Cotrimoxazole and teicoplanin in the management of Covid-19: Pleiotropic effects, shadows and lights

At present, coronavirus disease 2019 (Covid-19), caused by SARS-CoV-2 infection, has turned into a global pandemic. Comparable to the H7N9 virus, SARS-CoV-2 causes soaring mortality in elderly patients who have pre-existing chronic diseases. SARS-CoV-2 infects human epithelial cells by binding to human angiotensin-converting enzyme2 (ACE2). Multi-organ failure has been observed in some patients with severe COVID-19. TheACE2 expression profile suggests that SARS-CoV-2 infection may initiate or even directly cause organ failure. In addition to direct infection, evidence shows that an elevated inflammatory immune response is also involved in the pathogenesis of SARS-CoV-2 infection. The immunomodulatory and anti-inflammatory activity of the cotrimoxazole (CTX) and teicoplanin are seen in several studies that show the lower concentrations of plasma pro-inflammatory markers like CRP, IL6 in continuous CTX prophylaxis, suggesting its role as anti-inflammatory and immunomodulation. The present review concludes that both teicoplanin and CTX are effective in the management of Covid-19 through anti-SARS-CoV-2 and anti-inflammatory effects as well as controlling of secondary bacterial infections.