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.
Subject(s)
COVID-19 , Communicable Diseases , Humans , United States , SARS-CoV-2 , Ritonavir/therapeutic use , Hydroxychloroquine/therapeutic use , Pandemics/prevention & control , Brazil , Ivermectin , Communicable Diseases/drug therapy , Antiviral Agents/therapeutic useABSTRACT
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. 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. 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. 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
Subject(s)
Humans , SARS-CoV-2/drug effects , COVID-19/drug therapy , Antiviral Agents/therapeutic use , Chloroquine/therapeutic use , Hydroxychloroquine/therapeutic use , Antibodies, Monoclonal/therapeutic useABSTRACT
Introducción: la utilización de la escala NEWS podría construir una herramienta en el diagnóstico, pronóstico y estratificación precoz ante la sospecha de sepsis. El propósito de esta investigación fue determinar la eficacia de la escala NEWS como predictor de sepsis en pacientes ingresados por síndrome febril en el Hospital Salvador Bienvenido Gautier, en el período de octubre-diciembre 2019. Material y método: se realizó un estudio descriptivo, prospectivo y de corte transversal donde la técnica utilizada para la recolección de la información fue la evaluación directa de los 43 pacientes admitidos aplicando la escala NEWS y revisión de expedientes clínicos. Resultados: se determinó que el punto de corte ≥6 en la escala NEWS obtuvo valores de sensibilidad (91 %), especificidad (70 %), índice de Youden de 0.61, valor predictivo positivo de 78 %, valor predictivo negativo de 88 %, razón de verosimilitud positiva de 3 y negativa de 0.1. La aplicación de la escala NEWS en el sexo masculino presentó una sensibilidad de 92.9 % y especificidad de 87.5 %. En los grupos de 18-30 y 71-80 años, esta escala presentó una sensibilidad y especificidad de 100 %. Los pacientes clasificados como riesgo bajo, moderado y alto fueron diagnosticados con sepsis el 16.67 %, 63.64 % y un 70 %, respectivamente. Conclusiones: una puntuación mayor o igual a 6 en la escala NEWS se presenta como un predictor estadísticamente significativo que ayudaría en el diagnóstico temprano de sepsis, siendo más sensible que especifica. Fue mejor predictor en el sexo masculino y en los grupos etarios de 18-30 y 71-80 años
Introduction: The use of the NEWS could build a tool in the diagnosis, prognosis and early stratification in case of suspected sepsis. The purpose of this research was to determine the efficacy of the NEWS as a predictor of sepsis in patients admitted for febrile syndrome at the Salvador Bienvenido Gautier Hospital, October-December 2019. Materials and methods: A descriptive, prospective and crosssectional study was conducted where the technique used for the collection of the information was the direct evaluation of the 43 admitted patients applying the NEWS and the review of clinical records. Results: It was determined that the cutoff point ≥6 on the NEWS obtained sensitivity value (91%), specificity (70%), Youden index of 0.61, positive predictive value of 78%, negative predictive value of 88%, ratio of positive likelihood of 3 and negative of 0.1. The application of the NEWS scale in males presented a sensitivity of 92.9% and specificity of 87.5%. In the groups of 18-30 and 71-80 years, this scale presented a sensitivity and specificity of 100%. Patients classified as low, moderate and high risk were diagnosed with sepsis 16.67%, 63.64% and 70% respectively. Conclusions: A score greater than or equal to 6 on the NEWS is presented as a statistically significant predictor that would help in the early diagnosis of sepsis being more sensitive than specific. It was a better predictor in the male sex and in the age groups of 18-30 and 71-80 years
