Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: an evidence-based clinical practice guideline (updated version)
Mil. med. res. (Lond.); 7 (41), 2020
Publication year: 2020
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness,
coronavirus disease 2019 (COVID-19), affecting more than seventeen million people around the world. Diagnosis
and treatment guidelines for clinicians caring for patients are needed. In the early stage, we have issued “A rapid
advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia
(standard version)”; now there are many direct evidences emerged and may change some of previous
recommendations and it is ripe for develop an evidence-based guideline. We formed a working group of clinical
experts and methodologists. The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas: chemoprophylaxis, diagnosis, treatments, and discharge
management. We searched the literature for direct evidence on the management of COVID-19, and assessed its
certainty generated recommendations using the Grading of Recommendations, Assessment, Development and
Evaluation (GRADE) approach. Recommendations were either strong or weak, or in the form of ungraded
consensus-based statement. Finally, we issued 34 statements. Among them, 6 were strong recommendations for, 14
were weak recommendations for, 3 were weak recommendations against and 11 were ungraded consensus-based
statement. They covered topics of chemoprophylaxis (including agents and Traditional Chinese Medicine (TCM)
agents), diagnosis (including clinical manifestations, reverse transcription-polymerase chain reaction (RT-PCR),
respiratory tract specimens, IgM and IgG antibody tests, chest computed tomography, chest x-ray, and CT features
of asymptomatic infections), treatments (including lopinavir-ritonavir, umifenovir, favipiravir, interferon, remdesivir,
combination of antiviral drugs, hydroxychloroquine/chloroquine, interleukin-6 inhibitors, interleukin-1 inhibitors,
glucocorticoid, qingfei paidu decoction, lianhua qingwen granules/capsules, convalescent plasma, lung
transplantation, invasive or noninvasive ventilation, and extracorporeal membrane oxygenation (ECMO)), and
discharge management (including discharge criteria and management plan in patients whose RT-PCR retesting
shows SARS-CoV-2 positive after discharge). We also created two figures of these recommendations for the
implementation purpose. We hope these recommendations can help support healthcare workers caring for COVID19 patients
Chemoprevention/methods, Coronavirus Infections/diagnosis, Coronavirus Infections/drug therapy, Pneumonia, Viral/diagnosis, Pneumonia, Viral/drug therapy, Pandemics/prevention & control, Betacoronavirus/drug effects, Evidence-Based Practice/methods, Anti-Retroviral Agents/therapeutic use, Lopinavir/therapeutic use, Chloroquine/therapeutic use, Receptors, Interleukin-6/therapeutic use, Hydroxychloroquine/therapeutic use, Plasma/immunology