London 17 August : A lack of high-quality current guidance for treating monkeypox in the clinic could hinder safe and effective treatment of the virus across the globe in a study conducted by an international group of researchers.The existing guidance, as it is often isn’t clear enough and does not include diverse categories, and often is inconsistent according to researchers from the universities of Oxford in the UK, Bristol in Australia as well as the Liverpool School of Tropical Medicine as well as others.
They stated that “the absence of clear guidelines creates uncertainty for healthcare professionals treating patients with [monkeypox] that could affect patient treatment.”
The “study suggests the need for a robust framework for establishing guidelines ahead of outbreaks and also a recognized platform for quickly reviewing and revising guidance during outbreaks, as evidence is revealed.”
“Human moneypox is posing challenges even in environments with high resources with well-funded healthcare systems.The absence of guidelines can be particularly detrimental to clinics with no prior knowledge in treating patients with monkeypox,” the researchers wrote in the paper that was published in the journal that is open to access BMJ Global Health.
The team scoured six major research databases to find relevant content that had been published prior to mid-October 2021, and also the “gray literature” which includes newsletters, policy documents reports, etc which were published until May 2022 in various languages.
They identified 14 guidelines that were relevant.
The majority of them were of poor quality as per the Appraisal of Guidelines for Research and Evaluation II (AGREE) system, which scores on an average of two out of seven.Most were not detailed and only covered a limited range of subjects.
There was not much advice for the different risk categories Only five (36 percent) offered any advice for children, and only three (21 percent) offered guidance to pregnant women or for those who live with HIV.
Treatment guidelines were mostly limited to antivirals.It was not consistent Seven guidelines recommended Cidofovir, with four of which specifically recommended this for serious infections; four (29 percent) advised tecovirimat and one (seven percent) brincidofovir.
Recent guidance, including from the World Health Organization, recommends the use of the tecovirimat over cidofovir.
While both cidofovir as well as brincidofovir have been shown to be in fighting pox virus in lab studies however, there is not much information on their effectiveness in treating pox virus in people, in addition to that they are only approved to be used in certain countries, according to the researchers.
There was no indication of the guidelines detailed the optimal dosage, timing, or duration of treatment.
Only one guideline offered guidelines on support care and the treatment of complications.
All 14 guidelines advised vaccination as post-exposure prophylaxis (PEP) However, they were not all of them were up-to-date with the most recent generation of vaccines.
Also, PEP guidelines for various risk groups was sporadic and sometimes inconsistent.
The scientists acknowledged that their understanding of the monkeypox virus not fully developed and this could be the reason for some of the differences in the recommendations they came across.
However “even with a limited evidence basis, clinical management guidelines can be useful in guiding decisions and reducing the risk of incorrect treatments.”
In light of the recent worldwide publicity about monkeypox, this is an ideal time to draw interest and invest in further research to ensure that everyone gets the best treatment, they stated.
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