International recommendations on the treatment of COVID-19
| Intervention | IDSA guideline (Apr. 21, 2020) (51) | SSC guideline (Mar. 23, 2020) (52) | WHO interim guidance (Mar. 13, 2020) (8) | ANZICS guideline (version 1, Mar. 16, 2020) (53) | NICE guideline (Apr. 3, 2020) (54) | This guideline |
|---|---|---|---|---|---|---|
| Corticosteroids* | Among patients who have been admitted to hospital with COVID-19 pneumonia, the IDSA guideline panel suggests against the use of corticosteroids (conditional recommendation, very low-certainty evidence). | In adults on mechanical ventilation with COVID-19 and respiratory failure (without ARDS), the SSC guideline suggests against the routine use of systemic corticosteroids (weak recommendation). | The WHO interim guidance recommends not routinely giving systemic corticosteroids for treatment of viral pneumonia outside clinical trials. | The ANZICS guideline does not recommend corticosteroids for routine use in acute respiratory failure with COVID-19. Some patients will have appropriate alternative clinical indications for the use of corticosteroids, such as the presence of septic shock. | The NICE guideline recommends not routinely offering a corticosteroid unless the patient has other conditions for which these are indicated, such as asthma or chronic obstructive pulmonary disease. | We suggest using corticosteroids in patients with severe COVID-19 and ARDS (weak recommendation). |
| Among patients who have been admitted to hospital with ARDS owing to COVID-19, the IDSA guideline panel recommends the use of corticosteroids in the context of a clinical trial (knowledge gap). | In adults on mechanical ventilation with COVID-19 and ARDS, the SSC guideline suggests using systemic corticosteroids, over not using corticosteroids (weak recommendation). | We suggest not using corticosteroids in patients with severe COVID-19 who do not have ARDS (weak recommendation). | ||||
| Convalescent plasma* | Among patients who have been admitted to hospital with COVID-19, the IDSA guideline panel recommends COVID-19 convalescent plasma in the context of a clinical trial (knowledge gap). | In adults who are critically ill with COVID-19, the SSC guideline suggests against the routine use of convalescent plasma (weak recommendation). | NR | NR | NR | We suggest not using convalescent plasma in patients with severe COVID-19 (weak recommendation). |
| Antiviral drugs | ||||||
| Umifenovir | NR | NR | NR | NR | NR | We suggest not using umifenovir in patients with nonsevere and severe COVID-19 (weak recommendation). |
| Favipiravir | NR | NR | NR | NR | NR | We suggest not using favipiravir in patients with nonsevere and severe COVID-19 (weak recommendation). |
| Hydroxychloroquine | Among patients who have been admitted to hospital with COVID-19, the IDSA guideline panel recommends hydroxychloroquine in the context of a clinical trial (knowledge gap). | Insufficient evidence to make a recommendation | NR | NR | NR | We suggest not using hydroxychloroquine in patients with nonsevere and severe COVID-19 (weak recommendation). |
| Interferon-α | NR | NR | NR | NR | NR | We suggest not using interferon-α in patients with nonsevere and severe COVID-19 (weak recommendation). |
| Interferon-β | NR | NR | NR | NR | NR | We suggest not using interferon-β in patients with nonsevere and severe COVID-19 (weak recommendation). |
| Lopinavir-ritonavir | Among patients who have been admitted to hospital with COVID-19, the IDSA guideline panel recommends the combination of lopinavir-ritonavir only in the context of a clinical trial (knowledge gap). | In critically ill adults with COVID-19, the SSC guideline suggests against the routine use of lopinavir-ritonavir (weak recommendation). | NR | NR | NR | We suggest not using lopinavir-ritonavir in patients with nonsevere and severe COVID-19 (weak recommendation). |
| Ribavirin | NR | NR | NR | NR | NR | We suggest not using ribavirin in patients with nonsevere and severe COVID-19 (weak recommendation). |
Note: ANZICS = Australian and New Zealand Intensive Care Society, ARDS = acute respiratory distress syndrome, COVID-19 = coronavirus disease 2019, IDSA = Infectious Diseases Society of America, NICE = National Institute for Health and Care Excellence, NR = not reported, SSC = Surviving Sepsis Campaign, WHO = World Health Organization.
↵* These interventions were not considered for use in patients with nonsevere COVID-19 in this guideline.