Last update: May 14, 2020
The backbone of the treatment strategy for COVID-19 is good quality supportive care as in any viral pneumonia. There is no current evidence from RCTs to recommend any specific anti-COVID-19 treatment for patients with suspected or confirmed COVID-19 infection. In the absence of strong evidence, we recommend the following based upon limited reported data. This document will be updated continually as new evidence emerges and based on the availability of treatment regimens.
Currently, there is no evidence supporting outpatient management of patients with suspected or confirmed COVID-19, including the use of hydroxychloroquine and azithromycin.
Patient Admitted on Nasal Cannula
Disposition: Consider admission to intensive care unit if older than 65 years of age with a new oxygen requirement, D-dimer > 1 mcg/L, or RR > 22 breaths/min
Evaluate hematologic abnormalities and treat as appropriate. See Anticoagulation Dosing Recommendations for COVID-19 Patients.
Target SpO2 >90%. If oxygen requirement increases to 5 L, call primary team and ICU for evaluation.
Consider high-flow nasal cannula at 15 – 30 LPM with surgical mask over patient’s face.
Patient Admitted to Intensive Care Unit
Conservative fluid management strategy such as daily net neutral fluid balance in patients without evidence of shock
Evaluate for enrollment in clinical trials
Empiric early antibiotics for bacterial pneumonia; rule out influenza
Target SpO2 >92%. Consider HFNC at 15-30LPM with surgical mask over patients face.
If PaO2/FiO2 < 150, consider early proning and use of paralytics.
The agents listed below have no evidence supporting the use for treatment of COVID-19 but can be used for alternative diagnoses or in the context of clinical trials. * = drugs with low supply (recent shortage or currently on allocation) – contact Pharmacy with questions.
Information about ongoing or pottential clinical trials at UMMC can be found at this UMMC intranet site. (log-in required).
Hospitalized adults with confirmed SARS-CoV-2 or high suspicion for COVID-19Blinded, multicenter, placebo-controlled randomized clinical trial Intervention: hydroxychloroquine 400 mg twice daily for two doses (day 1), then 200 mg twice daily for days 2-5
A Phase 1b/2, Randomized, Double-Blind, Placebo-Controlled, Multi-Center Study to Evaluate the Safety and Efficacy of TJ003234 in Subjects with Severe Coronavirus Disease 2019 (COVID-19)
Evaluation of the safety and efficacy of TJ003234 administered as an intravenous (IV) infusion in subjects with severe COVID-19 under supportive care, and to assess the effect of TJ003234 on the levels of cytokines
Remdesivir for the Treatment of SARS-CoV2 Infection*Expanded Access*
Expanded access treatment protocol for use of RDV for thetreatment of a participant with coronavirus disease-2019 (COVID-19) resulting from infection ofSARS-CoV-2.
International, Multicenter, Randomized, Double-Blind, Placebo-Controlled Phase III Study Evaluating the Efficacy and Safety of Dapagliflozin in Respiratory Failure in Relation to COVID-19 (DARE 19)
Evaluation of the effects of dapagliflozin compared with placebo on risk of death or disease progression in patients hospitalized with COVID-19
Evaluation of impact of early losartan compared to placebo on change in respiratory failure
Evaluation of IV DNase treatment of COVID-19 patients with evidence of early hypercoagulable disseminated intravascular coagulation to determine safety and efficacy in reducing levels of circulating cell-free DNA
Duration: 5 days total
A/E: retinopathy, rash, nausea, glucose fluctuations
Available through either an expanded access protocol requiring study enrollment (above) or emergency use authorizationAdditional assessment
Pediatric – 2 years of age and older
Duration: 1 dose
Not Recommended: Risk/Benefit Ratio Does Not Favor Use
Pediatric - >3 months
A/E: hepatotoxicity, pancreatitis, QTc prolongation, diarrhea
Combination with ribavirin has been suggested based on synergistic action with lopinavir/ritonavir. Additional studies are needed before recommending this combination.
Information on drug interactions and administration for patients who cannot swallow can be found at: http://www.covid19-druginteractions.org/
These documents and content on this website are guidelines during the COVID-19 pandemic. Because new information is released rapidly, these documents can be updated or changed at any time. These documents are in no way to be considered as a standard of care and the content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The information in these documents is provided with no guarantees, accuracy, or timeliness. All content in these documents and website are for informational purposes only and do not constitute the providing of medical advice.