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) Remdesivir Recommendation against (weak) Lopinavir-ritonavir Recommendation against (strong) Hydroxychloroquine Recommendation against (strong) Ivermectin Recommendation against (except in clinical trials) Raised respiratory rate in children ≥60 in children <2 months ≥50 in children 2-11 months ≥40 in children 1-5 years

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 Every 8 hours for 7-10 days Daily for7-10 days Every 6 hours for 7-10 days Methylprednisolone 10 mg Intravenous Daily for7-10 days Prednisone 40 mg Oral
Recommendation 1Usual supportive careCorticosteroidsorPatients with severeand critical covid-19We recommend corticosteroidsStrongAll 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