Table 1.
Recommendations and suggestions for therapeutics of COVID-19 patients in low- and middle-income countries
| 1. Should remdesivir be given? | We recommend against using remdesivir for COVID-19 patients outside of a clinical trial (strong recommendation, moderate quality of evidence) |
| 2. Should hydroxychloroquine ± azithromycin be given? | We recommend against using hydroxychloroquine ± azithromycin (strong recommendation, high quality of evidence) |
| 3. Should lopinavir–ritonavir be given? | We recommend against using lopinavir–ritonavir (strong recommendation, high quality of evidence) |
| 4. Should broad-spectrum antimicrobial therapy be given empirically for potential coinfections? | We suggest close monitoring without additional empiric antimicrobials if there are no clinical or laboratory signs of other infections (weak recommendation, very low quality of evidence) |
| We suggest empiric antimicrobial treatment for likely coinfecting pathogens if an alternative infectious cause is likely (weak recommendation, very low quality of evidence) | |
| 5. Should corticosteroids be given? | We recommend using oral or intravenous low-dose dexamethasone in adults with COVID-19 disease who require oxygen or mechanical ventilation (strong recommendation, high quality of evidence) |
| We recommend the use of alternate equivalent doses of corticosteroids in the event that dexamethasone is unavailable (strong recommendation, low quality of evidence) | |
| We recommend against using dexamethasone in patients with COVID-19 who do not require supplemental oxygen (strong recommendation, high quality of evidence). | |
| We recommend using low-dose corticosteroids in adults with COVID-19 disease and shock requiring vasopressor support (strong recommendation, moderate quality of evidence) | |
| 6. Should convalescent plasma be transfused? | We recommend against the use of convalescent plasma in LMICs, except in the context of a clinical trial (strong recommendation, low quality of evidence) |
| 7. Should IL-6 inhibitors, such as tocilizumab, be given? | We recommend against the use of IL-6 inhibitors, such as tocilizumab, for the treatment of COVID-19 in LMICs outside of clinical trials (strong recommendation, low quality of evidence) |
IL-6 = interleukin-6; LMICs = low- and middle-income countries. For hospitalized COVID-19 patients in LMICs.