TY - JOUR

T1 - Guidelines for the pharmacological treatment of COVID-19

T2 - 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

AU - Falavigna, Maicon

AU - Colpani, Verônica

AU - Stein, Cinara

AU - Pontes de Azevedo, Luciano Cesar

AU - Bagattini, Angela Maria

AU - Vilela de Brito, Gabriela

AU - Chatkin, José Miguel

AU - Cimerman, Sergio

AU - de Freitas Dal Ben Corradi, Mirian

AU - Arns da Cunha, Clovis

AU - Cordeiro de Medeiros, Flávia

AU - Alves de Oliveira Junior, Haliton

AU - Genehr Fritscher, Leandro

AU - Basso Gazzana, Marcelo

AU - Dalmas Gräf, Débora

AU - Pires Marra, Lays

AU - Yumi Matuoka, Jessica

AU - Silva Nunes, Michelle

AU - Vianna Pachito, Daniela

AU - Garcia Moraes Pagano, Cássia

AU - do Carmo Silva Parreira, Patrícia

AU - Riera, Rachel

AU - Silva Júnior, Amilton

AU - de Melo Tavares, Bruno

AU - Prehn Zavascki, Alexandre

AU - Goulart Rosa, Regis

AU - Dal-Pizzol, Felipe

PY - 2020

Y1 - 2020

N2 - 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.

AB - 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.

UR - https://europepmc.org/articles/PMC7405746

U2 - 10.5935/0103-507x.20200039

DO - 10.5935/0103-507x.20200039

M3 - Journal article

VL - 32

SP - 166

EP - 196

JO - Revista Brasileira de Terapia Intensiva

JF - Revista Brasileira de Terapia Intensiva

SN - 0103-507X

IS - 2

ER -