Infectious Diseases I
ii.
Hydroxychloroquine or chloroquine
| (a) | Antimalarial agents that, in vitro, increase the endosomal pH, inhibiting fusion of SARS- |
|---|
CoV-2 to the host cell membranes
| (b) | Not recommended as definitive or prophylactic therapy because larger controlled trials |
|---|
have failed to show a difference in clinical recovery or mortality in hospitalized patients
with COVID-19
| (c) | Combination with azithromycin reserved for clinical trial |
|---|
iii.
Miscellaneous agents
| (a) | Ivermectin: Not recommended; evidence does not support use for patients with COVID-19 |
|---|---|
| (b) | Lopinavir/ritonavir and other HIV protease inhibitors: Not recommended outside clinical |
trial
| (c) | Nirmatrelvir-ritonavir, although FDA approved for the treatment for mild-moderate |
|---|
COVID-19, may reduce 28-day risk of all-cause mortality in critically ill patients with
Med. 2024;39(8):742-750).
Hospitalized with Coronavirus Disease 2019
Disease
Severity
Remdesivir
Dexamethasonea
Baricitinib
Tocilizumabb
Anticoagulation
No
supplemental
oxygen
requirement
Consider
patients at
high risk for
worsening
Against use
N/A
N/A
For patients without
an indication
for therapeutic
anticoagulation:
Prophylactic dose
of heparin, unless
contraindicated (AI)
Supplemental
oxygen
required
Recommended
in patients with
minimal oxygen
requirement
Recommended
in combination
with remdesivir
in most patients
requiring oxygen;
may use alone
if remdesivir is
unavailable
Patients who have rapidly
increasing oxygen
needs and systemic
inflammation, promptly
add either agent (rating
recommendation/
evidence level: baricitinib
BIIa; tocilizumab BIIa)
to dexamethasone ±
remdesivir in most patients
For nonpregnant
patients with D-dimer
levels above the ULN
who do not have an
increased bleeding
risk: Therapeutic dose
of heparin (CIIa)
For other patients:
Prophylactic dose
of heparin, unless
contraindicated (AI)