Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Başkent University, Ankara, Turkey.
Clin Microbiol Infect. 2022 Feb;28(2):222-238. doi: 10.1016/j.cmi.2021.11.007. Epub 2021 Nov 22.
In January 2021, the ESCMID Executive Committee decided to launch a new initiative to develop ESCMID guidelines on several COVID-19-related issues, including treatment of COVID-19.
An ESCMID COVID-19 guidelines task force was established by the ESCMID Executive Committee. A small group was established, half appointed by the chair, and the remaining selected with an open call. Each panel met virtually once a week. For all decisions, a simple majority vote was used. A long list of clinical questions using the PICO (population, intervention, comparison, outcome) format was developed at the beginning of the process. For each PICO, two panel members performed a literature search with a third panellist involved in case of inconsistent results. Voting was based on the GRADE approach.
A synthesis of the available evidence and recommendations is provided for each of the 15 PICOs, which cover use of hydroxychloroquine, bamlanivimab alone or in combination with etesevimab, casirivimab combined with imdevimab, ivermectin, azithromycin and empirical antibiotics, colchicine, corticosteroids, convalescent plasma, favipiravir, remdesivir, tocilizumab and interferon β-1a, as well as the utility of antifungal prophylaxis and enoxaparin. In general, the panel recommended against the use of hydroxychloroquine, ivermectin, azithromycin, colchicine and interferon β-1a. Conditional recommendations were given for the use of monoclonal antibodies in high-risk outpatients with mild-moderate COVID-19, and remdesivir. There was insufficient evidence to make a recommendation for use of favipiravir and antifungal prophylaxis, and it was recommended that antibiotics should not be routinely prescribed in patients with COVID-19 unless bacterial coinfection or secondary infection is suspected or confirmed. Tocilizumab and corticosteroids were recommended for treatment of severe COVID-19 but not in outpatients with non-severe COVID-19.
The aim of the present guidance is to provide evidence-based recommendations for management of adults with coronavirus disease 2019 (COVID-19). More specifically, the goal is to aid clinicians managing patients with COVID-19 at various levels of severity including outpatients, hospitalized patients, and those admitted to intensive care unit. Considering the composition of the panel, mostly clinical microbiologists or infectious disease specialists with no pulmonology or intensive care background, we focus only on pharmacological treatment and do not give recommendations on oxygen supplement/support. Similarly, as no paediatricians were included in the panel; the recommendations are only for adult patients with COVID-19. Considering the current literature, no guidance was given for special populations such as the immunocompromised.
2021 年 1 月，ESCMID 执行委员会决定发起一项新倡议，制定关于 COVID-19 相关问题的 ESCMID 指南，包括 COVID-19 的治疗。
ESCMID 执行委员会成立了 ESCMID COVID-19 指南工作组。成立了一个小组，一半由主席任命，另一半通过公开招募选择。每个小组每周虚拟开会一次。所有决定均采用简单多数票。在流程开始时，制定了一份使用 PICO（人群、干预、比较、结局）格式的临床问题长清单。对于每个 PICO，两名小组成员进行文献检索，如果结果不一致，则由第三名小组成员参与。投票基于 GRADE 方法。
为涵盖羟氯喹、巴伦尼韦单抗单药或与etesevimab 联合使用、casirivimab 联合 imdevimab、伊维菌素、阿奇霉素和经验性抗生素、秋水仙碱、皮质类固醇、恢复期血浆、法匹拉韦、瑞德西韦、托珠单抗和干扰素β-1a 以及抗真菌预防和依诺肝素的使用的 15 个 PICO 中的每一个提供了对现有证据的综合和建议。一般来说，小组建议不要使用羟氯喹、伊维菌素、阿奇霉素、秋水仙碱和干扰素β-1a。对高风险门诊轻中度 COVID-19 患者使用单克隆抗体和瑞德西韦的建议是有条件的。没有足够的证据推荐使用法匹拉韦和抗真菌预防，建议不要常规为 COVID-19 患者开抗生素，除非怀疑或确认有细菌合并感染或继发感染。托珠单抗和皮质类固醇推荐用于治疗严重 COVID-19，但不推荐用于非严重 COVID-19 的门诊患者。
本指南旨在为管理成人冠状病毒病 2019（COVID-19）提供循证建议。更具体地说，目标是帮助各级严重程度的 COVID-19 患者的临床医生进行管理，包括门诊患者、住院患者和入住重症监护病房的患者。考虑到小组成员的组成，主要是临床微生物学家或传染病专家，没有肺病学或重症监护背景，我们仅关注药物治疗，不提供关于氧补充/支持的建议。同样，由于小组中没有儿科医生，因此建议仅适用于 COVID-19 的成年患者。考虑到目前的文献，对于免疫功能低下等特殊人群，没有给出指导。
