Pan-American Guidelines for the treatment of SARS-CoV-2/COVID-19: a joint evidence-based guideline of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API)

Barbosa, Alexandre Naime; Chebabo, Alberto; Starling, Carlos; Pérez, Clevy; Cunha, Clóvis Arns; de Luna, David; Nunes, Estevão Portela; Zambrano, Gabriela; Ferreira, Juliana Carvalho; Croda, Julio; Falavigna, Maicon; Gomes-da-Silva, Monica Maria; Thormann, Monica; Cimerman, Sergio; Parahiba, Suena Medeiros; Tanni, Suzana; Bernardo, Wanderley Marques; Rodriguez-Morales, Alfonso J.

doi:10.1186/s12941-023-00623-w

Cited by 6 publications

(6 citation statements)

References 56 publications

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“…With these premises, we believe that antiviral drugs still have a clear indication in the early treatment of patients with COVID-19 and risk factors for a poor clinical course, particularly when other treatments such as monoclonal antibodies do not seem effective at present. Several institutions have issued recent recommendations on various aspects of treatment and in particular on antiviral treatment [ 62 , 63 ].…”

Section: What Should Be the Antiviral Treatment Of Patients With Covi...mentioning

confidence: 99%

COVID -19: On the threshold of the fifth year. The situation in Spain

Rodríguez-Artalejo,

Ruiz-Galiana,

Cantón

et al. 2023

Rev Esp Quimioter

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Despite having emerged from pandemic status, the incidence of COVID-19 episodes has recently increased in Spain, including pediatric cases and admissions to Intensive Care Units. Several recombinant variants are circulating among us, particularly XBB arising from two Omicron BA.2 sublineages with mutations in the genes encoding the spicule proteins that could increase binding to the ACE2 receptor and be more prone to immune escape. Faced with these, 3 pharmaceutical companies have developed vaccines adapted to the XBB.1.5 sublineage that are already available for administration in our setting with risks that should not be different from those of previous mRNA vaccines and with clearly favorable benefit/risk ratios. They should be applied to patients with potential for poor COVID-19 evolution and to collectives that have a particular relationship of proximity with them. Their application should be understood not only from a perspective of individual convenience but also from that of collective responsibility. The most convenient seems to be a simultaneous immunization of COVID-19 and influenza in our environment. In the therapeutic aspect, there is little to expect right now from antisera, but the already known antiviral drugs are still available and indicated, although their efficacy will have to be reevaluated due to their impact on populations that are mostly immunized and with a better prognosis than in the past. In our opinion, it is necessary to continue to make a reasonable and timely use of masks and other non-pharmacological means of protection.

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Section: What Should Be the Antiviral Treatment Of Patients With Covi...mentioning

confidence: 99%

COVID -19: On the threshold of the fifth year. The situation in Spain

Rodríguez-Artalejo,

Ruiz-Galiana,

Cantón

et al. 2023

Rev Esp Quimioter

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“…Em agosto de 2023, foi publicada a Diretriz Pan-Americana para o tratamento da COVID-19 baseada em evidências recentes, obtidas por especialistas membros da Sociedade Brasileira de Infectologia (SBI) e da Associação Pan-Americana de Infectologia (API) a partir de uma revisão sistemática de ensaios clínicos randomizados em fase III. Seguindo as recomendações do PRISMA, avaliando o risco de viés a partir do Cochrane Risk of Bias Tool 2.0 e a qualidade das evidências a partir da Grading of Recommendations Assessment, Development, and Evaluation (GRADE), as evidências foram sintetizadas e recomendações elaboradas, para um manejo da COVID-19 mais eficaz e com suporte científico robusto (Barbosa et al, 2023).…”

Section: Recomendações Atualizadasunclassified

Uso de cloroquina, azitromicina e ivermectina durante a pandemia da COVID-19: Uma revisão integrativa

