Pan-American Guidelines for the treatment of SARS-CoV-2/COVID-19: a joint evidence-based guideline of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API)
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Published:2023-08-07
Issue:1
Volume:22
Page:
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ISSN:1476-0711
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Container-title:Annals of Clinical Microbiology and Antimicrobials
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language:en
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Short-container-title:Ann Clin Microbiol Antimicrob
Author:
Barbosa Alexandre Naime,Chebabo Alberto,Starling Carlos,Pérez Clevy,Cunha Clóvis Arns,de Luna David,Nunes Estevão Portela,Zambrano Gabriela,Ferreira Juliana Carvalho,Croda Julio,Falavigna Maicon,Gomes-da-Silva Monica Maria,Thormann Monica,Cimerman Sergio,Parahiba Suena Medeiros,Tanni Suzana,Bernardo Wanderley Marques,Rodriguez-Morales Alfonso J.
Abstract
Abstract
Background
Since the beginning of the COVID-19 pandemic, therapeutic options for treating COVID-19 have been investigated at different stages of clinical manifestations. Considering the particular impact of COVID-19 in the Americas, this document aims to present recommendations for the pharmacological treatment of COVID-19 specific to this population.
Methods
Fifteen experts, members of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API) make up the panel responsible for developing this guideline. Questions were formulated regarding prophylaxis and treatment of COVID-19 in outpatient and inpatient settings. The outcomes considered in decision-making were mortality, hospitalisation, need for mechanical ventilation, symptomatic COVID-19 episodes, and adverse events. In addition, a systematic review of randomised controlled trials was conducted. The quality of evidence assessment and guideline development process followed the GRADE system.
Results
Nine technologies were evaluated, and ten recommendations were made, including the use of tixagevimab + cilgavimab in the prophylaxis of COVID-19, tixagevimab + cilgavimab, molnupiravir, nirmatrelvir + ritonavir, and remdesivir in the treatment of outpatients, and remdesivir, baricitinib, and tocilizumab in the treatment of hospitalised patients with severe COVID-19. The use of hydroxychloroquine or chloroquine and ivermectin was discouraged.
Conclusion
This guideline provides recommendations for treating patients in the Americas following the principles of evidence-based medicine. The recommendations present a set of drugs that have proven effective in the prophylaxis and treatment of COVID-19, emphasising the strong recommendation for the use of nirmatrelvir/ritonavir in outpatients as the lack of benefit from the use of hydroxychloroquine and ivermectin.
Funder
Pan-American Infectious Diseases Association
Publisher
Springer Science and Business Media LLC
Subject
Infectious Diseases,Microbiology (medical),General Medicine
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