Table 5.
Recommendations for use of corticosteroids for covid-19 in global guidelines produced early in pandemic
| Origin | Corticosteroid recommendations | Evidence base | Antimicrobials notes |
|---|---|---|---|
| WHO | Corticosteroid therapy contraindicated | Stockman LJ et al,27 Rodrigo C et al,28 Delaney et al,29 Arabi YM et al30 | Give empirical antimicrobials to treat all likely pathogens causing SARI |
| Italy | Not recommended for confirmed covid-19 patients, but low dose dexamethasone may be considered in patients with confirmed ARDS on ICU clinicians’ indication | World Health Organization interim guidance,9 Villar J et al31 | Add antibiotic (empirical or targeted) according to clinical indications, health policies, or protocols in use |
| US CDC | Corticosteroids should be avoided unless indicated for other reasons (eg, COPD exacerbation or septic shock) | Zumla A et a,l32 Arabi YM et al,30 Russell et al,33 Metlay JP et al34 | |
| India | Not recommended for viral pneumonia or ARDS outside of clinical trials, unless indicated for other reason | No link to supporting evidence provided | Antibiotics not recommended/covered |
| Turkey | Not recommended routinely | No link to supporting evidence provided | Give empirical antimicrobials to treat all likely pathogens causing SARI |
| South Korea | Steroids not indicated in general but may be considered for other conditions, such as septic shock | No link to supporting evidence provided | Empirical antimicrobials for possible pathogens are recommended |
| France | Steroids not indicated for SARS-CoV-2 infection alone | Stockman LJ et al27 | Routine use of antibiotics for treatment of covid-19 not recommended. However, antibiotics may be used if accompanying bacterial infection is suspected |
| Brazil | Not recommended for viral pneumonia or ARDS outside of clinical trials, unless indicated for other reasons | No link to supporting evidence provided | |
| Taiwan | Not recommended for viral pneumonia or ARDS outside of clinical trials, unless indicated for other reasons | No link to supporting evidence | Systematic coverage of bacterial infection/superinfection recommended in severe forms |
| Indonesia | Not recommended for viral pneumonia or ARDS outside of clinical trials, unless indicated for other reasons | No clear link to supporting evidence | |
| Spain | Not recommended | No clear link to supporting evidence | Give empirical antimicrobials to treat all likely pathogens that cause SARS |
| Malaysia | Not recommended unless indicated for other reasons (eg, COPD, septic shock) | No clear link to supporting evidence | Consider giving empirical antibiotics to treat other possible bacterial infection |
| Germany | Not recommended without clear indication | No clear link to supporting evidence | Give empirical antibiotics based on likely aetiology |
ARDS=acute respiratory distress syndrome; COPD=chronic obstructive pulmonary disease; ICU=intensive care unit; SARI=severe acute respiratory illness; SARS-CoV-2=severe acute respiratory syndrome coronavirus 2.