Pragmatic Recommendations for Therapeutics of Hospitalized COVID-19 Patients in Low- and Middle-Income Countries.
Identifieur interne : 000578 ( Main/Corpus ); précédent : 000577; suivant : 000579Pragmatic Recommendations for Therapeutics of Hospitalized COVID-19 Patients in Low- and Middle-Income Countries.
Auteurs : Varun U. Shetty ; Brian Jason Brotherton ; Andrew Achilleos ; Kevan M. Akrami ; Lia M. Barros ; William Checkley ; Natalie Cobb ; Stephanie Maximous ; David Misango ; Casey Park ; Shaurya Taran ; Burton W. Lee ; For The Covid-Lmic Task Force And The Mahidol-Oxford Research Unit Moru Bangkok ThailandSource :
- The American journal of tropical medicine and hygiene [ 1476-1645 ] ; 2020.
Abstract
The therapeutic options for COVID-19 patients are currently limited, but numerous randomized controlled trials are being completed, and many are on the way. For COVID-19 patients in low- and middle-income countries (LMICs), we recommend against using remdesivir outside of a clinical trial. We recommend against using hydroxychloroquine ± azithromycin or lopinavir-ritonavir. We suggest empiric antimicrobial treatment for likely coinfecting pathogens if an alternative infectious cause is likely. We suggest close monitoring without additional empiric antimicrobials if there are no clinical or laboratory signs of other infections. We recommend using oral or intravenous low-dose dexamethasone in adults with COVID-19 disease who require oxygen or mechanical ventilation. We recommend against using dexamethasone in patients with COVID-19 who do not require supplemental oxygen. We recommend using alternate equivalent doses of steroids in the event that dexamethasone is unavailable. We also recommend using low-dose corticosteroids in patients with refractory shock requiring vasopressor support. We recommend against the use of convalescent plasma and interleukin-6 inhibitors, such as tocilizumab, for the treatment of COVID-19 in LMICs outside of clinical trials.
DOI: 10.4269/ajtmh.20-1106
PubMed: 33377451
PubMed Central: PMC7957231
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Shetty</name><affiliation><nlm:affiliation>Critical Care Medicine Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.</nlm:affiliation></affiliation></author><author><name sortKey="Brotherton, Brian Jason" sort="Brotherton, Brian Jason" uniqKey="Brotherton B" first="Brian Jason" last="Brotherton">Brian Jason Brotherton</name><affiliation><nlm:affiliation>Department of Internal Medicine, Kijabe Medical Center, Kijabe, Kenya.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Critical Care Medicine Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.</nlm:affiliation></affiliation></author><author><name sortKey="Achilleos, Andrew" sort="Achilleos, Andrew" uniqKey="Achilleos A" first="Andrew" last="Achilleos">Andrew Achilleos</name><affiliation><nlm:affiliation>Department of Critical Care, Sunnybrook Health Sciences Center, Toronto, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Akrami, Kevan M" sort="Akrami, Kevan M" uniqKey="Akrami K" first="Kevan M" last="Akrami">Kevan M. 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Barros</name><affiliation><nlm:affiliation>Department of Cardiology, University of Washington Medical Center, Seattle, Washington.</nlm:affiliation></affiliation></author><author><name sortKey="Checkley, William" sort="Checkley, William" uniqKey="Checkley W" first="William" last="Checkley">William Checkley</name><affiliation><nlm:affiliation>Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland.</nlm:affiliation></affiliation></author><author><name sortKey="Cobb, Natalie" sort="Cobb, Natalie" uniqKey="Cobb N" first="Natalie" last="Cobb">Natalie Cobb</name><affiliation><nlm:affiliation>Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington Medical Center, Seattle, Washington.</nlm:affiliation></affiliation></author><author><name sortKey="Maximous, Stephanie" sort="Maximous, Stephanie" uniqKey="Maximous S" first="Stephanie" last="Maximous">Stephanie Maximous</name><affiliation><nlm:affiliation>Division of Pulmonary Allergy Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.</nlm:affiliation></affiliation></author><author><name sortKey="Misango, David" sort="Misango, David" uniqKey="Misango D" first="David" last="Misango">David Misango</name><affiliation><nlm:affiliation>Department of Anaesthesiology and Critical Care Medicine, Aga Khan University Hospital, Nairobi, Kenya.</nlm:affiliation></affiliation></author><author><name sortKey="Park, Casey" sort="Park, Casey" uniqKey="Park C" first="Casey" last="Park">Casey Park</name><affiliation><nlm:affiliation>Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Taran, Shaurya" sort="Taran, Shaurya" uniqKey="Taran S" first="Shaurya" last="Taran">Shaurya Taran</name><affiliation><nlm:affiliation>Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Lee, Burton W" sort="Lee, Burton W" uniqKey="Lee B" first="Burton W" last="Lee">Burton W. 