Intended for healthcare professionals

Rapid response to:

Practice Rapid Recommendations

A living WHO guideline on drugs for covid-19

BMJ 2020; 370 doi: (Published 04 September 2020) Cite this as: BMJ 2020;370:m3379

Visual summary of recommendation

Interventions Population Disease severity Non-severe Severe Critical SpO 2 <90% on room air Respiratory rate >30 in adults Signs of severe respiratory distress Requires life sustaining treatment Acute respiratory distress syndrome Sepsis Septic shock Absence of signs of severe or critical disease This recommendation applies only to people with these characteristics: Patients with confirmed covid-19 Corticosteroids Recommendation against (weak) Recommendation in favour (strong) Remdesivir Recommendation against (weak) Raised respiratory rate in children ≥60 in children <2 months≥50 in children 2-11 months≥40 in children 1-5 years

Remdesivir

Suggested regimen Remdesivir 100 mg Intravenous Daily for5-10 days 200 mg Intravenous On thefirst day then
Recommendation 1Usual supportive careRemdesivirorPatients with covid-19at any severityWe suggest no remdesivir StrongAll or nearly all informed people would likelywant the intervention to the left. Benefitswould outweigh harms for almost everyoneWeakMost people would likely want the interventionto the left. Benefits would outweigh harms forthe majority, but not for everyoneWeakMost people would likely want the interventionto the right. Benefits would outweigh harmsfor the majority, but not for everyoneStrongAll or nearly all informed people would likelywant the intervention to the left. Benefitswould outweigh harms for almost everyone

Corticosteroids

Corticosteroids Suggested regimen Acceptable alternative regimens Dexamethasone 6 mg Oral or intravenous Hydrocortisone 50 mg Intravenous Every 8 hours for 7-10 days Daily for7-10 days Every 6 hours for 7-10 days Methylprednisolone 10 mg Intravenous Daily for7-10 days Prednisone 40 mg Oral
Recommendation 1Usual supportive careCorticosteroidsorPatients with severeand critical covid-19We recommend corticosteroidsStrongAll or nearly all informed people would likelywant the intervention to the left. Benefitswould outweigh harms for almost everyoneWeakMost people would likely want the interventionto the left. Benefits would outweigh harms forthe majority, but not for everyoneWeakMost people would likely want the interventionto the right. Benefits would outweigh harmsfor the majority, but not for everyoneStrongAll or nearly all informed people would likelywant the intervention to the left. Benefitswould outweigh harms for almost everyone
Recommendation 2Usual supportive careCorticosteroidsorPatients withnon-severe covid-19We suggest no corticosteroidsStrongAll or nearly all informed people would likelywant the intervention to the left. Benefitswould outweigh harms for almost everyoneWeakMost people would likely want the interventionto the left. Benefits would outweigh harms forthe majority, but not for everyoneWeakMost people would likely want the interventionto the right. Benefits would outweigh harmsfor the majority, but not for everyoneStrongAll or nearly all informed people would likelywant the intervention to the left. Benefitswould outweigh harms for almost everyone

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Rapid Response:

Good Effort! Re: A living WHO guideline on drugs for covid-19

Dear Editor,

It was a nice coincidence that I read BMA/BMJ Best Practices Guidelines for CoVID-19 just some 12 hours before reading this article "A living WHO Guideline on Drugs for CoVID-19". I felt two articles should complement each other. Of course, the BMJ Best Practices Guidelines for CoVID-19 are far more extensive and exhaustive, almost all encompassing the subject.

The observations, analysis, interpretation, decision regarding the course of action, all these have to be arrived at the bedside, impromptu and extempore. But the Best Practices Guidelines such as those of WHO and BMJ lay a sound foundation to build upon the strong fortress of patient care.

Well done!

Arvind Joshi MBBS MD FCGP FAMS FICP.

Competing interests: No competing interests

20 November 2020
Arvind Joshi
Founder Convener and President Our Own Discussion Group, Consultant Physician.
Our Own Discussion Group, Mumbai PIN 400028; Consaltant Physician at Ruchi Diagnostic Center and Ruchi Clinical Laboratory Kharghar PIN 410210.
Mumbai PIN 400028, Kharghar PIN 410210; Maharashtra State INDIA.