Rapid COVID-19 Clinical Practice Guidelines (2020)

Provide the patient with effective oxygen therapy, which may include a nasal catheter, mask oxygen, high-flow nasal oxygen therapy, noninvasive ventilation, or invasive mechanical ventilation.

Consider using extracorporeal membrane oxygenation for patients with refractory hypoxemia that is difficult to correct with protective lung ventilation.

Antiviral Treatment

Currently, no evidence from randomized controlled trials supports specific drug treatment against the novel coronavirus in suspected or confirmed cases.

Medical treatments to consider include alfa-interferon atomization inhalation (5 million U/treatment in sterile injection water, twice daily) and oral lopinavir/ritonavir (2 capsules/treatment, twice daily).

Antibiotic Therapy

Blind or inappropriate use of antibacterial drugs should be avoided, particularly combined broad-spectrum antibacterials. Bacteriological surveillance should be performed, and appropriate antibacterial drugs should be promptly administered if a secondary bacterial infection is present.

Based on the patient’s clinical manifestations, if a secondary bacterial infection cannot be ruled out, those with mild symptoms can be administered antibacterial drugs targeted against community-acquired pneumonia (eg, amoxicillin, azithromycin, fluoroquinolones). Patients with severe symptoms should be given empirical antibacterial treatment to cover all possible pathogens, with deescalating therapy until pathogenic bacteria are determined.

Other Medications

For the symptomatic treatment of fever if the patient’s temperature is higher than 38.5°C (101.3°F), use ibuprofen as an antipyretic (0.2 g/dose every 4 hours, not to exceed 4 doses in 24 hours). A temperature of lower than 38°C (100.4°F) is acceptable.

To reduce the incidence of stress ulcers and gastrointestinal bleeding, H2 receptor antagonists or proton pump inhibitors should be used in those patients with gastrointestinal bleeding risk factors. These risk factors include mechanical ventilation for 48 hours or longer, coagulation dysfunction, renal replacement therapy, and liver disease, among others.

To reduce lung congestion and improve respiratory function in patients with dyspnea, coughing, wheezing, or respiratory distress syndrome due to increased respiratory gland secretion, use selective (M1, M3) receptor anticholinergic drugs, which help reduce secretions, relax smooth muscle in the airway, relieve airway spasm, and improve pulmonary ventilation.

To reduce the incidence of venous embolism in patients at risk (ie, after evaluation), use low-molecular-weight heparin or heparin in high-risk patients without contraindications.

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