Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
Int J Environ Res Public Health. 2020 Sep 19;17(18):6845. doi: 10.3390/ijerph17186845.
Our objective was to compare clinical protocols for the treatment of the novel coronavirus disease 2019 (COVID-19) among different hospitals in Andalusia, Spain. We reviewed the current COVID-19 protocols of the 15 largest hospitals in Andalusia. Antiviral treatment, empirical antibacterial agents, adjunctive therapies, anticoagulant treatment, supportive care, hospital organization, and discharge recommendations were analyzed. All protocols included were the latest updates as of July 2020. Hydroxychloroquine in monotherapy was the most frequent antiviral drug recommended for mild respiratory illness with clinical risk factors (33.3%). Combined hydroxychloroquine with azithromycin or lopinavir/ritonavir was found in 40% of protocols. The recommended treatment for patients with mild and moderate pneumonias was different antiviral combinations including hydroxychloroquine plus azithromycin (93.3%) or hydroxychloroquine plus lopinavir/ritonavir (79.9%). Different combinations of hydroxychloroquine and lopinavir/ritonavir (46.7%) and triple therapy with hydroxychloroquine, azithromycin, and lopinavir/ritonavir (40%) were the most recommended treatments for patients with severe pneumonia. There were five corticosteroid regimens, which used dexamethasone, methylprednisolone, or prednisone, with different doses and treatment durations. Anakinra was included in seven protocols with six different regimens. All protocols included prophylactic heparin and therapeutic doses for thromboembolism. Higher prophylactic doses of heparin for high-risk patients and therapeutic doses for patients in critical condition were included in 53.3% and 33.3% of protocols, respectively. This study showed that COVID-19 protocols varied widely in several aspects (antiviral treatment, corticosteroids, anakinra, and anticoagulation for high risk of thrombosis or critical situation). Rigorous randomized clinical trials on the proposed treatments are needed to provide consistent evidence.
我们的目的是比较西班牙安达卢西亚不同医院治疗 2019 年新型冠状病毒病（COVID-19）的临床方案。我们回顾了安达卢西亚 15 家最大医院的当前 COVID-19 方案。分析了抗病毒治疗、经验性抗菌药物、辅助治疗、抗凝治疗、支持性护理、医院组织和出院建议。所有纳入的方案均为截至 2020 年 7 月的最新更新。对于有临床风险因素的轻度呼吸道疾病，推荐使用单一羟氯喹作为最常用的抗病毒药物（33.3%）。40%的方案中发现联合使用羟氯喹与阿奇霉素或洛匹那韦/利托那韦。对于轻度和中度肺炎患者，推荐的治疗方法是不同的抗病毒联合用药，包括羟氯喹加阿奇霉素（93.3%）或羟氯喹加洛匹那韦/利托那韦（79.9%）。对于重症肺炎患者，最推荐的治疗方法是羟氯喹和洛匹那韦/利托那韦的不同联合用药（46.7%）和羟氯喹、阿奇霉素和洛匹那韦/利托那韦三联疗法（40%）。有 5 种皮质类固醇方案，使用地塞米松、甲泼尼龙或泼尼松，剂量和治疗时间不同。7 个方案中包含了不同方案的安那白滞素，共 6 种。所有方案均包括预防性肝素和血栓栓塞的治疗剂量。53.3%和 33.3%的方案中分别包括高危患者的预防性肝素高剂量和危重症患者的治疗剂量。本研究表明，COVID-19 方案在多个方面差异很大（抗病毒治疗、皮质类固醇、安那白滞素和抗凝治疗以预防高血栓风险或危急情况）。需要进行严格的随机临床试验，以提供一致的证据。
