From "anti-infection" to "anti-severe disease" The exchange meeting on treatment plans for elderly patients with severe disease infected with new crown infection was held, and new combination therapies were launched

At present, the prevention and control of the new crown virus epidemic has entered a new stage, and the focus of work has gradually shifted from "preventing infection" to "maintaining health and preventing severe disease"
.
At present, the Omicron strain circulating in China, although the virulence of the strain has been reduced, but the elderly infected people often have some underlying diseases, and the new coronavirus infection will also aggravate the underlying diseases, and the elderly account for a relatively high
proportion of severe infections.

In this context, the Expert Exchange Meeting on the treatment plan for elderly patients infected with new crown infection, hosted by the China Foundation for the Development of the Ageing, supported by Shenyang Tonglian Group as a public welfare, and supported by the media of People's Daily "Minsheng Weekly" and "Doctor Daily", was held online and offline simultaneously on January 13, with a total of 261,000 views
on each platform

The meeting was chaired by Qin Dongrui, Deputy Secretary-General of the China Foundation for the Development of the Ageing and Secretary-General of the Expert Committee
.

From "infection prevention" to "severe disease prevention"

The convening of this meeting is of great practical significance

As the chairman of this meeting, Professor Zhu Shijun, vice chairman of the Expert Committee of the China Foundation for the Development of the Ageing and General Hospital of the People's Liberation Army, said in his speech that since early December 2022, many cities in China have seen a peak of infection with the new crown Omicron strain, posing a major threat
to the life safety and health of the people.
Especially for the elderly over 65 years old with underlying diseases, it brings a higher risk
of progression to severe and critical disease.

With the implementation of Class B and B pipes for new coronavirus infection in China, China's new coronavirus epidemic prevention and control work has also entered a new stage, and the focus of epidemic prevention and control work is also shifting from "infection prevention" to "health and severe disease prevention"
.
Therefore, it is of great significance to go all out to do a good job in medical treatment, do everything possible to do a good job in clinical diagnosis and treatment of critically ill patients, and improve the level of clinical treatment of
critically ill patients.

Zhang Yanping, executive president and executive editor-in-chief of "Doctor Daily", said that China is rapidly entering an aging society, and "the elderly have dependence, the elderly have support" is not just an empty phrase
.
In the three years of the new crown epidemic, the most affected by the epidemic is the elderly, as a witness and recorder, practitioner and promoter of the industry, "Doctor Daily" has also maintained long-term attention
to elderly health care, geriatric related discipline construction, etc.
Under the situation of increasing elderly patients and critically ill patients, it is expected that this conference can propose new diagnosis and treatment ideas
for severely ill patients infected with the new coronavirus in the elderly.

R&D and application of original anti-new crown drugs

Cocktail therapy brings "double insurance" to antiviral diagnosis and treatment

Since the outbreak of the new crown epidemic, the research and development and exploration of anti-new crown drugs has become one of the hot topics in the world, and in this process, drugs such as remdesifer, monupiravir, and ritonavir have attracted a lot of public attention
.
With the gradual accumulation of clinical experience, they have gradually exposed their shortcomings in the process of new crown diagnosis and treatment
.

In recent years, China's new drug research and development has developed rapidly
.
Krithromycin is the first genetic engineering innovative drug with clinical application value independently developed by synthetic biology technology in China, after the outbreak of the new crown pneumonia epidemic in 2020, the results of clinical trials on whether clithromycin is for the treatment of new crown pneumonia show that clinomycin has extremely strong antiviral activity
against the new crown pneumonia virus.
Also thanks to its good anti-new crown pneumonia treatment effect, Cremycin was selected into the list
of "three drugs and three solutions" for the diagnosis and treatment of new coronary pneumonia in China.
Academician Jiang Jiandong of the Chinese Academy of Medical Sciences introduced that compared with another domestic original product Azvudine, the antiviral mechanism of clomycin is not the same
.

"For the treatment of the new crown, the Chinese Academy of Medical Sciences proposed a A + B scheme, that is, a combination of azvudine + clomycin, which can be double-insurance; Colimycin is an approved drug for marketing, mainly used to treat bacteria, chlamydia, mycoplasma and other infections
.
Academician Jiang Jiandong explained
.

Regulates immunity and suppresses inflammatory storms

DAIA features the importance of severe disease in the middle and late stages of new crown infection

Professor Zhang Jiancheng of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, analyzed the clinical significance and value
of clinomycin in the diagnosis and treatment of severe disease in the middle and late stages of new crown infection based on his personal clinical practice experience.

Professor Zhang Jiancheng introduced that in general, in patients with severe new crown infection whose disease progresses to the middle and late stages, immune imbalance and cytoinflammatory factor storm are important causes of injury and death, and the two affect each other and show a negative correlation
.
"The higher the inflammatory factor and the more obvious the immunosuppression, the greater the possibility of secondary infection in the later stage, and the more obvious the damage caused by infection.
.
.
"

As a class 1.
1 antibacterial new drug, clinomycin has a significant effect on overactivating a number of inflammatory factors that are easy to cause tissue damage, and can increase the number and function of immune cells to regulate immunity, which is consistent
with the disease process such as elevated inflammatory factors and decreased T cells in severe patients in the middle and late stages of new crown infection.
In addition, colithromycin also has high lipophilicity, fast oral absorption, strong tissue permeability, especially for the lungs, millimycin targeted lung infections or other site infections, has a better therapeutic effect
.

