*New updates from July 20
- We recommend dexamethasone for patients with confirmed COVID-19 infection who require oxygen therapy. Dexamethasone 6 mg PO/IV daily x 10 days (or until discharge).
- For patients who were symptomatic for less than 7 days or not on oxygen, there was no benefit demonstrated in the single trial.
- May need steroids for shock or other indications – treat as usual for those indications.
- [July 20]
Avoid steroids (may increase viral shedding).
- Remdesivir can be considered for moderately ill patients (i.e. patients who were admitted to hospital on oxygen therapy) with confirmed COVID-19 infection if the drug is available.
- We do not recommend Remdesivir in critically ill patients as no benefit was demonstrated in clinical trials (ICU, high-flow nasal cannula).
- The only benefit demonstrated in one large trial was a shortened hospital stay.
- Drug-drug interactions should be considered before prescribing any agent, including this drug.
- [July 20] Anti-virals:
Not recommended at this time. None have been shown to be beneficial in SARS MERS or SARS-CoV2 (COVID-19).
- Consider early antibiotics if bacterial co-infection is suspected but use clinical judgement to de-escalate or stop if no longer indicated.
- In immunocompetent and immunocompromised hosts, we recommend the same regimen.
- If severe (ICU) – consider Ceftriaxone 1 g IV q24h
- If allergy: Moxifloxacin 400 PO q24h
- For hypovolemia, we recommend crystalloid administration with a target of euvolemia.
- The cause of death is nearly always ARDS. This can be exacerbated by excessive fluid administration so a directed approach is appropriate. Target euvolemia.
Other Specialized Treatments & Drugs
All other drug therapies are considered investigational at this time and can only be provided in the context of a clinical trial.
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.