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Shetty</name><affiliation><nlm:affiliation>Critical Care Medicine Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.</nlm:affiliation></affiliation></author><author><name sortKey="Brotherton, Brian Jason" sort="Brotherton, Brian Jason" uniqKey="Brotherton B" first="Brian Jason" last="Brotherton">Brian Jason Brotherton</name><affiliation><nlm:affiliation>Department of Internal Medicine, Kijabe Medical Center, Kijabe, Kenya.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Critical Care Medicine Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.</nlm:affiliation></affiliation></author><author><name sortKey="Achilleos, Andrew" sort="Achilleos, Andrew" uniqKey="Achilleos A" first="Andrew" last="Achilleos">Andrew Achilleos</name><affiliation><nlm:affiliation>Department of Critical Care, Sunnybrook Health Sciences Center, Toronto, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Akrami, Kevan M" sort="Akrami, Kevan M" uniqKey="Akrami K" first="Kevan M" last="Akrami">Kevan M. Akrami</name><affiliation><nlm:affiliation>Critical Care Medicine, University of California San Diego, San Diego, California.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Divisions of Infectious Disease, University of California San Diego, San Diego, California.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.</nlm:affiliation></affiliation></author><author><name sortKey="Barros, Lia M" sort="Barros, Lia M" uniqKey="Barros L" first="Lia M" last="Barros">Lia M. Barros</name><affiliation><nlm:affiliation>Department of Cardiology, University of Washington Medical Center, Seattle, Washington.</nlm:affiliation></affiliation></author><author><name sortKey="Checkley, William" sort="Checkley, William" uniqKey="Checkley W" first="William" last="Checkley">William Checkley</name><affiliation><nlm:affiliation>Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland.</nlm:affiliation></affiliation></author><author><name sortKey="Cobb, Natalie" sort="Cobb, Natalie" uniqKey="Cobb N" first="Natalie" last="Cobb">Natalie Cobb</name><affiliation><nlm:affiliation>Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington Medical Center, Seattle, Washington.</nlm:affiliation></affiliation></author><author><name sortKey="Maximous, Stephanie" sort="Maximous, Stephanie" uniqKey="Maximous S" first="Stephanie" last="Maximous">Stephanie Maximous</name><affiliation><nlm:affiliation>Division of Pulmonary Allergy Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.</nlm:affiliation></affiliation></author><author><name sortKey="Misango, David" sort="Misango, David" uniqKey="Misango D" first="David" last="Misango">David Misango</name><affiliation><nlm:affiliation>Department of Anaesthesiology and Critical Care Medicine, Aga Khan University Hospital, Nairobi, Kenya.</nlm:affiliation></affiliation></author><author><name sortKey="Park, Casey" sort="Park, Casey" uniqKey="Park C" first="Casey" last="Park">Casey Park</name><affiliation><nlm:affiliation>Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Taran, Shaurya" sort="Taran, Shaurya" uniqKey="Taran S" first="Shaurya" last="Taran">Shaurya Taran</name><affiliation><nlm:affiliation>Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Lee, Burton W" sort="Lee, Burton W" uniqKey="Lee B" first="Burton W" last="Lee">Burton W. Lee</name><affiliation><nlm:affiliation>Division of Pulmonary Allergy Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland.</nlm:affiliation></affiliation></author><author><name sortKey="For The Covid Lmic Task Force And The Mahidol Oxford Research Unit Moru Bangkok Thailand" sort="For The Covid Lmic Task Force And The Mahidol Oxford Research Unit Moru Bangkok Thailand" uniqKey="For The Covid Lmic Task Force And The Mahidol Oxford Research Unit Moru Bangkok Thailand" last="For The Covid-Lmic Task Force And The Mahidol-Oxford Research Unit Moru Bangkok Thailand">For The Covid-Lmic Task Force And The Mahidol-Oxford Research Unit Moru Bangkok Thailand</name></author></analytic><series><title level="j">The American journal of tropical medicine and hygiene</title><idno type="eISSN">1476-1645</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The therapeutic options for COVID-19 patients are currently limited, but numerous randomized controlled trials are being completed, and many are on the way. For COVID-19 patients in low- and middle-income countries (LMICs), we recommend against using remdesivir outside of a clinical trial. We recommend against using hydroxychloroquine ± azithromycin or lopinavir-ritonavir. We suggest empiric antimicrobial treatment for likely coinfecting pathogens if an alternative infectious cause is likely. We suggest close monitoring without additional empiric antimicrobials if there are no clinical or laboratory signs of other infections. We recommend using oral or intravenous low-dose dexamethasone in adults with COVID-19 disease who require oxygen or mechanical ventilation. We recommend against using dexamethasone in patients with COVID-19 who do not require supplemental oxygen. We recommend using alternate equivalent doses of steroids in the event that dexamethasone is unavailable. We also recommend using low-dose corticosteroids in patients with refractory shock requiring vasopressor support. We recommend against the use of convalescent plasma and interleukin-6 inhibitors, such as tocilizumab, for the treatment of COVID-19 in LMICs outside of clinical trials.