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COVID-19 Treatment Guidelines Coronavirus Disease 2019 (COVID-19) Treatment Guidelines Credit NIAID-RML How to Cite the COVID-19 Treatment Guidelines: COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/. Accessed [insert date]. The COVID-19 Treatment Guidelines Panel regularly updates the recommendations in these guidelines as new information on the management of COVID-19 becomes available. The most recent version of the guidelines can be found on the COVID-19 Treatment Guidelines website (https://www.covid19treatmentguidelines.nih.gov/). Table of Contents What’s New in the Guidelines .................................................................................................. 5 The COVID-19 Treatment Guidelines Panel’s Statement on the Updated Emergency Use Authorization of the Anti-SARS-CoV-2 Monoclonal Antibody Combination Casirivimab Plus Imdevimab for the Treatment of COVID-19 ................................................ 9 The COVID-19 Treatment Guidelines Panel’s Statement on the Emergency Use Authorizations of Anti-SARS-CoV-2 Monoclonal Antibodies for the Treatment of COVID-19 ................................................................................................................................ 11 Introduction ............................................................................................................................ 16 Overview of COVID-19 ........................................................................................................... 19 Testing for SARS-CoV-2 Infection ...................................................................................... 24 Prevention and Prophylaxis of SARS-CoV-2 Infection ...................................................... 30 Clinical Spectrum of SARS-CoV-2 Infection ...................................................................... 41 Clinical Management Summary ............................................................................................. 49 General Management of Nonhospitalized Patients with Acute COVID-19 ........................ 52 Therapeutic Management of Nonhospitalized Adults With COVID-19 .............................. 59 Therapeutic Management of Hospitalized Adults With COVID-19 .................................... 64 Care of Critically Ill Adult Patients With COVID-19 ............................................................... 75 General Considerations ..................................................................................................... 77 Infection Control ................................................................................................................ 85 Hemodynamics .................................................................................................................. 88 Oxygenation and Ventilation .............................................................................................. 92 Acute Kidney Injury and Renal Replacement Therapy....................................................... 99 Pharmacologic Interventions ........................................................................................... 100 Extracorporeal Membrane Oxygenation .......................................................................... 101 Antiviral Drugs That Are Approved or Under Evaluation for the Treatment of COVID-19 . 103 Remdesivir ....................................................................................................................... 105 Table 2a. Remdesivir: Selected Clinical Data ............................................................. 108 Chloroquine or Hydroxychloroquine and/or Azithromycin ............................................... 114 Table 2b. Chloroquine or Hydroxychloroquine and/or Azithromycin: Selected Clinical Data ............................................................................................... 118 Ivermectin ........................................................................................................................ 128 Table 2c. Ivermectin: Selected Clinical Data .............................................................. 133 Lopinavir/Ritonavir and Other HIV Protease Inhibitors .................................................... 152 Nitazoxanide .................................................................................................................... 157 Table 2d. Nitazoxanide: Selected Clinical Data .......................................................... 159 Table 2e. Characteristics of Antiviral Agents That Are Approved or Under Evaluation for the Treatment of COVID-19 ....................................................................... 162 COVID-19 Treatment Guidelines 2 Anti-SARS-CoV-2 Antibody Products ................................................................................. 166 Anti-SARS-CoV-2 Monoclonal Antibodies ....................................................................... 168 Table 3a. Anti-SARS-CoV-2 Monoclonal Antibodies: Selected Clinical Data ............. 175 Convalescent Plasma ...................................................................................................... 181 Table 3b. COVID-19 Convalescent Plasma: Selected Clinical Data ........................... 188 Immunoglobulins: SARS-CoV-2-Specific ........................................................................ 199 Table 3c. Characteristics of SARS-CoV-2 Antibody-Based Products Under Evaluation for the Treatment of COVID-19 ....................................................................... 200 Cell-Based Therapy Under Evaluation for the Treatment of COVID-19 ............................. 203 Immunomodulators Under Evaluation for the Treatment of COVID-19.............................. 206 Colchicine ........................................................................................................................ 207 Corticosteroids ................................................................................................................. 211 Table 4a. Corticosteroids: Selected Clinical Data ...................................................... 216 Fluvoxamine ..................................................................................................................... 227 Granulocyte-Macrophage Colony-Stimulating Factor Inhibitors ..................................... 230 Table 4b. Granulocyte-Macrophage Colony-Stimulating Factor Inhibitors: Selected Clinical Data ................................................................................................ 233 Immunoglobulins: Non-SARS-CoV-2-Specific ................................................................ 237 Interferons (Alfa, Beta) ..................................................................................................... 239 Interleukin-1 Inhibitors ..................................................................................................... 243 Interleukin-6 Inhibitors ..................................................................................................... 246 Table 4c. Interleukin-6 Inhibitors: Selected Clinical Data ........................................... 252 Kinase Inhibitors: Baricitinib and Other Janus Kinase Inhibitors, and Bruton’s Tyrosine Kinase Inhibitors ................................................................................................ 264 Table 4d. Characteristics of Immunomodulators Under Evaluation for the Treatment of COVID-19 .................................................................................................... 271 Antithrombotic Therapy in Patients with COVID-19 ........................................................... 283 Supplements ......................................................................................................................... 292 Vitamin C .......................................................................................................................... 293 Vitamin D .......................................................................................................................... 296 Zinc .................................................................................................................................. 298 Considerations for Certain Concomitant Medications in Patients with COVID-19 ........... 302 COVID-19 and Special Populations ..................................................................................... 308 Special Considerations in Pregnancy .............................................................................. 309 Special Considerations in Children .................................................................................. 314 Special Considerations in Adults and Children With Cancer ........................................... 325 Special Considerations in Solid Organ Transplant, Hematopoietic Stem Cell Transplant, and Cellular Therapy Candidates, Donors, and Recipients .......................... 333 COVID-19 Treatment Guidelines 3 Special Considerations in People With HIV ..................................................................... 340 Influenza and COVID-19 .................................................................................................. 346 Appendix A, Table 1. COVID-19 Treatment Guidelines Panel Members ............................ 350 Appendix A, Table 2. Panel on COVID-19 Treatment Guidelines Financial Disclosure for Companies Related
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