ARDS caused by the new coronavirus infection is an important cause of death

Respiratory therapy strategies should be moved forward

Since the implementation of the "Class B tube" on January 8, the treatment of patients infected with the new coronavirus, especially severe and critically ill patients, has become the focus
of medical staff at this stage.
Professor Chen Minying of the First Affiliated Hospital of Sun Yat-sen University introduced that ARDS caused by new coronavirus infection is an important fatal factor for people infected with new coronavirus infection, especially the
elderly.

The definition of ARDS in previous clinics can be divided into the following points: (1) there is a clear cause, new onset, or onset within one week after the pre-existing disease is triggered; (2) Chest x-ray or CT showed bilateral lung infiltrates; (3) respiratory failure cannot be fully explained by heart failure and fluid overload; (4) Hypoxemia
.

However, the pathological characteristics of ARDS caused by the new crown are different: (1) the onset time is late, 1~2 weeks later; (2) "Silent type" hypoxemia; (3) Hypercarbonemia is obvious; (4) Pulmonary coagulation is highly activated; (5) Lung CT performance: ground-glass opacity, mainly interstitial edema, not alveolar edema, lung parenchyma is not serious
.

Professor Chen Minying introduced that the respiratory treatment strategy for patients infected with the new crown needs to be gradual, but due to the particularity of the disease itself, the overall treatment strategy shows that the threshold is moved forward, not limited to a specific process, but will shorten the time for patients to correct hypoxia as the ultimate goal
.
"Of course, we can see that the current evidence-based evidence shows that immunotherapy is beneficial to improve the clinical outcomes of patients, and clitromycin as a product that also has immunomodulatory effects, and we are also looking forward to
its future development.
" ”

Hot Discussions

Professor Wang Ning of Xuanwu Hospital of Capital Medical University introduced that clinical diagnosis and treatment of new crown infected patients, especially severe or critically ill patients
.
Antiviral therapy, ventilator support, and oxygen therapy are the main ones
.
From a clinical point of view, the people with severe and critical diseases in the new crown infection are very old and have a variety of diseases, which brings a variety of challenges
to diagnosis and treatment.
In this process, it has also been found that the use of antivirals alone cannot solve problems related to immune function, in which case the use of cocktail therapy may be one of
the solutions to this problem.

Professor Qu Hongping of Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine said that clinomycin has been confirmed to have definite efficacy in two indications of anti-infection and treatment of new coronary pneumonia, and it has dual efficacy on drug-resistant bacteria and new coronavirus infection, and has both immunomodulatory effects.

Professor Xue Xiaoyan of Aerospace Center Hospital also shared his experience in treating critically ill patients in the Department of Intensive Care Medicine: today's antiviral drugs are causal treatment, each has its own advantages and disadvantages in specific applications, and colithromycin can enhance immune regulation and promote lymphocyte recovery while anti-virus, making the clinical drug full of expectations
.
Secondly, clinical attention should also be paid to
the treatment of inflammatory storms and organ protection in severe patients.

Professor Yang Jiankun of Fuxing Hospital Affiliated to Capital Medical University introduced that the use of antiviral drugs in the early stage of new crown diagnosis and treatment can significantly reduce viral load, which is of great significance for disease control; In addition, if the early inflammatory response caused by new coronavirus infection is not controlled in time, it may bring difficulties to subsequent treatment, and early application of glucocorticoids and tocilizumab is particularly necessary
.
In terms of promoting human immune reconstitution, clinical trial data of clothromycin show that it can significantly reduce interleukin 6, interleukin 1, interleukin 2, interleukin 12, restore CD3, CD4+, CD8+, and meet the diagnosis and treatment needs of patients with severe new crown disease
.
In the future, it is expected that the relevant research of clitinomycin will be further improved, and its specific intervention timing, treatment cycle and other related contents will be clarified, so as to help the diagnosis and treatment
of patients with severe new crown infection.

Professor Chang Zhigang of Beijing Hospital said that since the outbreak of the new crown epidemic in 2020, the importance
of immune regulation has been emphasized.
The problem of immune regulation in the elderly is prominent, the virus clears zero, turns to negative slowly, and lymphocytes rise slowly, and the role of corithromycin in immunoregulation has brought new clinical expectations
.

Professor Sun Bing of Beijing Chaoyang Hospital affiliated to Capital Medical University said that clinomycin has a dual role, which can not only directly block pathogen protein synthesis, directly inhibit and kill pathogens, but also indirectly remove pathogenic microorganisms by mobilizing host immune function, bringing new hope
to the clinic.

Typesetting: Wang Lu

Editor: Wang Lu

Review: Qiu Jia

The power to move the industry forward! The 8th Annual Meeting of Physicians 2023 is here!

2023 "Doctor Daily" hot subscription!!! Millions of doctors are watching.
.
.

"Physician Daily" submission public mailbox: yishibao2017@163.
com

【Note】Some pictures come from the Internet and WeChat moments, if there is infringement, please contact to delete, thank you! Phone: 010-58302828-6808

At present, 1130000+ doctors have followed and joined us