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COVID-19 guidelines update on remdesivir, steroids, antivirals


Anastasia Tsirtsakis


5/05/2020 2:16:13 PM

Find out the latest expert recommendations in Australia’s living clinical guidelines for coronavirus patients.

Taking swab
The ‘Australian living guidelines for the clinical care of people with COVID-19’ will continue to be updated weekly throughout the pandemic.

The National COVID-19 Clinical Evidence Taskforce (the taskforce) has provided greater clarity for clinicians on the definition of disease severity for mild COVID-19:
 
‘[A] person not presenting any clinical features suggestive of moderate or severe disease a complicated course of illness.’
 
Characteristics include:

  • no symptoms
  • mild upper respiratory tract symptoms
  • cough, new myalgia or asthenia without new shortness of breath or a reduction in oxygen saturation.
When it comes to antivirals such as hydroxychloroquine and lopinavir-ritonavir, and other disease-modifying treatments, the expert panels have determined there remains e inadequate evidence of effectiveness for any treatments for COVID-19.
 
Remdesivir – the first therapy to receive FDA approval for emergency use – is on the taskforce’s radar. It is currently reviewing a randomised trial of the drug that was published in The Lancet on 29 April, as well as the Adaptive COVID-19 Treatment Trial (ACTT). Preliminary results for the ACCT have shown promise for faster recovery time in advanced COVID-19 cases.
 
The taskforce will incorporate an analysis of the findings into the clinical guidelines as soon as sufficient information becomes available.
 
Meanwhile, for patients with COVID-19 who also have asthma or chronic obstructive pulmonary disease (COPD), experts recommend clinicians follow the same protocol they would with exacerbated asthma or COPD and prescribe inhaled or oral steroids. Use of a nebuliser, however, is not advised.
 
GPs can download useful flowcharts incorporating the updated guideline recommendations and guidance on the following topics:
  The flowcharts also include additional details on in-person assessment of suspected cases, and updated advice from the Communicable Diseases Network Australia (CDNA) on criteria for SARS-CoV-2 testing.
 
GPs can also access guidance issued by the Australian Commission on Safety and Quality in Health Care (ACSQHC) on the use of antipyretics and nonsteroidal anti-inflammatory drugs (NSAIDs) in COVID-19 patients.
 
Evidence currently under review includes:
 
  • protocols for managing stroke and cardiac arrest
  • incidence of thrombosis among COVID-19 patients and use of anticoagulants
  • prone positioning during spontaneous breathing
  • early rehabilitation.
Launched in April, the Australian living guidelines for the clinical care of people with COVID-19 will continue to be updated weekly throughout the pandemic with evidence-based recommendations that address key clinical questions across the health sector, including primary care.
 
The research around COVID-19 is rapidly developing, with close to 3000 new papers and articles published last week alone, and 500 new studies added to the Cochrane COVID-19 Register of Studies.
 
The taskforce has recruited 40 additional clinical experts for three new expert panels on palliative and aged care, care of children, and pregnancy and perinatal care.
 
GPs can submit their clinical questions and provide feedback on the taskforce website.
 
The RACGP has more information on coronavirus available on its website.
 
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