The CURRENT treatment recommendations by The Infectious Diseases Society of America (IDSA)
is used as a template by many hospitals around the world as the most up to date treatment protocols.
Treatment (Table)
Supplementary Materials - the "why" behind each treatment or why a treatment is not recommended
Recommendations - What is, and what isn't recommended.
Red is NOT recommended, Blue is conditional, and Green is strongly recommended.
Recommendation 1: Among patients with COVID-19, the IDSA guideline panel
recommends against hydroxychloroquine. (Strong recommendation, Moderate certainty of evidence)
Remark: Chloroquine is considered to be class equivalent to hydroxychloroquine.
Recommendation 2: Among hospitalized patients with COVID-19, the IDSA guideline panel
recommends against hydroxychloroquine plus azithromycin. (Strong recommendation, Low certainty of evidence)
Remark: Chloroquine is considered to be class equivalent to hydroxychloroquine
Recommendation 3: In persons exposed to COVID-19, the IDSA guideline panel
recommends against hydroxychloroquine. (Strong recommendation, Low certainty of evidence)
Recommendation 4: Among hospitalized patients with COVID-19, the IDSA guideline panel
recommends against the use of the combination lopinavir/ritonavir. (Strong recommendation, Moderate certainty of evidence)
Recommendation 5: Among hospitalized critically ill patients* with COVID-19, the IDSA guideline panel
recommends dexamethasone rather than no dexamethasone.
(Strong recommendation, Moderate certainty of evidence)
Remark: If dexamethasone is unavailable, equivalent total daily doses of alternative glucocorticoids may be used. Dexamethasone 6mg IV or PO for 10 days (or until discharge) or equivalent glucocorticoid dose may be substituted if dexamethasone unavailable. Equivalent total daily doses of alternative glucocorticoids to dexamethasone 6 mg daily are methylprednisolone 32 mg and prednisone 40 mg.
*Critical illness is defined as patients on mechanical ventilation and ECMO. Critical illness includes end organ dysfunction as is seen in sepsis/septic shock. In COVID-19, the most commonly reported form of end organ dysfunction is ARDS.
Recommendation 6: Among hospitalized patients with severe*, but non-critical, COVID-19, the IDSA guideline panel
suggests dexamethasone rather than no dexamethasone.
(Conditional recommendation, Moderate certainty of evidence)
Remark: Dexamethasone 6 mg IV or PO for 10 days (or until discharge) or equivalent glucocorticoid dose may be substituted if dexamethasone unavailable. Equivalent total daily doses of alternative glucocorticoids to dexamethasone 6 mg daily are methylprednisolone 32 mg and prednisone 40 mg.
*Severe illness is defined as patients with SpO2 ≤94% on room air, including patients on supplemental oxygen.
Recommendation 7: Among hospitalized patients with non-severe* COVID-19 without hypoxemia requiring supplemental oxygen, the IDSA guideline panel
suggests against the use of glucocorticoids.
(Conditional recommendation, Low certainty of evidence)
*Non-severe illness is defined as patient with a SpO2 > 94% not requiring supplemental oxygen.
Recommendation 8: Among hospitalized adults with progressive severe* or critical** COVID-19 who have elevated markers of systemic inflammation, the IDSA guideline panel
suggests tocilizumab in addition to standard of care (i.e., steroids) rather than standard of care alone. (Conditional recommendation, Low certainty of evidence)
Remarks:
Patients, particularly those who respond to steroids alone, who put a high value on avoiding possible adverse events of tocilizumab and a low value on the uncertain mortality reduction, would reasonably decline tocilizumab.
In the largest trial on the treatment of tocilizumab, criterion for systemic inflammation was defined as CRP ≥75 mg/L.
*Severe illness is defined as patients with SpO2 ≤94% on room air, including patients on supplemental oxygen.
**Critical illness is defined as patients on mechanical ventilation and ECMO. Critical illness includes end organ dysfunction as is seen in sepsis/septic shock. In COVID-19, the most commonly reported form of end organ dysfunction is ARDS.
Recommendation 9: When tocilizumab is not available, for patients who would otherwise qualify for tocilizumab, the IDSA guideline panel
suggests sarilumab in addition to standard of care (i.e., steroids) rather than standard of care alone. (Conditional recommendation, Very low certainty of evidence)
Remark: Patients, particularly those who respond to steroids alone, who put a high value on avoiding possible adverse events of sarilumab and a low value on the uncertain mortality reduction, would reasonably decline sarilumab.
Recommendation 10: Among patients hospitalized with COVID-19, the IDSA guideline panel
suggests against COVID-19 convalescent plasma. (Conditional recommendation, Low certainty of evidence)
Recommendation 11: Among ambulatory patients with mild-to-moderate COVID-19, the IDSA guideline panel
recommends COVID-19 convalescent plasma only in the context of a clinical trial. (Knowledge gap)
Recommendation 12a: In hospitalized patients with severe* COVID-19, the IDSA panel
suggests remdesivir over no antiviral treatment. (Conditional recommendation, Moderate certainty of evidence)
*Severe illness is defined as patients with SpO2 ≤94% on room air.
Recommendation 12b:
In patients with COVID-19 on invasive ventilation and/or ECMO, the IDSA panel
suggests against the routine initiation of remdesivir (Conditional recommendation, Very low certainty of evidence)
Recommendation 13: In patients on supplemental oxygen but not on mechanical ventilation or ECMO, the IDSA panel
suggests treatment with five days of remdesivir rather than 10 days of remdesivir. (Conditional recommendation, Low certainty of evidence)
Recommendation 14: In patients with COVID-19 admitted to the hospital without the need for supplemental oxygen and oxygen saturation >94% on room air, the IDSA panel
suggests against the routine use of remdesivir. (Conditional recommendation, Very low certainty of evidence)
Recommendation 15:
Among hospitalized patients with severe COVID-19, the IDSA panel
suggests against famotidine use for the sole purpose of treating COVID-19 outside of the context of a clinical trial. (Conditional recommendation, Very low certainty of evidence)
. Whatever buddy.
