied or even preceded the usual respiratory manifestations and/or complications in an increasing number of patients in this wave of SARS CoV-2 Omicron infection with/without anosmia, ageusia.
Since SARS CoV-2 has been introduced to our medical challenges in November, 2019, physicians in Africa were obliged to take care of COVID-19 patients basing on our best clinical judgment and we can proudly and humbly announce, three years later, that the minimal COVID-19 mortality in Africa has proved us right when we decided to boost our natural immunity with safe, effective and generic drugs as best scientifically revealed in Kelleni's protocol
6
,7
.From a daily real-life experience in my clinic which is focusing in management of COVID-19 and Post COVID syndrome, I wish to declare that early treatment using Kelleni's COVID-19 protocol is as safe and effective in management of this tripledemic as it was in SARS CoV-2 pre Omicron variants in pediatric, geriatric, immune-compromised and pregnant patients
8
. Noteworthy, nitazoxanide, an integral part of Kelleni's COVID-19 protocol, was previously shown to inhibit the in-vitro replication of Paramyxoviridae including RSV and parainfluenza viruses 9
and human influenza viruses 10
.However, as more immune-evasive SARS CoV-2 variants are continuing to emerge, I adjusted my clinical practice and I wish to recommend a full 5-day-course of Kelleni's protocol rather than the usual 3-day-course
8
in all high risk populations especially kids under 5 years, elderly above 75 years and immune-compromised patients to avoid COVID-19 rebound that was seldom encountered in my clinical practice until recently in a young child who did not receive azithromycin in the initial 3-day-course and after 4 days of clinical resolution, runny nose, cough nausea and low grade fever reappeared and was perfectly and promptly controlled by another 3-day-course of nitazoxanide and azithromycin. Notably, bacterial co-infection is suggested to be considered in such clinical scenario; i.e. in virally infected patients who deteriorate after initial improvement 11
. I currently use and recommend the full Kelleni's protocol, including azithromycin, for 5 days in all high risk groups as I suggest a favorable risk benefit ratio is obvious considering its high safety and efficacy as well as the additional potential benefits when using azithromycin prophylactically in those populations 12
.Funding/Financial exposure
None
Declaration of Competing Interest
The author declares that there is no conflict of interest.
References
- A child with acute respiratory distress syndrome caused by avian influenza H3N8 virus.J Infect. 2022; 85: 174-211
- Human infection with H3N8 avian influenza virus: a novel H9N2-original reassortment virus.J Infect. 2022; 85 (-e9): e187
- Pathogenicity and transmissibility of current H3N2 swine influenza virus in Southern China: a zoonotic potential.Transbound Emerg Dis. 2022; 69: 2052-2064
- A characterization and an evolutionary and a pathogenicity analysis of reassortment H3N2 avian influenza virus in South China in 2019-2020.Viruses. 2022; : 14
- Viral infections of the lung and respiratory tract.in: Grippi MA Antin-Ozerkis DE Dela-Cruz CS Kotloff RM Kotton CN Pack AI Fishman's Pulmonary Diseases and Disorders, 6e. McGraw-Hill Education, New York, NY2023
- NSAIDs and Kelleni's protocol as potential early COVID-19 treatment game changer: could it be the final countdown?.Inflammopharmacology. 2022; 30: 343-348
- NSAIDs/nitazoxanide/azithromycin repurposed for COVID-19: potential mitigation of the cytokine storm interleukin-6 amplifier via immunomodulatory effects.Expert Rev Anti Infect Ther. 2022; 20: 17-21
- NSAIDs/Nitazoxanide/azithromycin immunomodulatory protocol used in adult, geriatric, pediatric, pregnant, and immunocompromised COVID-19 patients: a real-world experience.Can J Med. 2021; 3: 121-143
- Nitazoxanide inhibits paramyxovirus replication by targeting the Fusion protein folding: role of glycoprotein-specific thiol oxidoreductase.ERp57. Sci Rep. 2018; 8: 10425
- The susceptibility of circulating human influenza viruses to tizoxanide, the active metabolite of nitazoxanide.Antiviral Res. 2017; 147: 142-148
- Clinical practice guidelines by the infectious diseases society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenzaa.Clin Infect Dis: Off Publ Infect Dis Soc Am. 2019; 68: e1-e47
- Anti-inflammatory effect of prophylactic macrolides on children with chronic lung disease: a protocol for a double-blinded randomised controlled trial.BMJ Open. 2016; 6e012060
Article info
Publication history
Published online: December 09, 2022
Accepted:
December 8,
2022
Identification
Copyright
© 2022 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
