Evaluation of Antibacterial and Antiviral Drug Effectiveness in COVID-19 Therapy: A Data-Driven Retrospective Approach

Round 1

Reviewer 1 Report

  "I would like to congratulate the authors for nice work. However the manuscript faces several issues. Firstly, I have noticed several editing mistakes in the manuscript, therefore I think that the authors should advise a native English speaking scholar for a thorough review. Secondly, the main problem of the manuscript is that it tries to evaluate the potential treatment effectiveness of agents that have been proven no to be effective in COVID-19 management, as chloroquine, azithromycine and oseltamivir. Therefore, there is no rationale for such an assessment. I suggest the authors should advise contemporary Guidelines as the NIH, ERS and WHO Guidelines, in order to provide new information to the field.   Finally, it would be nice if the authors provide more information regarding their study design i.e. patients' inclusion criteria, time initiation and length of each therapy, purpose of choice of various endpoints and statistical analysis of their results, with emphasis on the various confounders."

Author Response

The authors would like to thank the reviewer for their comments. Please see attached for comments and response.

Author Response File: Author Response.docx

Reviewer 2 Report

Dear Authors,

Your work is important addition to the overall knowledge of the ways how the COVID-19 patients have to be treated. Here are small comments/suggestions, how the work can be improved to highlight the importance of your results.

1. If possible, could you please consult english language usage with the company that professionally edits scientific manuscripts.
2. Section 3.3 would require addition of the Table. Since, the main stress of the manuscript (based on the abstract) is effectiveness of the treatment drugs in COVID-19 patients, then this could be highlighted in specific Table.
3. Section 3.4. I find it important to make the result more visible in separate Table.
4. Discussion section reminds more the section of the results. I would suggest to discuss the results rather than to summarize them once again in the discussion part.
5. Since the manuscript gives good overview of the drugs effectiveness and outcome of their usage, i would like to suggest authors to propose guidelines for the drugs usage in the COVID-19 patients.

Thank you

Author Response

The authors would like to thank the reviewer for their comments. Please see attached for comments and response.

Author Response File: Author Response.docx

Reviewer 3 Report

In Understanding drug profile and effectiveness in COVID-19 patients: a data-driven retrospective approach, Yulia et al. discuss the effect of various pharmacological treatments on COVID-19 prognosis at 4 hospitals in Indonesia. The authors recognized the importance of this information in the current era where effective interventions for management of patients with symptomatic COVID-19 infection is scarce; however, the findings of the present study are limited in application due to sample size and would benefit from major revisions.

1. The introduction/methods should include a more detailed description of the COVID situation in Indonesia as well as specific differences between the different hospital sites. In the present state, it is not clear why other antibiotic/antiviral treatments are used more than remdesivir, an FDA approved treatment. Is this due to access/supply? The range in disease severity also seems to be highly variable between the sites. Are there differences in the patient population?
2. While a power analysis was performed to determine an appropriate overall sample size, the prevalence of specific treatment subgroups is too small to reach reliable conclusions. For example, as discussed in the manuscript, a significant treatment effect was found for tenofovir; however, there was only 1 case in which it was used.
3. Significance values should be provided for all the variables included in the significance analysis. It is currently unclear what role each variable plays unless it was mentioned within the text of the results/discussion.
4. While mentioned, there is no analysis/discussion on the effect of dexamethasone on length of stay/mortality in the analyzed patient population. This would be very interesting to include as it is one of the few treatments shown to improve outcome.
5. While length of stay is important, overall mortality is also an important end point to consider. The present discussion provides very little data on the mortality rate within each severity group as well as the effect of different treatments on mortality. This should be discussed in depth within the discussion.
6. The tables would benefit from reformatting so that each table is on one page.
7. The manuscript would benefit significantly from grammatical revision by a native English speaker.

Author Response

The authors would like to thank the reviewer for their comments. Please see attached for comments and response.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

I congratulate the authors for their nice work.

Their manuscript has been impresively improved and all amendments have been answered.

Therefore, I suggest that this work may be eligible for publication.

 

Author Response

We'd like to thank the reviewer for their help in reviewing this manuscript

Reviewer 2 Report

Dear Authors,

Thank you for providing responses to my concern. I will recommend to accept the manuscript for publishing in the journal. I would be very glad if you would add description of PCR kits, used to detect COVID-19 positive patients

 

Author Response

mBioCoV-19 RT-PCR Kit (PT Bio Farma, Indonesia) was used in this study to validate patients' COVID status. This has been added to the manuscript.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.