Table 3.

Variability in recommendations of targeted covid-19 therapies across guidelines

Country	Antivirals	Level of support	Notes
Italy	If need for oxygen or clinical worsening: remdesivir ampoules 150 mg 1 day 200 mg IV in 30 min, then 100 mg IV OD for another 9 days in combination with chloroquine 500 mg BD or hydroxychloroquine 200 mg BD (duration of treatment 5-20 days)	Expert consensus following literature review	Methods for reaching conclusions unclear
	In severe disease: remdesivir 1 day 200 mg IV, then 100 mg/day IV (days 2-10) + chloroquine 500 mg BD or hydroxychloroquine 200 mg × 2 PO 5-20 days
Russia	In moderate to severe infections: 400 mg lopinavir/100 mg ritonavir BD for 14 days PO; or 400 mg lopinavir/100 mg ritonavir) (5 mL) BD 14 days NGT; or recombinant interferon 1b 0.25 mg/mL (8 million IU) SC every second day for 14 days; or ribavarin 2 g loading dose, then 1200 mg TID for 4 days, then 4-6 days 600 mg TID	Results from literature review led to three drugs being chosen. No preference or order is recommended. Not clear how authors excluded other options	Advises antivirals can be prescribed off label after benefits v risk assessment. Oseltamivir not recommended
France	Advised for all patients admitted to ICU on confirmation of diagnosis. First line: lopinavir/ritonavir 400 mg BD; second line: hydroxychloroquine 200 mg BD	If parenchymal involvement. Recommendations based on data in SARS and MERS. First line treatment chosen because readily available	Advises against ribavarin owing to inconclusive data
Netherlands	In moderate disease: first line chloroquine 600 mg PO, then 300 mg for 5 days; second line lopinavir/ritonavir 400/100 mg BD for 14 days	Noting that very little information is available, makes no definitive recommendations. Acknowledges lack of phase I data for remdesivir	Advises against use of ribavirin alone owing to toxicity at required doses. Notes poor evidence for interferon in combination with ribavirin. Oseltamivir not recommended
	In severe disease: remdesivir + chloroquine or lopinavir/ritonavir + chloroquine
Spain	First line: lopinavir/ritonavir 400/100 mg BD PO until disappearance of fever for maximum 14 days; second line: interferon β1b 0.25 mg SC every 48 h for 14 days or interferon α2b 5 million units in 2 mL of sterile serum, BD INH	Only for severe pneumonia, CURB >65, SpO2 <90%	Notes in-vitro studies and ongoing Chinese trials. Oseltamivir not recommended
	Remdesivir 200 mg IV, then 100 mg IV OD for 9 days	For compassionate use only in severe disease
China	Alpha-interferon (5 million units or equivalent dose BD INH) or lopinavir/ritonavir (200/50 mg × 2 BD for ≤10 days); or ribavirin (used jointly with interferon or lopinavir/ritonavir, 500 mg IV TID for adults, for ≤10 days); or chloroquine phosphate (500 mg BD for ≤10 days); or arbidol (200 mg TID for adults, for ≤10 days)		Does not recommend using three or more antiviral drugs at same time
Germany	Numerous antiviral therapies are used in the context of SARS-CoV-2. Too little data are currently available to make a therapy recommendation in Germany. Even for severe forms of COVID-19 there is insufficient evidence to recommend therapy
Japan	No specific therapy recommended. Lopinavir/ritonavir, anti-influenza drug favipiravir, remdesivir, and ciclesonide, an inhaled steroid used in asthma, are listed as potential therapeutic agents		Advises these agents may be future therapeutic agents pending trials
South Korea	Lopinavir/ritonavir 400/100 mg BD for 7-10 days; or hydroxychloroquine 400 mg OD; or interferon can be administered in combination with lopinavir/ritonavir	Remdesivir only to be used in clinical trials	Ribavirin not recommended owing to adverse reactions

BD=twice daily; ICU=intensive care unit; INH=inhalation; IV=intravenous; MERS=Middle East respiratory syndrome; NGT=nasogastric tube; OD=once daily; PO=oral; SARS-CoV-2=severe acute respiratory disorder coronavirus 2; SC=subcutaneous; TID=three times daily;