Role of Co-Trimoxazole in Patients with COVID-19 with Acute Respiratory Failure Requiring Non-Invasive Ventilation: A Single Center Experience

IntroductionCOVID-19 may become a potentially life threatening condition presenting with acute respiratory failure secondary to acute respiratory distress syndrome mediated by cytokine storm syndrome. There are no effective evidence based treatment available for this condition except steroids. The mainstay of treatment is only supportive. MethodsData from consecutive, newly diagnosed patients with COVID-19 with acute respiratory failure on non-invasive ventilation receiving oral co-trimoxazole in addition to standard therapy presenting to the Intensive Care Unit of IQ City Medical College Hospital, Durgapur, West Bengal, India between June 2020 and October 2020 was retrospectively collected. Results142 patients were identified (Age (59±13 years), 81% Male and BMI (28±2)). Co-morbidities included hypertension (60%, n=85), diabetes mellitus (40%, n=57), coronary artery disease(11%, n=15), chronic obstructive pulmonary disease (9%, n=13), chronic kidney disease (3%, n=4) and cancer (0.70%, n=1). The commonest symptom was breathlessness which was present in 100% of patients. 16% (n=23) patients required intubation with mean length of stay in hospital of 10±4 days and an inpatient mortality of 13% (n=18). There was a significant fall in the C Reactive protein after 7 days of treatment with co-trimoxazole (mean 193±39mg/L (day 0) vs 37±42mg/L (day 7), p<0.001). ConclusionThis case series suggests that co-trimoxazole may potentially improve outcomes in patients with severe to critical COVID-19. This may be due to its antimicrobial and anti-inflammatory properties. A randomized control trial in patients with severe COVID-19 on cotrimoxazole is underway.