Guidelines for the pharmacological treatment of COVID-19. The task force/consensus guideline of the Brazilian Association of Intensive Care Medicine, the Brazilian Society of Infectious Diseases and the Brazilian Society of Pulmonology and Tisiology

• DOI: 10.5935/0103-507x.20200039
• Publication Date: 2020-07-08T16:44:24Z
• Authors: Maicon Falavigna; Verônica Colpani; Cinara Stein; Luciano Cesar Pon...; Angela Maria Baga...; Gabriela Vilela d...; José Miguel Chatkin; Sergio Cimerman; Mirian de Freitas...; Clovis Arns da Cunha; Flávia Cordeiro d...; Haliton Alves de ...; Leandro Genehr Fr...; Marcelo Basso Gaz...; Débora Dalmas Gräf; Lays Pires Marra; Jessica Yumi Matuoka; Michelle Silva Nunes; Daniela Vianna Pa...; Cássia Garcia Mor...; Patrícia do Carmo...; Rachel Riera; Amilton Silva Júnior; Bruno de Melo Tav...; Alexandre Prehn Z...; Regis Goulart Rosa; Felipe Dal-Pizzol
• Keywords: SARS-CoV-2; RC86-88.9; Brasil; Pneumonia, Viral; COVID-19; Medical emergencies. Critical care. Intensive care. First aid; Diretrizes; Guidelines; Betacoronavirus; Special Article; 03 medical and health sciences; GRADE; 0302 clinical medicine; Infecções por coronavirus/tratamento farmacológico; Humans; Coronavirus Infections; Pandemics; Coronavirus infections/drug therapy; Brazil

Different therapies are currently used, considered, or proposed for the treatment of COVID-19; for many of those therapies, no appropriate assessment of effectiveness and safety was performed. This document aims to provide scientifically available evidence-based information in a transparent interpretation, to subsidize decisions related to the pharmacological therapy of COVID-19 in Brazil.A group of 27 experts and methodologists integrated a task-force formed by professionals from the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB), the Brazilian Society of Infectious Diseases (Sociedad Brasileira de Infectologia - SBI) and the Brazilian Society of Pulmonology and Tisiology (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT). Rapid systematic reviews, updated on April 28, 2020, were conducted. The assessment of the quality of evidence and the development of recommendations followed the GRADE system. The recommendations were written on May 5, 8, and 13, 2020.Eleven recommendations were issued based on low or very-low level evidence. We do not recommend the routine use of hydroxychloroquine, chloroquine, azithromycin, lopinavir/ritonavir, corticosteroids, or tocilizumab for the treatment of COVID-19. Prophylactic heparin should be used in hospitalized patients, however, no anticoagulation should be provided for patients without a specific clinical indication. Antibiotics and oseltamivir should only be considered for patients with suspected bacterial or influenza coinfection, respectively.So far no pharmacological intervention was proven effective and safe to warrant its use in the routine treatment of COVID-19 patients; therefore such patients should ideally be treated in the context of clinical trials. The recommendations herein provided will be revised continuously aiming to capture newly generated evidence.