Guidelines for the pharmacological treatment of COVID-19. The task-force/consensus guideline of the Brazilian Association of Intensive Care Medicine, the Brazilian Society of Infectious Diseases and the Brazilian Society of Pulmonology and Tisiology

ABSTRACT Introduction: Different therapies are currently used, considered, or proposed for the treatment of COVID-19; for many of those therapies, no appropriate assessment of effectiveness and safety was performed. This document aims to provide scientifically available evidence-based information in a transparent interpretation, to subsidize decisions related to the pharmacological therapy of COVID-19 in Brazil. Methods: A group of 27 experts and methodologists integrated a task-force formed by professionals from the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB), the Brazilian Society of Infectious Diseases (Sociedad Brasileira de Infectologia - SBI) and the Brazilian Society of Pulmonology and Tisiology (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT). Rapid systematic reviews, updated on April 28, 2020, were conducted. The assessment of the quality of evidence and the development of recommendations followed the GRADE system. The recommendations were written on May 5, 8, and 13, 2020. Results: Eleven recommendations were issued based on low or very-low level evidence. We do not recommend the routine use of hydroxychloroquine, chloroquine, azithromycin, lopinavir/ritonavir, corticosteroids, or tocilizumab for the treatment of COVID-19. Prophylactic heparin should be used in hospitalized patients, however, no anticoagulation should be provided for patients without a specific clinical indication. Antibiotics and oseltamivir should only be considered for patients with suspected bacterial or influenza coinfection, respectively. Conclusion: So far no pharmacological intervention was proven effective and safe to warrant its use in the routine treatment of COVID-19 patients; therefore such patients should ideally be treated in the context of clinical trials. The recommendations herein provided will be revised continuously aiming to capture newly generated evidence.

摘要
引言：当前已有多种疗法被应用于、拟应用于或考虑应用于新型冠状病毒肺炎（COVID-19）的治疗，但其中多数疗法尚未开展规范的有效性与安全性评估。本文件旨在以透明的解读方式提供科学可得的循证信息，辅助巴西境内新型冠状病毒肺炎药物治疗的临床决策。
方法：由来自巴西重症医学协会（Associação de Medicina Intensiva Brasileira - AMIB）、巴西传染病学会（Sociedade Brasileira de Infectologia - SBI）以及巴西肺科学与胸科学会（Sociedade Brasileira de Pneumologia e Tisiologia - SBPT）的专业人员组建专项工作组，共吸纳27名专家与方法学家。本研究于2020年4月28日完成更新后开展了快速系统综述。证据质量评估与推荐意见的制定均遵循GRADE系统。推荐意见撰写于2020年5月5日、8日及13日。
结果：基于低或极低等级证据，本工作组共提出11条推荐意见。我们不推荐常规使用羟氯喹、氯喹、阿奇霉素、洛匹那韦/利托那韦、糖皮质激素或托珠单抗治疗新型冠状病毒肺炎。住院患者应给予预防性肝素治疗，但无明确临床指征者不应实施抗凝治疗。仅分别在疑似合并细菌感染或流感病毒感染时，方可考虑使用抗生素与奥司他韦。
结论：截至目前，尚无任何药物干预措施被证实安全有效，足以支撑其在新型冠状病毒肺炎患者的常规治疗中应用，因此此类患者的治疗应优先纳入临床试验范畴。本文件所提出的推荐意见将持续更新，以纳入最新产生的研究证据。