Infectious Diseases Department - Botucatu School of Medicine - UNESP, Av. Prof. Mário R. G. Montenegro, s/n, Botucatu, SP, CEP 18.618-687, Brazil.
Universidade Estadual Paulista, Julio de Mesquita Filho, Distrito de Rubiao Jr, s/n, Botucatu, SP, CEP 18618-970, Brazil.
Ann Clin Microbiol Antimicrob. 2023 Aug 7;22(1):67. doi: 10.1186/s12941-023-00623-w.
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.
自 COVID-19 大流行开始以来，针对 COVID-19 的治疗选择已在不同的临床表现阶段进行了研究。考虑到 COVID-19 在美洲的特殊影响，本文件旨在针对该人群提出 COVID-19 特定的药理学治疗建议。
由 15 名专家组成，他们是巴西传染病学会（SBI）和泛美传染病协会（API）的成员，负责制定本指南。针对门诊和住院环境中 COVID-19 的预防和治疗提出了问题。决策中考虑的结果是死亡率、住院、需要机械通气、有症状的 COVID-19 发作和不良事件。此外，还进行了随机对照试验的系统评价。证据质量评估和指南制定过程遵循 GRADE 系统。
评估了 9 种技术，并提出了 10 项建议，包括使用替沙格韦单抗+西加韦单抗预防 COVID-19、替沙格韦单抗+西加韦单抗、莫努匹韦、奈玛特韦/利托那韦和瑞德西韦治疗门诊患者，以及瑞德西韦、巴瑞替尼和托珠单抗治疗住院的重症 COVID-19 患者。不鼓励使用羟氯喹或氯喹和伊维菌素。
本指南根据循证医学原则为治疗美洲患者提供了建议。这些建议提出了一组已被证明对 COVID-19 的预防和治疗有效的药物，特别强调了奈玛特韦/利托那韦在门诊患者中的强烈推荐，因为使用羟氯喹和伊维菌素没有益处。