Reis,

Rocha Junior,

Dominato

2023

RSD

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Durante a pandemia de COVID-19, a comunidade científica buscou veementemente por medicamentos que pudessem auxiliar no tratamento da doença em questão. Utilizaram-se medicamentos como cloroquina, azitromicina e ivermectina como automedicação, antes de confirmar sua eficácia contra o vírus e a doença. Após pouco mais de dois anos do início da pandemia mundial de COVID, a maneira como cuidamos da saúde, ainda levanta hipóteses, por parte da população, sobre as diversas formas corretas de lidar com a doença, afirmando que as diferentes abordagens seriam efetivas ou não? O objetivo reuniu evidências sobre a farmacocinética, mecanismo de ação proposto na COVID-19, efeitos adversos, eficácia e segurança da cloroquina/ hidroxicloroquina, azitromicina e ivermectina para profilaxia e tratamento da COVID-19. A metodologia usada foi uma revisão integrativa, que seguiu as recomendações da diretriz PRISMA adaptada. A busca na literatura foi conduzida nas bases de dados PubMed, LILACS e MEDLINE. Uma análise crítica foi realizada para apurar o rigor metodológico dos estudos, a partir da avaliação do nível das evidências científicas. Os resultados evidenciaram que o uso de hidroxicloroquina, cloroquina, azitromicina ou ivermectina, nas formas leve ou grave da COVID-19, tanto no tratamento como profilaxia, não demonstrou nenhum benefício na diminuição da mortalidade, hospitalizações ou outros desfechos desfavoráveis, não limitando a transmissão viral nem evitando a instalação da infecção. Concluindo que é contraindicado o uso destes medicamentos supracitados como medidas profiláticas e terapêuticas para a COVID-19, pela escassez de evidências favoráveis consistentes e pelos numerosos relatos de desfechos adversos em tais tratamentos.

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“…Furthermore, since the publication of the first version of this guideline in June 2022, ( 6 ) there have been advances in knowledge of the pharmacological treatment of patients hospitalized with COVID-19 and changes in the regulations on the use of medication in Brazil, such as the suspension of the use authorization of casirivimab + imdevimab, the authorization to use baricitinib and new evidence on the use of tocilizumab. Furthermore, the Pan-American Guidelines for the Treatment of SARS-CoV-2/COVID-19 ( 7 ) were recently published and include recommendations for the use of remdesivir, baricitinib and tocilizumab for the treatment of patients hospitalized with COVID-19. Therefore, it is necessary to update the guidelines in the Brazilian context.…”

Section: Introductionmentioning

confidence: 99%

The II Brazilian Guidelines for the pharmacological treatment of patients hospitalized with COVID-19 Joint Guidelines of the Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia and Sociedade Brasileira de Reumatologia

Falavigna,

Araujo,

Barbosa

et al. 2023

Crit Care Sci

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Objective To update the recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods Experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results Twenty-one recommendations were generated, including strong recommendations for the use of corticosteroids in patients using supplemental oxygen and conditional recommendations for the use of tocilizumab and baricitinib for patients on supplemental oxygen or on noninvasive ventilation and anticoagulants to prevent thromboembolism. Due to suspension of use authorization, it was not possible to make recommendations regarding the use of casirivimab + imdevimab. Strong recommendations against the use of azithromycin in patients without suspected bacterial infection, hydroxychloroquine, convalescent plasma, colchicine, and lopinavir + ritonavir and conditional recommendations against the use of ivermectin and remdesivir were made. Conclusion New recommendations for the treatment of hospitalized patients with COVID-19 were generated, such as those for tocilizumab and baricitinib. Corticosteroids and prophylaxis for thromboembolism are still recommended, the latter with conditional recommendation. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and to promote resource economy.

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Pan-American Guidelines for the treatment of SARS-CoV-2/COVID-19: a joint evidence-based guideline of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API)

Cited by 6 publications

References 56 publications

COVID -19: On the threshold of the fifth year. The situation in Spain

COVID -19: On the threshold of the fifth year. The situation in Spain

Uso de cloroquina, azitromicina e ivermectina durante a pandemia da COVID-19: Uma revisão integrativa

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