Straight Dope Message Board

Straight Dope Message Board (https://boards.straightdope.com/sdmb/index.php)
-   The Quarantine Zone (https://boards.straightdope.com/sdmb/forumdisplay.php?f=41)
-   -   Considering Zpack for a virus (COVID19) - Destroys don't take a antibiotic for a virus argument? (https://boards.straightdope.com/sdmb/showthread.php?t=892417)

kanicbird 03-23-2020 05:41 PM

Considering Zpack for a virus (COVID19) - Destroys don't take a antibiotic for a virus argument?
 
It seems like Zpack is being considered as part of a cure/treatment for COVID19. That seems to obliterate the argument that antibiotics do nothing against viruses. Just that it was considered as a potential treatment seems to say a lot . If it was so sure that it does nothing, why even consider it at all? Many of us know from personal experience that they seem to help, though others say that the person would most likely have recovered the same without them. We might not know how it helps, but is this the crack in the armor against 'inappropriate' antibiotic usage?

susan 03-23-2020 05:54 PM

I haven't read anything about this, and in the absence of information I speculate that the idea is decreasing secondary infections, not treating COVID itself.

USCDiver 03-23-2020 06:00 PM

Azithromycin does not do anything for viruses. That is NOT in question. There's not even a mechanism by which it might help.

It is being used in severe Covid cases due to superimposed bacterial pneumonia.

RivkahChaya 03-23-2020 06:07 PM

As I understand it, many of the deaths from Covid-19 are from pneumonia, that technically is from an opportunistic bacterial infection which would not have gotten a foothold if not for the changes to the mucous of the lungs and bronchial tubes brought on by the virus.

So, like HIV, Covid-19 does not always kill directly. It kills by making you vulnerable to something you otherwise never would have gotten.

Azithomycin keeps at bay those opportunistic infections until you can fight off the Covid-19 itself.

Caveat: IANAD. I just have attended lots of workshops and symposia on subjects like this, because it was relavant to the job I had in the late 90s and early 00s.

ETA: the times doctors have prescribed antibiotics when you have a viral infections, it's usually been some kind of situation like this.

DinoR 03-23-2020 06:13 PM

Quote:

Originally Posted by kanicbird (Post 22206279)
That seems to obliterate the argument that antibiotics do nothing against viruses.

Azithromyicin also has anti-inflammatory properties. That presents the possibility that it is some other effect of the chemical and not its antibiotic properties that helps with the disease. (Assuming that the really small test holds up.) Drawing broader lessons about antibiotics that don't share those properties would be problematic.

There is another possibility. We are constantly being exposed to all manner of bacteria that our immune systems kill off as a matter of routine. Usually that is without us being aware of them or needing medical treatment. When our immune system is struggling to fight off a very serious, and potentially deadly, virus those secondary infections may simply be too much for us to handle all at once. An antibiotic may help with the disease by killing those other threats and leaving our immune system in better position to handle the virus. That does not mean we should think that more normal viral infections, like the common cold, can benefit from fighting bacteria with antibiotics.

kanicbird 03-23-2020 06:20 PM

Many have stated that the antibiotic may be helpful in fighting off secondary infections. But that could be helpful in other virus infections as well.

VOW 03-23-2020 06:34 PM

The z-pack is used in conjunction with the anti-malarial chloroquine. Whether it is a synergistic effect, or if the anti-inflammatory effect of z-mycin allows the chloroquine to attack the virus more efficiently, I doubt there have been many studies to show exactly why this combo works.


~VOW

Dr_Paprika 03-23-2020 06:42 PM

If memory serves, azithromycin works by binding to the 50S subunit in ribosomes affecting RNA synthesis. So it theoretically might help for an RNA virus. Secondary prevention of bacterial infections, specifically hospital acquired pneumonia, might also help. But by the time the patient is in the ICU you are sometimes throwing the kitchen sink at things.

BigT 03-23-2020 07:50 PM

Quote:

Originally Posted by kanicbird (Post 22206341)
Many have stated that the antibiotic may be helpful in fighting off secondary infections. But that could be helpful in other virus infections as well.

Possibly, but not usually. Most viruses don't compromise the immune system so much as to allow for opportunistic infections from bacteria. It is only the worst cases where an antibiotic might be useful--we're talking people in the hospital or certain viruses (like HIV).

If the viral infection will resolve on its own with no lasting damage (i.e. most viruses we acquire), then the antibiotic is wasted, even if it could technically help. And we can't waste antibiotics.

