INTRODUCTION:Coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swept rapidly throughout the world. So far, no therapeutics have yet proven to be effective. Ribavirin was recommended for the treatment of COVID-19 in China because of its in vitro activity. However, evidence supporting its clinical use with good efficacy is still lacking. METHODS:A total of 208 confirmed severe COVID-19 patients who were hospitalized in Wuhan Union West Campus between 1 February 2020 and 10 March 2020 were enrolled in the retrospective study. Patients were divided into two groups based on the use of ribavirin. The primary endpoint was the time to clinical improvement. The secondary endpoints included mortality, survival time, time to throat swab SARS-CoV-2 nucleic acid negative conversion, and the length of hospital stay. RESULTS:68 patients were treated with ribavirin while 140 not. There were no significant between-group differences in demographic characteristics, baseline laboratory test results, treatment, and distribution of ordinal scale scores at enrollment, except for coexisting diseases especially cancer (ribavirin group vs no ribavirin group, P = 0.01). Treatment with ribavirin was not associated with a difference in the time to clinical improvement (P = 0.48, HR = 0.88, 95% CI = 0.63-1.25). There were also no significant differences between-group in SARS-CoV-2 nucleic acid negative conversion, mortality, survival time, and the length of hospital stay. CONCLUSIONS:In hospitalized adult patients with severe COVID-19, no significant benefit was observed with ribavirin treatment.

目的:基于帕累托图分析静脉用药调配中心(PIVAS)不合理医嘱,为医嘱审核以及临床合理化用药提供参考.方法:审方药师对本院住院部2019年1月～12月静脉用药长期医嘱进行前置审核,对审核不合理医嘱的科室和类型进行帕累托图分析,发掘不合理用药的主次要因素,阐明医嘱不合理原因.结果:共审核长期医嘱371799组,发现不合理医嘱1145组(0.31％),干预成功的不合理医嘱有905组,干预成功率为79.0％.在不合理医嘱科室中,泌尿外科、胃肠外科、骨科等为主要因素(占79.4％).在不合理医嘱类型中,溶剂不合理(35.0％)和用法用量不合理(25.7％)为主要因素;频次不合理(21.4％)为次要因素;配伍禁忌(11.8％)和联用不合理(3.4％)等为一般因素.结论:利用帕累托图可精准掌握不合理用药医嘱中的主次要因素,便于审方药师针对性干预,保障临床合理用药.

Background: Coronavirus disease-2019 (COVID-19) spreads rapidly throughout the world. So far, no therapeutics have yet been proven to be effective. Ribavirin was recommended for the treatment of COVID-19 because of its in vitro activity. However, evidence supporting its clinical use with good efficacy is still lacking. Methods: A total of 208 confirmed severe or critical COVID-19 patients who were hospitalized in Wuhan Union West Campus between 1 February 2020 and 10 March 2020 were enrolled in the retrospective study. Patients were divided into two groups based on the use of ribavirin. The primary endpoint was the time to clinical improvement. The secondary endpoints included mortality, survival time, time to throat swab SARS-CoV-2 nucleic acid negative conversion, and hospital duration. Results: 68 patients were treated with ribavirin while 140 not. There were no significant between-group differences in demographic characteristics, baseline laboratory test results, treatment, and distribution of ordinal scale scores at enrollment, except coexisting diseases especially cancer (ribavirin group vs no ribavirin group, P = 0.014). Treatment with ribavirin was not associated with a difference in the time to clinical improvement ( P = 0.483, HR = 0.884, 95% CI = 0.627-1.247). There were also no significant differences between-group in the number of patients with SARS-CoV-2 nucleic acid negative conversion, mortality, survival time, and hospital duration. Conclusion: In hospitalized adult patients with severe or critical COVID-19, no significant benefit was observed with ribavirin treatment.

Objective:To establish an FPLC-MS/MS method for the determination of fluvoxamine in human plasma. Methods:The separation was performed on an Inertsil? ODS-SP column(2. 1 × 100 mm, 3 μm). The mobile phase was acetonitrile-2 mmol· L-1 ammonium acetate (45: 55, v/v) containing 0. 1% formic acid at a flow rate of 0. 3 ml·min-1 . Lansoprazole was used as the internal standard( IS) . Electrospray ionization ( ESI) source was applied and operated in a positive ion model. Multiple reaction moni-toring (MRM) model with the transitions of fluvoxamine m/z 319. 1→m/z 69. 8 and lansoprazole m/z 370. 2→m/z 252. 1 was used to quantify fluvoxamine and IS, respectively. Results:In human plasma, the standard curve was linear within the range of 1-100 μg· L-1 . The lower limit of quantification of fluvoxamine( LLOQ) was 1μg·L-1 . The intra-day RSD was less than 5%, the inter-day RSD was less than 10%, and the method recovery was 85%-95%. Conclusion:The method is simple, sensitive, accurate and reproduci-ble. It is applicable in the pharmacokinetic study of fluvoxamine for clinical pharmacokinetics and bioequivalence studies.