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We have learnt so much but there is lots more to learn
Evidence does not support the use of many proposed therapies, including vitamins C and D, zinc, lopinavir-ritonavir, colchicine, interferons, fluvoxamine, ivermectin, and convalescent plasma
#MedTwitter #Covid19
Evidence does not support the use of many proposed therapies, including vitamins C and D, zinc, lopinavir-ritonavir, colchicine, interferons, fluvoxamine, ivermectin, and convalescent plasma
#MedTwitter #Covid19
Glucocorticoids are the only medication known to decrease mortality in patients admitted to hospital with covid-19
The Recovery study found that dexamethasone 6 mg daily for 10 days (or until discharge if earlier) decreased mortality in patients with hypoxaemia, especially those requiring mechanical ventilation.11
There was no difference in mortality—and a suggestion of increased mortality—in patients without hypoxaemia. Subsequent meta-analyses confirmed glucocorticoids’ benefits in critically ill patients
Management of SARS-CoV-2 infection continues to evolve. For patients requiring hospital treatment, mortality can be high (up to 20%) but has decreased over the course of the pandemic.
Death rates depend on many factors, including age, gender, ethnicity, comorbidities, region, and the community prevalence of covid-19
Current therapeutic approaches are largely focused on 1 of the 2 phases of the infection. The initial phase is marked by viral replication followed by a second phase associated with immune dysregulation, worsening respiratory symptoms, sepsis, organ dysfunction & higher mortality
This is what we know at this point
you can read the whole paper here https://www.bmj.com/content/373/bmj.n1147
you can read the whole paper here https://www.bmj.com/content/373/bmj.n1147
Monoclonal antibodies against the SARS-CoV-2 spike protein are a promising therapy for mild-to-moderate illness in patients outside hospital.
The US National Institutes of Health and Infectious Diseases Society of America for example conditionally recommend remdesivir for hypoxaemic patients whereas the World Health Organization recommends against, particularly when costs and feasibility of use globally are considered.
In the Recovery trial, tocilizumab increased survival only when given with a corticosteroid, so the observed benefit may be due to steroids alone.
In a trial of baricitinib plus remdesivir, a subset of patients requiring non-invasive ventilation or high flow oxygen recovered eight days quicker than those given remdesivir alone. However, this advantage disappeared in those also given glucocorticoids.
Guidelines recommend against empirical antibiotics for hospital patients with covid-19 unless there is strong evidence of bacterial infection.
Biomarkers such as procalcitonin can be raised in patients with covid-19 and should not be used in isolation to guide use of antibiotics.
In critically ill patients, evidence supports prophylactic doses of anticoagulants for adults without frank thromboembolism, but trials of intermediate or therapeutic intensity treatment have been halted because of lack of benefit.
Patients with covid-19 are managed by a variety of health professionals, including nurses, physiotherapists, and physician specialists in hospital medicine, infectious diseases, pulmonary medicine, critical care, and palliative care.
