Guidelines for the pharmacological treatment of COVID-19. The task force/consensus guideline of the Brazilian Association of Intensive Care Medicine, the Brazilian Society of Infectious Diseases and the Brazilian Society of Pulmonology and Tisiology

Abstract

Introduction Different therapies are currently used, considered, or proposed for the treatment of COVID-19; for many of those therapies, no appropriate assessment of effectiveness and safety was performed. This document aims to provide scientifically available evidence-based information in a transparent interpretation, to subsidize decisions related to the pharmacological therapy of COVID-19 in Brazil. Methods A group of 27 experts and methodologists integrated a task-force formed by professionals from the Brazilian Association of Intensive Care Medicine ( Associação de Medicina Intensiva Brasileira - AMIB), the Brazilian Society of Infectious Diseases ( Sociedad Brasileira de Infectologia - SBI) and the Brazilian Society of Pulmonology and Tisiology ( Sociedade Brasileira de Pneumologia e Tisiologia - SBPT). Rapid systematic reviews, updated on April 28, 2020, were conducted. The assessment of the quality of evidence and the development of recommendations followed the GRADE system. The recommendations were written on May 5, 8, and 13, 2020. Results Eleven recommendations were issued based on low or very-low level evidence. We do not recommend the routine use of hydroxychloroquine, chloroquine, azithromycin, lopinavir/ritonavir, corticosteroids, or tocilizumab for the treatment of COVID-19. Prophylactic heparin should be used in hospitalized patients, however, no anticoagulation should be provided for patients without a specific clinical indication. Antibiotics and oseltamivir should only be considered for patients with suspected bacterial or influenza coinfection, respectively. Conclusion So far no pharmacological intervention was proven effective and safe to warrant its use in the routine treatment of COVID-19 patients; therefore such patients should ideally be treated in the context of clinical trials. The recommendations herein provided will be revised continuously aiming to capture newly generated evidence.

Pharmacologic Thromboprophylaxis and Thrombosis in Hospitalized Patients with COVID-19: A Pooled Analysis

“… 12 13 14 15 16 17 18 Current national and international guidelines recommend universal pharmacologic thromboprophylaxis with subcutaneous low-molecular-weight heparin (LMWH) or unfractionated heparin in hospitalized patients. 12 13 15 16 19 20 21 22 23 24 25 Institutional practices have varied based on individual and collective experience and range from standard prophylactic doses to full therapeutic anticoagulation strategies in select populations. 26 27 Although randomized controlled studies evaluating different anticoagulation strategies are at various stages of development, there is no current consensus on best practices regarding the use of anticoagulation in this population to prevent thrombosis given the lack of high-quality prospective data.…”

All-cause mortality among patients treated with repurposed antivirals and antibiotics for COVID-19 in Mexico City: A real-world observational study

“…Most trials on the World Health Organization (WHO) platform were for lopinavir/ritonavir (156), favipiravir (62), remdesivir (52), oseltamivir (19), and ribavirin (16) (WHO, 2020[ 39 ]). Other common antivirals are not tested for COVID-19, but may be widely used in the general population and in hospitals, as most antivirals are not recommended in practice guidelines due to lack of evidence (Bhimraj et al, 2020[ 4 ]; NIH, 2020[ 27 ]), others advise against most (Mexican Secretariat of Health, 2020[ 24 ]; WHO, 2020[ 38 ]), or recommend oseltamivir empirically during the influenza season (Mexican Secretariat of Health, 2020[ 23 ]) and when coinfection exists (Falavigna et al, 2020[ 8 ]).…”

Preparedness of pharmacists to respond to the emergency of the COVID-19 pandemic in Brazil: a comprehensive overview

“…Whilst waiting the results of ongoing clinical trials, experimental treatments are being used worldwide. [38]. Off-label drugs currently used in Brazil include hydroxychloroquine (chloroquine) solely or in combination with azithromycin, lopinavir/ritonavir/oseltamivir, tocilizumab, glucocorticoids and parenteral anticoagulation.…”

“…Various protocols have been proposed by different committees and institutions in Brazil. On 18 May, a consensus of the Brazilian Association of Intensive Medicine, Brazilian Society of Infectology and Brazilian Society of Pneumology and Tisiology was published as a reference for the pharmacological treatment of COVID-19 [ 38 ]. Off-label drugs currently used in Brazil include hydroxychloroquine (chloroquine) solely or in combination with azithromycin, lopinavir/ritonavir/oseltamivir, tocilizumab, glucocorticoids and parenteral anticoagulation.…”