Every time we use an antibiotic, we are increasing the chances that a resistant bacteria will evolve. That is why we are so much more stingy with antibiotics now. We do not use them unless we must, where the risk is less than the reward.

With people who are dying, why not try something that may work? You're already keeping them quarantined, so any resistant infection won't get out. So the risk there is minor.

The statement "an antibiotic is useless for viral infections" is about the types of viral infections you go to your out-patient doctor for. It's about explaining why your doctor won't give you an antibiotic to take home if you have a viral infection.

Dr_Paprika 03-23-2020 08:31 PM

https://www.nature.com/articles/s41429-019-0204-x

So to some extent, yes. But only for some viruses.

nearwildheaven 03-23-2020 08:35 PM

Quote:

Originally Posted by susan (Post 22206296)
I haven't read anything about this, and in the absence of information I speculate that the idea is decreasing secondary infections, not treating COVID itself.

It's exactly this.

DSeid 03-23-2020 08:42 PM

Some suggestions that it may have some antiviral action. https://pubmed.ncbi.nlm.nih.gov/?ter...ycin+antiviral

Dr Paprika’s cite in the list.

Doesn’t mean it does. This was a few patient and not a difference in clinical outcomes.

Napier 03-24-2020 07:20 AM

IANAD but am a pulmonary patient, and I often wind up on azithromycin or levaquin due to a cold. Doctors tell me the purpose is to handle bacterial infections that move in because of the damage the viral illness caused.

Mama Zappa 03-25-2020 02:47 AM

Quote:

Originally Posted by DinoR (Post 22206325)
Azithromyicin also has anti-inflammatory properties. That presents the possibility that it is some other effect of the chemical and not its antibiotic properties that helps with the disease. (Assuming that the really small test holds up.) Drawing broader lessons about antibiotics that don't share those properties would be problematic.

There is another possibility. We are constantly being exposed to all manner of bacteria that our immune systems kill off as a matter of routine. Usually that is without us being aware of them or needing medical treatment. When our immune system is struggling to fight off a very serious, and potentially deadly, virus those secondary infections may simply be too much for us to handle all at once. An antibiotic may help with the disease by killing those other threats and leaving our immune system in better position to handle the virus. That does not mean we should think that more normal viral infections, like the common cold, can benefit from fighting bacteria with antibiotics.

I popped in to say what you did about the anti-inflammatory properties. A friend of mine, about 20 years ago, had ongoing problems with her lungs. They finally wound up leaving her on azithromycin long term, not because she necessarily had a bacterial infection, but because of the antiinflammatory effect. I think she was on it for several years.

i am curious about COVID-induced pneumonia. Pneumonia can "just" be viral, or a viral illness can make room for an opportunistic bacterial infection. Are there any statistics (or theories) as to whether COVID pneumonia usually, sometimes or rarely involves a secondary infection? Any scuttlebutt about whether doctors are proactively adding antibiotics earlier in those patients who are more susceptible to such secondary infections due to existing lung disease or other circumstances? Any scuttlebutt about whether having had the pneumonia vaccine reduces the risk of COVID turning nasty on you? (as it might prevent a secondary infection from developing).

Hilarity N. Suze 03-25-2020 03:49 AM

Quote:

Originally Posted by Mama Zappa (Post 22209313)
...Any scuttlebutt about whether having had the pneumonia vaccine reduces the risk of COVID turning nasty on you? (as it might prevent a secondary infection from developing).

On the question of whether the pneumonia vaccine reduces the risk of COVID turning nasty, WHO says no, it doesn't. But it says that vaccination against respiratory illness is a good idea anyway. Cite (scroll down).

AK84 03-25-2020 04:12 AM

IANAD but I thought many anti biotic do have some sort of action against viruses, but that is usually coincidental and not useful clinically,.

aruvqan 03-25-2020 08:43 AM

Quote:

Originally Posted by USCDiver (Post 22206300)
Azithromycin does not do anything for viruses. That is NOT in question. There's not even a mechanism by which it might help.

It is being used in severe Covid cases due to superimposed bacterial pneumonia.

Exactly ... which is why my primary will often scrip me a zpack when I have a rhinovirus, I have a noted predisposition to roll into pneumonia when I am ill. Sucks, but at least he recognizes the uniqueness of each patient. I do wish I were my husband, he rarely has complications to basic illnesses. THough in retrospect, perhaps not - I swear he could go online and look at a picture of poison ivy and get it ... *sigh* [poor guy hates me, I am one of the rare people that is very non-allergic to it. I can handle it and get nothing.]

