Since there are limited treatment options for Ebola virus, the patient was given experimental drugs to fight the disease, and supportive care to alleviate the numerous symptoms as recommended by WHO.
Recommended treatment
So far two drugs are being recommended by WHO (WHO,2024):
- mAb114 (Ansuvimab; Ebanga): a single human monoclonal antibody derived from an Ebola survivor.
- REGN-EB3 (Inmazeb): a co-formulated mixture of three IgG1 monoclonal antibodies
There is also a recommendation on therapeutics that should not be used to treat patients: these include ZMapp and remdesivir especially for patients with RT-PCR confirmed EHF.
However, all these recommendations only apply to Ebola virus disease caused by Ebola virus (EBOV; Zaire ebolavirus).
Adjunct therapies
Supportive care and treatment of complications are the cornerstones of the treatment of EBOV. This includes maintaining hydration, blood pressure monitoring, and nutritional support as well as symptomatic relief.
Treatment of hypovolaemia from dehydration/volume loss
Glucose 13.5 g/l, sodium chloride 2.6 g/l, potassium chloride 1.5 g/l, trisodium citrate dihydrate 2.9 g/l, (total osmolarity of 245 mOsm/l) or alternate between IV 0.9% saline and Ringer’s lactate in case the patient is not able to drink.
Fluid management in sepsis and shock algorithm
Isotonic crystalloid fluid for fluid resuscitation; 0.9% saline or Ringer’s lactate (RL) solution. Bolus with 500 ml up to 30 ml/kg or until normalization of signs of perfusion. If shock persists, despite fluid loading, vasopressors were used to maintain perfusion. In this case noradrenaline is the first-line vasopressor for shock
Fever
Paracetamol: 1 g paracetamol PO/IV every 6–8 hours. Maximum dose 4 g every 24 hours.
Pain control
Mild pain – paracetamol: 1 g PO/IV every 6–8 hours as needed, maximum dose 4 g every 24 hours. Severe pain – tramadol: 50–100 mg PO/IV every 4–6 hours as needed, daily maximum 400 mg/day. Non-steroidal anti-inflammatory drugs (including aspirin) should be avoided because of the associated increased risk of bleeding and potential for nephrotoxicity.
Haemorrhage
Transfusion if active bleeding and haemodynamic instability or Hb < 7 g/dl. Transfuse with red blood cells to target Hb > 7g/dl, fresh plasma to target international normalized ratio < 1.5, and platelets to target > 50.
High dose proton pump inhibitor for GI bleed: pantoprazole 80 mg IV over 60 minutes then 8 mg/hour for 72 hours as continuous infusion or 40 mg
Hypoxic respiratory failure
Face mask with reservoir bag was used. It was titrated to the lowest flow rate necessary to reach target SpO2 > 94%.
Treatment of potential co-infections
Co-infection with malaria: artesunate-amodiaquine (10) or pyronaridine-artesunate
Bacterial co-infection: Severe disease (IV ceftriaxone 2 g once daily 5 days +/- IV metronidazole 500 mg three times/day (usually 7 days). Mild disease (PO cefixime 200 mg twice daily for 5 days).
