- Anti-virals: Not recommended at this time. None have been shown to be beneficial in SARS MERS or SARS-CoV2 (COVID-19).
- Antibiotics: Like in influenza, may consider early antibiotics but stop early.
- Delayed bacterial superinfection is uncommon (11/68 in one series)
- In immunocompetent and immunocompromised hosts, the same regimen.
- If severe (ICU) – consider Ceftriaxone 1 g IV q24h x 5 days
- If allergy: Moxifloxacin 400 PO q24h x 5 days
- Antibiotics did not help in Wuhan, China.
- Avoid steroids (may increase viral shedding). May need steroids for shock or other indications but careful consideration.
- Limit IV Fluid
- For hypovolemia, we recommend crystalloid administration.
- The cause of death is nearly always ARDS. This can be exacerbated by excessive fluid administration so a directed approach is appropriate. Target euvolemia.
- Antiplatelets not indicated.
- 5-10% who die, die of fulminant myocarditis (CHF, + trop, shock).
- Very severe cases may warrant experimental treatment. Consult ID.
Specialized Treatments & Drugs
There is no current treatment well supported by evidence for COVID-19 infection. All therapies are investigational. The initiation of Hydroxychloroquine or Remdesivir requires an Infectious Diseases phone consultation.
Therapies currently not approved or which are supported by limited data require infectious disease consultation prior to initiation and should only be considered in the critically ill or comorbid at this time. We have a very strong preference for enrollment in clinical trials over empiric therapy.
Drug Shortages and Drug Conservation
As volumes of patient care increase, it will be critical that we are conscious of potential for drug shortages. We have created local guidance around drug conservation that will be updated on an ongoing basis.