Dr_Paprika 03-25-2020 10:12 AM

There are many different types of known antibiotics. Every type works in a different way. Many infections cause problems using the bodyís immune system and inflammatory reactions.

In general, most antibiotics are not very helpful against virus infections. There are a few which are pretty specific for viruses - for example amantadine is used for flu. Many medications are anti-inflammatory. Some affect the immune response.

Macrolides such as Zithromax work on ribosomes. Youíll recall some of the types of RNA: ribosomal, transfer, messenger, mitochondrial. It is not unrealistic for azithromycin to interfere with viral RNA at ribosome and so have some effect. To say antibiotics are no good to treat viruses is often true but oversimplistic. Many other medicines including those for HIV and gout are also undergoing trials and being used.

AK84 03-25-2020 11:24 AM

Some of the drugs being tested.
https://www.livescience.com/coronavi...reatments.html

One or two of them has got to work damnit.
:(

Qadgop the Mercotan 03-25-2020 11:34 AM

Quote:

Originally Posted by Dr_Paprika (Post 22209737)
In general, most antibiotics are not very helpful against virus infections. There are a few which are pretty specific for viruses - for example amantadine is used for flu.

Used to be used for influenza A, anyway. Not so much anymore. And it's a dopamine agonist rather than antibiotic.
Quote:

The adamantanes: amantadine and rimantadine, are active only against influenza A viruses, but high rates of resistance have developed among influenza A viruses, and these drugs are infrequently indicated.
CF patients frequently get put on zithromax for maintenance, but it's done to reduce inflammation and not to fight bacterial infection.

asahi 03-25-2020 11:44 AM

Quote:

Originally Posted by kanicbird (Post 22206279)
It seems like Zpack is being considered as part of a cure/treatment for COVID19. That seems to obliterate the argument that antibiotics do nothing against viruses. Just that it was considered as a potential treatment seems to say a lot . If it was so sure that it does nothing, why even consider it at all? Many of us know from personal experience that they seem to help, though others say that the person would most likely have recovered the same without them. We might not know how it helps, but is this the crack in the armor against 'inappropriate' antibiotic usage?

Others have probably beaten me to it, but antibiotics do nothing to stop viruses - absolutely nothing at all. They stop the secondary effects of a virus that lead to bacterial infection, but it would be terribly unwise to take Z-pack as a prophylactic if that's what you are suggesting.

When you get a viral infection of the lungs, your lungs will produce an inflammatory response as a way to eject the virus and to give your body time to build up antibodies, and hopefully, immunity.

The problem is that this inflammatory response is fertile ground for a secondary bacterial infection. The deeper into the lungs the fluid goes, the greater the danger for a bacterial infection. It's the bacteria within the lung that antibiotics fight - your body could be producing antibodies to fight of the initial virus at the same time that your body is struggling to keep bacteria from multiplying and spreading into the bloodstream, or struggling to keep the bacteria from drowning you in your own fluids.

But it does nothing to stop the virus itself. It doesn't kill the virus. It doesn't help build antibodies. Once you've got the virus, you've got it.

Dr_Paprika 03-25-2020 12:19 PM

Amantadine was fairly useless for the flu even before local resistance, at best reducing symptoms by days. But you are right it is a dopamine agonist. I just didnít want to get into the mechanisms of all the reverse transcriptases and more complex things.

I was just hoping to make the point viruses act differently and antibiotics vary a lot from each other. So best not to throw the baby out with the bath water even if a typical antibiotic does little for a typical viral infection.

OldOlds 03-26-2020 11:41 AM

Quote:

Originally Posted by VOW (Post 22206382)
The z-pack is used in conjunction with the anti-malarial chloroquine. Whether it is a synergistic effect, or if the anti-inflammatory effect of z-mycin allows the chloroquine to attack the virus more efficiently, I doubt there have been many studies to show exactly why this combo works.


~VOW

IF it works. There are literally hundreds if not thousands of cases of exciting, novel treatments for things that turned out to be utterly useless.

My advice is that nobody get excited about something like this until there's real evidence of wide-scale success.


All times are GMT -5. The time now is 11:25 PM.

Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2020, vBulletin Solutions, Inc.

Send questions for Cecil Adams to: cecil@straightdope.com

Send comments about this website to: webmaster@straightdope.com

Terms of Use / Privacy Policy

Advertise on the Straight Dope!
(Your direct line to thousands of the smartest, hippest people on the planet, plus a few total dipsticks.)

Copyright © 2019 STM Reader, LLC.