Table 3.

Recommendations on use of disease‐modifying treatments for pregnant or postpartum women with COVID‐19^†

Dexamethasone as treatment for COVID‐19	Use dexamethasone 6 mg daily intravenously or orally for up to ten days in pregnant or breastfeeding women with COVID‐19 who are receiving oxygen (including mechanically ventilated patients) (strong recommendation, low certainty evidence). Do not routinely use dexamethasone to treat COVID‐19 in pregnant or breastfeeding women who do not require oxygen (strong recommendation, low certainty evidence). Antenatal corticosteroids should still be used for fetal lung maturation in pregnant women at risk of preterm birth who also have COVID‐19. Dexamethasone should still be used for other evidence‐based indications in pregnant and breastfeeding women who have COVID‐19.
Remdesivir as treatment for COVID‐19	Use of remdesivir for pregnant or breastfeeding women with COVID‐19 outside of a trial setting should not be considered routinely (conditional recommendation, very low certainty evidence). As pregnant and breastfeeding women are often excluded from clinical trials, use of remdesivir in this population would be outside a clinical trial setting. Pregnant and breastfeeding women receiving remdesivir should nonetheless be enrolled in national COVID‐19 registries. Currently, there is no direct evidence of the effects of remdesivir in pregnant and breastfeeding women. Information about the patients and the intervention (dosages, duration) in the trials used for this recommendation can be found in the Practical info tab. Due to antagonism observed in vitro, concomitant use of remdesivir with chloroquine or hydroxychloroquine is not recommended. 90
Hydroxychloroquine as treatment for COVID‐19	Do not use hydroxychloroquine for the treatment of COVID‐19 (strong recommendation, moderate certainty evidence). This recommendation applies to adults, children and adolescents, pregnant and breastfeeding women, older people living with frailty and those receiving palliative care. Use of hydroxychloroquine may still be considered in the context of randomised trials with appropriate ethical approval, such as combination therapies that include hydroxychloroquine.
Hydroxychloroquine for post‐exposure prophylaxis	For people exposed to individuals with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, do not use hydroxychloroquine for post‐exposure prophylaxis outside of randomised trials with appropriate ethical approval (strong recommendation, low certainty evidence). Trials are needed in special populations, including children and adolescents, pregnant and breastfeeding women, older people living with frailty and those receiving palliative care. Until further evidence is available, do not use hydroxychloroquine for post‐exposure prophylaxis in these populations unless they are eligible to be enrolled in trials.
Other disease‐modifying treatments	For people with COVID‐19, do not use the other disease‐modifying treatments‡ outside of randomised trials with appropriate ethical approval (strong recommendation, very low certainty evidence). Trials are needed in special populations, including children and adolescents, pregnant and breastfeeding women, older people living with frailty and those receiving palliative care. Until further evidence is available, do not use in these populations unless they are eligible to be enrolled in trials.

^†Recommendations were current at the time of writing. Please visit The National COVID‐19 Clinical Evidence Taskforce (https://covid19evidence.net.au/) for the latest updates to the recommendations.

^‡The treatments include: aprepitant, baloxavir marboxil, calcifediol, chloroquine, colchicine, convalescent plasma, darunavir‐cobicistat, favipiravir, human mesenchymal stem cells, immunoglobulin plus methylprednisolone, interferon β‐1a, interferon β‐1b, interferon gamma, lopinavir‐ritonavir, ruxolitinib, sofosbuvir‐daclatasvir, telmisartan and umifenovir.