Saving lives without new drugs

SCIENCE        By Jon Cohen                                                                                         Nov. 21, 2014

...Just a handful of basic interventions to fight the killer effects of Ebola, including dehydration and secondary infections, could dramatically lower the CFR there, says Michael Callahan, an infectious disease specialist at Massachusetts General Hospital in Boston..

With so much room for improvement in supportive care, the current international focus on drugs is “misguided,” says Callahan, who has recently worked in Monrovia and provided care in four previous Ebola outbreaks. “While we wait for months for forthcoming experimental therapies, many lives can be saved, certainly hundreds and possibly thousands, using inexpensive and simple therapies,” he says.

Callahan is helping an international team develop guidelines dubbed Maximum Use of Supportive Therapy (MUST), aimed at keeping more patients alive. It includes intravenous (IV) drips to replace massive fluid loss from diarrhea and vomiting, a risk factor for shock; balancing of electrolytes such as calcium or potassium, which prevents kidney and heart failure; nasogastric tubes for feeding; and testing and treatment of secondary infections such as malaria. Introducing MUST will also make it easier to study new treatments, Callahan says...

It's an important proposal, but Ebola clinics will need more resources to offer MUST, says John Fankhauser, an American clinician who has worked at the ELWA hospital in Monrovia since before the outbreak surfaced.

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http://www.sciencemag.org/content/346/6212/911.full?intcmp=collection-ebola