COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Shetty VU, Brotherton BJ, Achilleos A, et al. Pragmatic Recommendations for Therapeutics of Hospitalized COVID-19 Patients in Low- and Middle-Income Countries. Am J Trop Med Hyg. 2020 Dec 29. doi: 10.4269/ajtmh.20-1106.
Abstract

The therapeutic options for COVID-19 patients are currently limited, but numerous randomized controlled trials are being completed, and many are on the way. For COVID-19 patients in low- and middle-income countries (LMICs), we recommend against using remdesivir outside of a clinical trial. We recommend against using hydroxychloroquine ± azithromycin or lopinavir-ritonavir. We suggest empiric antimicrobial treatment for likely coinfecting pathogens if an alternative infectious cause is likely. We suggest close monitoring without additional empiric antimicrobials if there are no clinical or laboratory signs of other infections. We recommend using oral or intravenous low-dose dexamethasone in adults with COVID-19 disease who require oxygen or mechanical ventilation. We recommend against using dexamethasone in patients with COVID-19 who do not require supplemental oxygen. We recommend using alternate equivalent doses of steroids in the event that dexamethasone is unavailable. We also recommend using low-dose corticosteroids in patients with refractory shock requiring vasopressor support. We recommend against the use of convalescent plasma and interleukin-6 inhibitors, such as tocilizumab, for the treatment of COVID-19 in LMICs outside of clinical trials.

Ratings
Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Emergency Medicine
Infectious Disease
Tropical and Travel Medicine
Comments from MORE raters

Emergency Medicine rater

There has been a lot of misinformation about therapeutics for Covid-19. This lays out the information in a reasonable fashion.

Hospital Doctor/Hospitalists rater

No words for the use of low molecular weight heparin!

Hospital Doctor/Hospitalists rater

This is a good review of the treatment options in COVID-19. Awfully, they don't cover non-pharmacologic treatment.

Infectious Disease rater

This article is highly relevant and gives the much needed evidence based guidelines in managing patients with COVID-19.

Tropical and Travel Medicine rater

Most of this is already known. This is useful information to argue against enthusiastic prescriptions by colleagues.