Monday, September 21, 2020

COVID-19 Management (Updated @ 21.09.2020)

 Disease Severity

 

Clinical Stage

 

MILD

1

Asymptomatic

No antiviral treatment required

2

Symptomatic, No Pneumonia

ü No antiviral treatment required in the absence of warning signs

ü Close observation of vital signs and oxygen saturation

ü Look for warning signs at each review. Treat as category 4 if any warning signs present

3

Symptomatic, Pneumonia

ü Antiviral treatment required in the absence of risk factors / warning signs

ü Close observation of vital signs and oxygen saturation

ü Look for warning signs at each review. Treat as category 4 if any warning signs present

ü Treat as category 4 if patient has any of the following risk factors: Age 50 years or ESRF 

SEVERE

4

Symptomatic, Pneumonia, Requiring supplemental oxygen

5

Critically ill with multiorgan involvement

 

 

Updated COVID-19 Drugs and Dosing (Used by ID , HQE)

 

Drug

Dose Recommended

Remark(s)

1

Favipravir 200 mg Tab*

1800 mg bd for 1 day then 800 mg bd (5 – 10 days)

·        Teratogenic effect; Contraindicated for women of childbearing potential and men whose partner is of childbearing potential.

·        Avoid if GFR < 30 mL/min

2

Interferon Beta-1b 250 mcg Inj*

(NO LONGER RECOMMENDED SINCE OCT 2020)

250 mcg stat then EOD for 3-5 doses

·        Use in the first week of illness as viral activity may predominate.

·        It may not be useful if started in the second week of illness.

3

Tocilizumab*

4-8 mg/kg single dose (MAX: 800 mg/dose)

·        Given that we will be giving dexamethasone more routinely, the need for Tocilizumab will drop.

·        But it still has a role in the following situations:

o   Coming in late with evidence of advanced CRS disease – Grade 3/4

o   Rapidly progressive disease

Ø Fold increases, net increases, or rate of change in cytokine levels may provide better correlates of CRS severity than absolute cytokine levels.*

Ø CRP levels serve as a reliable surrogate for IL-6 bioactivity.*

4

Dexamethasone

6 mg OD (5-7 days)

·       Recommended in all patients needing supplemental oxygen > 7 day of illness

·       Benefits of use in patients < 7 day of illness is still uncertain

5

Methylprednisolone

0.5-1 mg/kg (5-7 days)

 

*May refer to Askdis Blogspot for details of administration

*Dosing suggested is for normal patient. Dose may need to be renally / hepatically adjusted PRN. Please double check.

 

As per agreed with ID HQE, Hydroxychloroquine, Kaletra and Ribavirin are no longer part of COVID-19 management.

 

References:

1)       Slides: COVID-19 Clinical Updates (by Dr Suresh, ID Physician, Hospital Sg Buloh)

2)       Slides: Mesyuarat Pengurusan Pesakit COVID-19 bersama TKPK(P) [28 Ogos 2020]

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