Experts say guidelines for treatment of Ebola patients are urgently needed

As the Ebola virus disease (EVD) epidemic continues to rage in West Africa, infectious disease experts are calling attention to the lack of treatment guidelines for the disease. With more than 16,000 total cases and more than 500 new infections still being reported in Africa per week, and probable underreporting of both cases and fatalities, the medical community still does not have a specific approved treatment in place for Ebola, according to an editorial published in theInternational Journal of Infectious Diseases.

Not only are treatment guidelines lacking, but there are conflicting reports of mortality rates and few descriptions of actual treatments being used. What is clear is that the treatments in industrialized nations with well-developed public health systems differ significantly from those in less-developed nations, especially those with histories of civil wars and little health infrastructure. The few data available indicate that simple fluid replacement and correction of electrolyte imbalances will significantly reduce mortality.

According to authors Eskild Petersen, MD, and Boubacar Maiga, MD, PhD, “Very little data has emerged. One published study reported a mortality of 72%, but the study contained no information on any treatment. Thus the question remains whether the patients included in that study received any treatment at all.”

Petersen and Maiga explain that management of the epidemic has fallen primarily to non-governmental organizations, which have not published any treatment result data and have been simply reporting confirmed cases and outcomes. Without data about the success or failure of specific treatments, treatment may only be palliation, and “Ebola hospitals” may be no more than hospices intended to isolate cases from the community.

The authors suggest that the World Health Organization develop guidelines for treatment, including:

• diagnosis of EVD
• principles for intravenous fluid replacement
• principles for measurement and correction of electrolyte imbalance
• diagnosis and treatment of concomitant malaria
• guidelines for administration of antibiotics based on suspicion of septicemia
• HIV testing
• implementation of a reporting system for all EVD treatment facilities with weekly survival figure updates reported for each NGO to ensure quality control, transparency, and optimization of treatment algorithms.