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The human corona virus Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-
CoV-2) has been spreading throughout numerous nations since December 2019, causing
millions of illnesses and hundreds of thousands of fatalities. COVID-19 is a virus-borne
disease that originated in Wuhan, China. The virus can easily spread in the population by
respiratory droplets, direct contact with infected individuals, or contaminated surfaces.
Because of its global and rapid spread, the World Health Organization (WHO) declared a
pandemic state on March 11, 2020, prompting some countries around the world including
Malaysia to implement specific restrictive measures namely Movement Control Orders
(MCO). This virus infected gastrointestinal and respiratory epithelial cells which might cause
gastroenteritis and respiratory infection (Facciolà et al., 2021).
To curb the spread of this epidemic, various efforts are underway especially by testing
appropriate drugs on positive patients including antibiotics. However, antibiotics are
ineffective to treat some bacterial and viral infections including COVID-19. Antibiotics are
drugs which often used to treat or prevent bacterial infection in humans and animals. It only
works by inhibit the multiplication and bacterial growth but not viruses. Antibiotics can be
administered in three different ways which are orally, topically, and injectable. There are
several classes of antibiotics which are aminoglycosides, ansamycin, carbapenem,
cephalosporin, glycopeptides, lincosamides, lipopeptide, macrolides, monobactams,
nitrofurans, oxazolidinones, penicillins, polypeptides, quinolones, sulfonamides, tetracyclines
and other antiobiotics classes. Currently, only antivirals drugs are potentially used in
treatment for COVID-19. Indeed, improving the active ingredients in an existing antiviral is
the best way to find out effective treatment for COVID-19 infection. Several studies have
been conducted and published in the literature emphasizing the effectiveness of several types
of drugs including ribavirin, penciclovir, nitazoxanide, nafamostat, chlorquine, remdesivir
(RDV, GS-5734) and favipiravir (T-705) (Saqrane et al., 2021).

Remdesivir is an adenosine nucleotide prodrug that is transformed within the cell into
the pharmacologically active nucleoside triphosphate metabolite (GS-443902). Remdesivir
triphosphate is an ATP analogue that competes with RNA-dependent RNA polymerase for
inclusion in RNA chains, causing chain termination to be delayed during viral RNA
replication. In investigations, it shows a broad spectrum of activity against CoV, filoviruses,
and paramyxoviruses, as well as Nipah virus and Hendra virus. RDV's active form has three
phosphate groups that the virus's RNA polymerase enzyme recognises.
When RDV is mixed in an RNA growth chain, the carbon-nitrogen (CN) groups in
the sugar can cause the sugar to flex, changing the form of the RNA chains. As a result, only
three more nucleotides need to be added to terminate the creation of RNA strands and block
viral replication. To generate carbon-carbon bonding, the nitrogen atom in the carbon-
nitrogen bond has been replaced with another carbon atom. Because the Corona Virus has an
unique enzyme that can recognise and eliminate artificial nucleosides, this combination is the
key to the drug's efficacy.
Adult hospitalised patients should get 200mg intravenously as a single dosage on the
first day of admission, followed by 100mg once day from the second day until the tenth day.
As pediatric patient, healthcare professional needs to adjust according to the patient weight.
Chemical structure of remdesivir

Remdesivir's mechanism of action was discovered to be the polymerase enzyme of
the coronavirus that causes MERS, which may incorporate RDV and create RNA building
blocks into new strands of RNA. Shortly after the addition of RDV, enzymes can no longer
add other RNA subunits resulting in an entry stop genome replication.
Remdesivir possible mechanism of action against the replication of coronavirus
Currently, RDV is the among the COVID-19 treatments however preclinical data on it
is quite limited. Most clinical trials conclude that there is insufficient evidence to suggest it as
a COVID-19 treatment. Any treatment should, in fact, be given as part of a randomised
controlled study. The researchers advise employing different compounds alone or in

