Inmazeb and Ebanga improve survival from Zaire ebolavirus when started early, but neither is licensed for Bundibugyo. For BDBV, aggressive supportive care — IV fluids, electrolytes, treatment of co-infections — remains the backbone, with experimental antivirals deployed under research protocols.
Two monoclonal antibody therapies are approved for Ebola: Inmazeb (atoltivimab/maftivimab/odesivimab), a triple-antibody cocktail, and Ebanga (ansuvimab), a single monoclonal antibody. Both target the Zaire ebolavirus glycoprotein and were shown to reduce mortality significantly in the PALM trial during the 2018-2020 DRC outbreak. However, neither is licensed or proven effective against Bundibugyo ebolavirus.
For the current BDBV outbreak, aggressive supportive care is the primary treatment strategy. This includes intravenous fluid replacement to counter severe dehydration from vomiting and diarrhoea, electrolyte correction (particularly potassium, sodium, and bicarbonate), and management of secondary infections with broad-spectrum antibiotics.
Haemodynamic support — including vasopressors when needed — addresses the shock that develops in severe cases. Coagulopathy (disseminated intravascular coagulation) may require fresh frozen plasma or platelet transfusions. Renal replacement therapy is considered for patients with acute kidney injury, though availability in outbreak settings is often limited.
Experimental antivirals are being deployed under research protocols. Remdesivir (GS-5734), a broad-spectrum nucleotide analogue originally developed for Ebola, has shown in-vitro activity against multiple filoviruses including BDBV. Its use in the current outbreak is governed by randomised controlled trial or monitored emergency use frameworks.
Convalescent plasma from recovered BDBV patients is another investigational approach. While earlier trials against Zaire ebolavirus showed inconsistent benefit, BDBV-specific convalescent plasma with high neutralising antibody titres may offer passive immunity when administered early in illness. Collection and safety screening of donor plasma is underway in affected regions.
Nutritional support is critical and often overlooked. Patients with EVD can lose litres of fluid daily and become profoundly malnourished. Oral rehydration solution (ORS) is used when patients can tolerate it; parenteral nutrition may be required in severe cases. Maintaining caloric intake improves outcomes independently of other interventions.
Pain management and symptomatic treatment — antipyretics for fever, antiemetics for nausea, and analgesics for the severe myalgia and arthralgia typical of EVD — improve patient comfort and cooperation with care. Paracetamol is preferred; NSAIDs are generally avoided due to bleeding risk.
Post-recovery complications include uveitis, hearing loss, joint pain, and neuropsychiatric symptoms — collectively termed post-Ebola syndrome. Survivors require long-term follow-up, and male survivors must be counselled on viral persistence in semen (up to 18 months post-recovery) and offered semen testing before resuming unprotected sexual contact.
Clinical trial infrastructure is being rapidly stood up in affected areas to evaluate BDBV-specific therapeutics. Adaptive platform trials allow multiple candidates to be tested simultaneously against a shared control arm, accelerating the path to evidence-based treatment while ensuring patients receive the best available supportive care.