July 3, 2020

IDSA updates guidelines on treatment and management of patients with COVID-19

The Infectious Diseases Society of America (IDSA) has updated its guidelines intended to support patients, clinicians and other health-care professionals in their decisions about treatment and management of patients with COVID-19.

The updated guidelines include both revised and new recommendations.

1) Revised recommendations on corticosteroids:

  • Among hospitalized patients with severe (SpO2≤94% on room air; those who require supplemental oxygen, mechanical ventilation, or extracorporeal mechanical oxygenation [ECMO]) COVID-19, the IDSA guideline panel suggests glucocorticoids rather than no glucocorticoids. (Conditional recommendation, Moderate certainty of evidence)
    According to the panel’s recommendation, dexamethasone can be administered at 6 mg daily for up to 10 days or until discharge, if earlier, either intravenously or orally. The panel noted that an equivalent glucocorticoid dose may be substituted if dexamethasone is unavailable, adding that the equivalent total daily doses of alternative glucocorticoids to dexamethasone 6 mg daily are methylprednisolone 32 mg and prednisone 40 mg.
  • Among hospitalized patients with COVID-19 without hypoxemia requiring supplemental oxygen, the IDSA guideline panel suggests against the use of glucocorticoids. (Conditional recommendation, Low certainty of evidence)

2) New recommendations for remdesivir

  • Among hospitalized patients with severe (SpO2≤94% on room air; those who require supplemental oxygen, mechanical ventilation, or ECMO) COVID-19, the IDSA panel suggests remdesivir over no antiviral treatment. (Conditional recommendation, Moderate certainty of evidence)
    For consideration in contingency or crisis capacity settings (i.e., limited remdesivir supply): the panel noted that remdesivir appears to demonstrate the most benefit in those with severe COVID-19 on supplemental oxygen rather than in patients on mechanical ventilation or ECMO.
  • Among patients with severe COVID-19 on supplemental oxygen but not on mechanical ventilation or ECMO, the IDSA panel suggests treatment with five days of remdesivir rather than 10 days of remdesivir. (Conditional recommendation, low certainty of evidence). The panel noted, however, that the duration of treatment is 10 days for patients on mechanical ventilation or ECMO.

3) New recommendations for famotidine

  • Among hospitalized patients with severe COVID-19, the IDSA panel suggests against famotidine use for the sole purpose of treating COVID-19 outside of the context of a clinical trial. (Conditional recommendation, very low certainty of evidence)
SOURCE: Infectious Diseases Society of America
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