Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients With COVID-19 (April 2020)

Abstract

Background: There are many pharmacologic therapies that are being used or considered for treatment of COVID-19. There is a need for frequently updated practice guidelines on their use, based on critical evaluation of rapidly emerging literature. Objective: Develop evidence-based rapid guidelines intended to support patients, clinicians and other health-care professionals in their decisions about treatment and management of patients with COVID-19. Methods: IDSA formed a multidisciplinary guideline panel of infectious disease clinicians, pharmacists, and methodologists with varied areas of expertise. Process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. Results: The IDSA guideline panel agreed on 7 treatment recommendations and provided narrative summaries of other treatments undergoing evaluations. Conclusions:The panel expressed the overarching goal that patients be recruited into ongoing trials, which would provide much needed evidence on the efficacy and safety of various therapies for COVID-19, given that we could not make a determination whether the benefits outweigh harms for most treatments.

Myth Busters: Dietary Supplements and COVID-19

“…65 Current guidelines for the treatment of COVID-19 do not comment on dietary supplements and, currently, do not recommend any pharmacological interventions widely with the exception of use through clinical trials. [66][67][68] Pharmacists have the responsibility to ensure that patients have accurate information regarding the current lack of data supporting efficacy of these supplements in COVID-19. On the other hand, patients may choose to self-treat with these supplements because they are easily accessible and may provide a sense of security.…”

Treatment of patients with nonsevere and severe coronavirus disease 2019: an evidence-based guideline

“…However, misleading statements about and advocacy for use of medications for which we were unable to find robust evidence of benefit at this time present the major barriers to this guideline's implementation. Table 1 summarizes the recommendations addressing corticosteroids, convalescent plasma and antiviral drugs from 5 guidelines on COVID-19, from the Infectious Diseases Society of America (IDSA), 51 Surviving Sepsis Campaign (SSC), 52 WHO, 8 Australian and New Zealand Intensive Care Society (ANZICS) 53 and UK National Institute for Health and Care Excellence (NICE). 54 With respect to corticosteroids and ARDS, IDSA recommends use only in the clinical trial context; SSC suggests in favour; and WHO, ANZICS and NICE all recommend against.…”

Antivirals for COVID-19

“…11 Overall, based on the lack of supportive data for its use in COVID-19, its adverse effect profi le and signifi cant drug interactions, lopinavir/ritonavir for COVID-19 should be reserved for use only in the context of a clinical trial. 12 on June 9, 2020. For personal use only.…”

“…14 Furthermore, 1 of 3 randomized, open label clinical trials evaluating darunavir/cobicistat for COVID-19 recently concluded that the agent was not effective at achieving viral clearance at day 7 post-randomization compared with standard care. 12 The neuraminidase inhibitor antiviral oseltamivir was used empirically in several patients during the COVID-19 outbreak in China due to the overlap with peak infl uenza season. However, oseltamivir has no documented in vitro activity against SARS-CoV-2 and is not expected to play a role in the management of COVID-19.…”