Intended for healthcare professionals

Practice Rapid Recommendations

A living WHO guideline on drugs for covid-19

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3379 (Published 04 September 2020) Cite this as: BMJ 2020;370:m3379

Visual summary of recommendation

Interventions Population Disease severity Non-severe Severe Critical SpO 2 <90% on room air Respiratory rate >30 in adults Signs of severe respiratory distress Requires life sustaining treatment Acute respiratory distress syndrome Sepsis Septic shock Absence of signs of severe or critical disease This recommendation applies only to people with these characteristics: Patients with confirmed covid-19 Corticosteroids Recommendation against (weak) Recommendation in favour (strong) Recommendation in favour (strong) Remdesivir Recommendation against (weak) Lopinavir-ritonavir Recommendation against (strong) Hydroxychloroquine Recommendation against (strong) Ivermectin Recommendation against (except in clinical trials) IL-6 receptor blockers Raised respiratory rate in children ≥60 in children <2 months ≥50 in children 2-11 months ≥40 in children 1-5 years Interleukin-6 receptor blockers

IL-6 receptor blockers

Suggested regimen Tocilizumab Max 800mg 8mg per kg Intravenous Intial dose over 1 hour or Sarilumab 400mg Intravenous Intial dose over 1 hour A second dose may be administered after 12 to 48 hours
Recommendation 1Usual supportive careIL-6 receptor blockersorPatients with severeand critical covid-19We recommend treatment with IL-6 receptor blockers(tociluzimab or sarilumab)StrongAll or nearly all informed people would likelywant the intervention to the left. Benefitswould outweigh harms for almost everyoneWeakMost people would likely want the interventionto the left. Benefits would outweigh harms forthe majority, but not for everyoneWeakMost people would likely want the interventionto the right. Benefits would outweigh harmsfor the majority, but not for everyoneStrongAll or nearly all informed people would likelywant the intervention to the right. Benefitswould outweigh harms for almost everyone

Ivermectin

No suggested regimen Trials used variable dosing strategies
Recommendation 1Usual supportive careIvermectinorPatients with covid-19at any severityWe recommend not using ivermectin in patients withcovid-19 except in the context of a clinical trialStrongAll or nearly all informed people would likelywant the intervention to the left. Benefitswould outweigh harms for almost everyoneWeakMost people would likely want the interventionto the left. Benefits would outweigh harms forthe majority, but not for everyoneWeakMost people would likely want the interventionto the right. Benefits would outweigh harmsfor the majority, but not for everyoneStrongAll or nearly all informed people would likelywant the intervention to the right. Benefitswould outweigh harms for almost everyone

Hydroxychloroquine

Suggested regimen Hydroxychloroquine 800 to 1600mg Oral On the first day then Hydroxychloroquine 200 to 800mg Oral Daily for 5 to 21 days 1 to 3 divided doses 1 to 2 divided doses
Recommendation 1Usual supportive careHydroxychloroquineorPatients with covid-19at any severityWe recommend against administeringhydroxychloroquine or chloroquineStrongAll or nearly all informed people would likelywant the intervention to the left. Benefitswould outweigh harms for almost everyoneWeakMost people would likely want the interventionto the left. Benefits would outweigh harms forthe majority, but not for everyoneWeakMost people would likely want the interventionto the right. Benefits would outweigh harmsfor the majority, but not for everyoneStrongAll or nearly all informed people would likelywant the intervention to the right. Benefitswould outweigh harms for almost everyone

Lopinavir-ritonavir

Suggested regimen Lopinavir 800mg Oral Daily Ritonavir 200mg Oral Daily Combinedwith Divided intotwo doses
Recommendation 1Usual supportive careLopinavir-ritonavirorPatients with covid-19at any severityWe recommend against administeringlopinavir-ritonavirStrongAll or nearly all informed people would likelywant the intervention to the left. Benefitswould outweigh harms for almost everyoneWeakMost people would likely want the interventionto the left. Benefits would outweigh harms forthe majority, but not for everyoneWeakMost people would likely want the interventionto the right. Benefits would outweigh harmsfor the majority, but not for everyoneStrongAll or nearly all informed people would likelywant the intervention to the right. Benefitswould outweigh harms for almost everyone

Remdesivir

Suggested regimen Remdesivir 200 mg Intravenous On the first day Remdesivir 100 mg Intravenous Daily for 5-10 days then
Recommendation 1Usual supportive careRemdesivirorPatients with covid-19at any severityWe suggest no remdesivir StrongAll or nearly all informed people would likelywant the intervention to the left. Benefitswould outweigh harms for almost everyoneWeakMost people would likely want the interventionto the left. Benefits would outweigh harms forthe majority, but not for everyoneWeakMost people would likely want the interventionto the right. Benefits would outweigh harmsfor the majority, but not for everyoneStrongAll or nearly all informed people would likelywant the intervention to the right. Benefitswould outweigh harms for almost everyone

Corticosteroids

Corticosteroids Suggested regimen Acceptable alternative regimens Dexamethasone 6 mg Oral or intravenous Hydrocortisone 50 mg Intravenous