COVID-19 Treatment Guidelines Coronavirus Disease 2019 (COVID-19) Treatment Guidelines Credit NIAID-RML Downloaded from https://www.covid19treatmentguidelines.nih.gov/ on 9/25/2021 Visit https://www.covid19treatmentguidelines.nih.gov/ to access the most up-to-date guideline. 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/). Downloaded from https://www.covid19treatmentguidelines.nih.gov/ on 9/25/2021 Table of Contents What’s New in the Guidelines .................................................................................................. 5 The COVID-19 Treatment Guidelines Panel’s Statement on Bamlanivimab Plus Etesevimab for the Treatment of Mild to Moderate COVID-19 in Nonhospitalized Patients ..... 8 The COVID-19 Treatment Guidelines Panel’s Statement on the Prioritization of Anti-SARS-CoV-2 Monoclonal Antibodies for the Treatment or Prevention of SARS-CoV-2 Infection When There Are Logistical Constraints ...................................................................... 9 The COVID-19 Treatment Guidelines Panel’s Statement on the Emergency Use Authorization of Casirivimab Plus Imdevimab as Post-Exposure Prophylaxis for SARS-CoV-2 Infection ... 10 Introduction ............................................................................................................................ 14 Overview of COVID-19 ........................................................................................................... 17 Testing for SARS-CoV-2 Infection ...................................................................................... 22 Prevention and Prophylaxis of SARS-CoV-2 Infection ...................................................... 28 Clinical Spectrum of SARS-CoV-2 Infection ...................................................................... 39 Clinical Management Summary ............................................................................................. 47 General Management of Nonhospitalized Patients with Acute COVID-19 ........................ 50 Therapeutic Management of Nonhospitalized Adults With COVID-19 .............................. 57 Therapeutic Management of Hospitalized Adults With COVID-19 .................................... 62 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 Downloaded from https://www.covid19treatmentguidelines.nih.gov/ on 9/25/2021 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 ............. 177 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 ............................. 204 Immunomodulators Under Evaluation for the Treatment of COVID-19.............................. 207 Colchicine ........................................................................................................................ 208 Corticosteroids ................................................................................................................. 212 Table 4a. Systemic Corticosteroids: Selected Clinical Data ....................................... 219 Table 4b. Inhaled Corticosteroids: Selected Clinical Data .......................................... 230 Fluvoxamine ..................................................................................................................... 232 Granulocyte-Macrophage Colony-Stimulating Factor Inhibitors ..................................... 235 Table 4c. Granulocyte-Macrophage Colony-Stimulating Factor Inhibitors: Selected Clinical Data ................................................................................................ 238 Immunoglobulins: Non-SARS-CoV-2-Specific ................................................................ 242 Interferons (Alfa, Beta) ..................................................................................................... 244 Interleukin-1 Inhibitors ..................................................................................................... 248 Interleukin-6 Inhibitors ..................................................................................................... 251 Table 4d. Interleukin-6 Inhibitors: Selected Clinical Data ........................................... 257 Kinase Inhibitors: Baricitinib and Other Janus Kinase Inhibitors, and Bruton’s Tyrosine Kinase Inhibitors ................................................................................................ 269 Table 4e. Characteristics of Immunomodulators Under Evaluation for the Treatment of COVID-19 .................................................................................................... 276 Antithrombotic Therapy in Patients with COVID-19 ........................................................... 289 Supplements ......................................................................................................................... 298 Vitamin C .......................................................................................................................... 299 Vitamin D .......................................................................................................................... 302 Zinc .................................................................................................................................. 304 Considerations for Certain Concomitant Medications in Patients with COVID-19 ........... 308 COVID-19 and Special Populations ..................................................................................... 314 Special Considerations in Pregnancy .............................................................................. 315 Special Considerations in Children .................................................................................. 320 Special Considerations in Adults and Children With Cancer ........................................... 331 Special Considerations in Solid Organ Transplant, Hematopoietic Stem Cell Transplant, and Cellular Therapy Candidates, Donors, and Recipients .........................