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Falavigna M, Colpani V, Stein C, Azevedo LCP, Bagattini AM, de Brito GV, Chatkin JM, Cimerman S, Corradi MDFDB, da Cunha CA, de Medeiros FC, de Oliveira Junior HA, Fritscher LG, Gazzana MB, Gräf DD, Marra LP, Matuoka JY, Nunes MS, Pachito DV, Pagano CGM, Parreira PDCS, Riera R, Silva Júnior A, Tavares BDM, Zavascki AP, Rosa RG, Dal-Pizzol F. 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. Rev Bras Ter Intensiva 2020; 32:166-196. [PMID: 32667444 PMCID: PMC7405746 DOI: 10.5935/0103-507x.20200039] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023] Open
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.
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Affiliation(s)
- Maicon Falavigna
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
- Instituto para Avaliação de Tecnologia em Saúde, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
- Department of Health Research Methods, Evidence, and Impact, McMaster University - Hamilton, Canadá
| | - Verônica Colpani
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
- Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Cinara Stein
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Luciano Cesar Pontes Azevedo
- Hospital Sírio-Libanês - São Paulo (SP), Brasil
- Disciplina de Emergências Clínicas, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Angela Maria Bagattini
- Hospital Sírio-Libanês - São Paulo (SP), Brasil
- Programa de Pós-Graduação em Medicina Tropical e Saúde Pública, Universidade Federal de Goiás - Goiânia (GO), Brasil
| | | | - José Miguel Chatkin
- Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brasil
- Sociedade Brasileira de Pneumologia e Tisiologia - Brasília (DF), Brasil
| | - Sergio Cimerman
- Instituto de Infectologia Emílio Ribas - São Paulo (SP), Brasil
- Sociedade Brasileira de Infectologia - São Paulo (SP), Brasil
| | | | - Clovis Arns da Cunha
- Sociedade Brasileira de Infectologia - São Paulo (SP), Brasil
- Universidade Federal do Paraná - Curitiba (PR), Brasil
| | | | | | - Leandro Genehr Fritscher
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
- Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Marcelo Basso Gazzana
- Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
- Serviço de Pneumologia e Cirurgia Torácica, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | | | - Lays Pires Marra
- Centro Internacional de Pesquisa, Hospital Alemão Oswaldo Cruz - São Paulo (SP), Brasil
| | - Jessica Yumi Matuoka
- Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | | | - Daniela Vianna Pachito
- Hospital Sírio-Libanês - São Paulo (SP), Brasil
- Fundação Getúlio Vargas - São Paulo (SP), Brasil
| | | | | | - Rachel Riera
- Hospital Sírio-Libanês - São Paulo (SP), Brasil
- Escola Paulista de Medicina, Universidade Federal de São Paulo - São Paulo (SP), Brasil
| | | | | | - Alexandre Prehn Zavascki
- Serviço de Infectologia e Controle de Infecção, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | | | - Felipe Dal-Pizzol
- Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense - Criciúma (SC), Brasil
- Serviço de Medicina Intensiva, Hospital São José - Criciúma (SC), Brasil
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Abstract
The new coronavirus (severe acute respiratory syndrome-related coronavirus 2, SARS-CoV-2) is a virus that causes a potentially serious respiratory disease that has spread in several countries, reaching humans in all age groups, including pregnant women. The purpose of this protocol is to provide technical and scientific support to Brazilian obstetricians regarding childbirth, postpartum and abortion care during the pandemic.
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MESH Headings
- Abortion, Legal/methods
- Betacoronavirus/isolation & purification
- Brazil
- COVID-19
- COVID-19 Testing
- Clinical Laboratory Techniques/methods
- Comorbidity
- Coronavirus Infections/diagnosis
- Coronavirus Infections/drug therapy
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Coronavirus Infections/therapy
- Delivery, Obstetric/methods
- Disease Transmission, Infectious/prevention & control
- Female
- Humans
- Infection Control/methods
- Infection Control/organization & administration
- Pandemics/prevention & control
- Perinatal Care/methods
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/therapy
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/prevention & control
- Pregnancy Complications, Infectious/therapy
- Risk Assessment/methods
- SARS-CoV-2
- COVID-19 Drug Treatment
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Affiliation(s)
- Alberto Trapani Júnior
- Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
- Universidade do Sul de Santa Catarina (Unisul), Palhoça, SC, Brazil
| | - Laura Rassi Vanhoni
- Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
- Hospital Regional Homero de Miranda Gomes, São José, SC, Brazil
| | - Sheila Koettker Silveira
- Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Alessandra Cristina Marcolin
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Lemos MM, Pedrosa AC, Tavares AP, Góes MA, Draibe SA, Sesso R. Divergences in antihypertensive therapy in special situations in nephrology. SAO PAULO MED J 2008; 126:34-40. [PMID: 18425285 PMCID: PMC11020520 DOI: 10.1590/s1516-31802008000100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 03/19/2007] [Accepted: 01/04/2008] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE The choice of an antihypertensive drug is based on several criteria and specific situations give rise to doubt and controversy. The aim here was to evaluate physicians approaches towards treatment with antihypertensive agents in specific situations. DESIGN AND SETTING Cross-sectional study, at Universidade Federal de São Paulo, São Paulo. METHODS A questionnaire was applied during a nephrology meeting to evaluate individual approaches towards each hypothetical clinical situation. The questionnaire consisted of five multiple-choice questions (clinical cases) concerning controversial aspects of antihypertensive therapy. RESULTS A total of 165 questionnaires were analyzed. Most participants were nephrologists (93.2%). There was a preference for angiotensin-converting enzyme (ACE) inhibitors in at least two of the cases. Only 57.2% of the physicians were correct in choosing beta-blockers as the first-line drugs for patients with ischemic coronary disease. Moreover, 66.2% chose ACE inhibitors as the first-line drugs for patients with chronic kidney disease and proteinuria. About 5% of the physicians did not follow the current recommendations for the use of ACE inhibitors in diabetic patients with microalbuminuria. The most controversial question concerned the first-line drug for advanced chronic kidney disease. Most physicians were correct in choosing calcium channel blockers and avoiding ACE inhibitors in renovascular hypertension in the case of a patient with a single functioning kidney. CONCLUSIONS Most physicians adopted the correct approach, but some had an alternative strategy for the same situations that was not based on evidence.
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