combination in health-related emergencies. To the end, this drug has the potential to be one
of the options that present broad spectrum of activity to treat this virus.
Paxlovid is another antiviral which has potential to treat COVID-19. It is an
oral antiviral produced by Pfizer and MSD which has shown no complication on the
monoclonal antibodies given in hospital. Paxlovid is a complex product consisting of a
combination of two types of drugs namely Ritonavir and combined with Nirmatrelvir (novel
protease inhibitors PF-07321332). Both drugs work with different ways. Nirmatrelvir
prevents the virus from replicating by inhibiting the SARS-CoV-2 protein, whereas Ritonavir
inhibits the breakdown of Nirmatrelvir, allowing it to stay in the body for longer and at a
higher concentration. Paxlovid is given in the form of three tablets (two Nirmatrelvir tablets
and one Ritonavir tablet) taken orally two times daily for five days for a total of 30 tablets.
Paxlovid should not be used for more than 5 days in a row.
Impairment of taste, diarrhoea, increased blood pressure, and muscle aches are all
possible medication adverse effects when taking Paxlovid. When Paxlovid is taken at the
same time as certain other drugs, it might cause serious drug interactions. Paxlovid
administration to patients with undiagnosed or uncontrolled HIV-1 could result in HIV-1
medication resistance. Because ritonavir can harm the liver, patients with pre-existing liver
illness, abnormal liver enzymes, or liver inflammation should be given Paxlovid with caution.
Because it works in part by inhibiting a group of enzymes that break down certain
drugs, Paxlovid is contraindicated with certain drugs that are highly dependent on those
enzymes for metabolism and for which elevated concentrations of certain drugs are
associated with serious and/or life-threatening reactions. Lower Nirmatrelvir or ritonavir
concentrations have been associated to a loss of virologic response and the development of
viral resistance, hence Paxlovid is contraindicated with medications that substantially activate
those same enzymes, resulting in faster Nirmatrelvir or ritonavir breakdown. Because the
effects of these medications last after they are stopped, Paxlovid cannot be begun right away
after they have been stopped.
References:
Saqrane, S., el Mhammedi, M. A., Lahrich, S., Laghrib, F., el Bouabi, Y., Farahi, A., &
Bakasse, M. (2021). Recent knowledge in favor of remdesivir (GS-5734) as a therapeutic
option for the COVID-19 infections. In Journal of Infection and Public Health (Vol. 14,
Issue 5, pp. 655–660). Elsevier Ltd. https://doi.org/10.1016/j.jiph.2021.02.006
Chedid, M., Waked, R., Haddad, E., Chetata, N., Saliba, G., & Choucair, J. (2021).
Antibiotics in treatment of COVID-19 complications: a review of frequency, indications, and
efficacy. Journal of Infection and Public Health, 14(5), 570–576.
https://doi.org/10.1016/j.jiph.2021.02.001
Rizvi, S. G., & Ahammad, S. Z. (2022). COVID-19 and antimicrobial resistance: A cross-
study. In Science of the Total Environment (Vol. 807). Elsevier B.V.
https://doi.org/10.1016/j.scitotenv.2021.150873
Facciolà, A., Laganà, P., & Caruso, G. (2021). The COVID-19 pandemic and its implications
on the environment. In Environmental Research (Vol. 201). Academic Press Inc.
https://doi.org/10.1016/j.envres.2021.111648

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The human corona virus Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-

millions of illnesses and hundreds of thousands of fatalities. COVID-19 is a virus-borne

respiratory droplets, direct contact with infected individuals, or contaminated surfaces.

Malaysia to implement specific restrictive measures namely Movement Control Orders

gastroenteritis and respiratory infection (Facciolà et al., 2021).

appropriate drugs on positive patients including antibiotics. However, antibiotics are

several classes of antibiotics which are aminoglycosides, ansamycin, carbapenem,

cephalosporin, glycopeptides, lincosamides, lipopeptide, macrolides, monobactams,

nitrofurans, oxazolidinones, penicillins, polypeptides, quinolones, sulfonamides, tetracyclines

of drugs including ribavirin, penciclovir, nitazoxanide, nafamostat, chlorquine, remdesivir

(RDV, GS-5734) and favipiravir (T-705) (Saqrane et al., 2021).

the pharmacologically active nucleoside triphosphate metabolite (GS-443902). Remdesivir

replication. In investigations, it shows a broad spectrum of activity against CoV, filoviruses,

phosphate groups that the virus's RNA polymerase enzyme recognises.

key to the drug's efficacy.

Chemical structure of remdesivir

add other RNA subunits resulting in an entry stop genome replication.

Remdesivir possible mechanism of action against the replication of coronavirus

a COVID-19 treatment. Any treatment should, in fact, be given as part of a randomised

controlled study. The researchers advise employing different compounds alone or in

Paxlovid is another antiviral which has potential to treat COVID-19. It is an

monoclonal antibodies given in hospital. Paxlovid is a complex product consisting of a

Paxlovid should not be used for more than 5 days in a row.

administration to patients with undiagnosed or uncontrolled HIV-1 could result in HIV-1

associated with serious and/or life-threatening reactions. Lower Nirmatrelvir or ritonavir

after they have been stopped.

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