The Beneficial Effects of Oral Trimethoprim or Cotrimoxazole in Patients with Severe COVID-19: A Case Series

COVID-19 may become a critical illness which is thought to be mediated by a cytokine storm syndrome. There is no effective anti-viral treatment to date and the mainstay of treatment is supportive. We treated 22 patients with severe COVID-19 with oral trimethoprim (TMP) or cotrimoxazole (CTX) in addition to standard antibiotic therapy (ST) and compared this with 22 patients with severe COVID-19 receiving standard therapy alone. We observed that the patients with severe COVID-19 receiving TMP/CTX in addition to ST had significantly better outcomes including reduced in-patient mortality (5% versus 32%), length of hospital stay (mean, 9 versus 22 days), and the need for ventilatory support (numbers, 3 versus 16) with improved clinical parameters within 48 hours of starting treatment. This may be due to the anti-cytokine effects of TMP/CTX. Urgent clinical trials are recommended.