</div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">33377451</PMID><DateRevised><Year>2021</Year><Month>03</Month><Day>19</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1476-1645</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>Dec</Month><Day>29</Day></PubDate></JournalIssue><Title>The American journal of tropical medicine and hygiene</Title><ISOAbbreviation>Am J Trop Med Hyg</ISOAbbreviation></Journal><ArticleTitle>Pragmatic Recommendations for Therapeutics of Hospitalized COVID-19 Patients in Low- and Middle-Income Countries.</ArticleTitle><ELocationID EIdType="doi" ValidYN="Y">10.4269/ajtmh.20-1106</ELocationID><Abstract><AbstractText>The therapeutic options for COVID-19 patients are currently limited, but numerous randomized controlled trials are being completed, and many are on the way. For COVID-19 patients in low- and middle-income countries (LMICs), we recommend against using remdesivir outside of a clinical trial. We recommend against using hydroxychloroquine ± azithromycin or lopinavir-ritonavir. We suggest empiric antimicrobial treatment for likely coinfecting pathogens if an alternative infectious cause is likely. We suggest close monitoring without additional empiric antimicrobials if there are no clinical or laboratory signs of other infections. We recommend using oral or intravenous low-dose dexamethasone in adults with COVID-19 disease who require oxygen or mechanical ventilation. We recommend against using dexamethasone in patients with COVID-19 who do not require supplemental oxygen. We recommend using alternate equivalent doses of steroids in the event that dexamethasone is unavailable. We also recommend using low-dose corticosteroids in patients with refractory shock requiring vasopressor support. We recommend against the use of convalescent plasma and interleukin-6 inhibitors, such as tocilizumab, for the treatment of COVID-19 in LMICs outside of clinical trials.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Shetty</LastName><ForeName>Varun U</ForeName><Initials>VU</Initials><AffiliationInfo><Affiliation>Critical Care Medicine Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Brotherton</LastName><ForeName>Brian Jason</ForeName><Initials>BJ</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Kijabe Medical Center, Kijabe, Kenya.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Critical Care Medicine Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Achilleos</LastName><ForeName>Andrew</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Critical Care, Sunnybrook Health Sciences Center, Toronto, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Akrami</LastName><ForeName>Kevan M</ForeName><Initials>KM</Initials><AffiliationInfo><Affiliation>Critical Care Medicine, University of California San Diego, San Diego, California.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Divisions of Infectious Disease, University of California San Diego, San Diego, California.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Barros</LastName><ForeName>Lia M</ForeName><Initials>LM</Initials><AffiliationInfo><Affiliation>Department of Cardiology, University of Washington Medical Center, Seattle, Washington.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Checkley</LastName><ForeName>William</ForeName><Initials>W</Initials><AffiliationInfo><Affiliation>Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cobb</LastName><ForeName>Natalie</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington Medical Center, Seattle, Washington.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Maximous</LastName><ForeName>Stephanie</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Division of Pulmonary Allergy Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Misango</LastName><ForeName>David</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Department of Anaesthesiology and Critical Care Medicine, Aga Khan University Hospital, Nairobi, Kenya.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Park</LastName><ForeName>Casey</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Taran</LastName><ForeName>Shaurya</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lee</LastName><ForeName>Burton W</ForeName><Initials>BW</Initials><AffiliationInfo><Affiliation>Division of Pulmonary Allergy Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>For The Covid-Lmic Task Force And The Mahidol-Oxford Research Unit Moru Bangkok Thailand</LastName></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>12</Month><Day>29</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Am J Trop Med 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