Table 3

Variability in recommendations of targeted covid-19 therapies across guidelines

CountryAntiviralsLevel of supportNotes
ItalyIf need for oxygen or clinical worsening: remdesivir ampoules 150 mg 1 day 200 mg IV in 30 min, then 100 mg IV OD for another 9 days in combination with chloroquine 500 mg BD or hydroxychloroquine 200 mg BD (duration of treatment 5-20 days)Expert consensus following literature reviewMethods for reaching conclusions unclear
In severe disease: remdesivir 1 day 200 mg IV, then 100 mg/day IV (days 2-10) + chloroquine 500 mg BD or hydroxychloroquine 200 mg × 2 PO 5-20 days
RussiaIn moderate to severe infections: 400 mg lopinavir/100 mg ritonavir BD for 14 days PO; or 400 mg lopinavir/100 mg ritonavir) (5 mL) BD 14 days NGT; or recombinant interferon 1b 0.25 mg/mL (8 million IU) SC every second day for 14 days; or ribavarin 2 g loading dose, then 1200 mg TID for 4 days, then 4-6 days 600 mg TIDResults from literature review led to three drugs being chosen. No preference or order is recommended. Not clear how authors excluded other optionsAdvises antivirals can be prescribed off label after benefits v risk assessment. Oseltamivir not recommended
FranceAdvised for all patients admitted to ICU on confirmation of diagnosis. First line: lopinavir/ritonavir 400 mg BD; second line: hydroxychloroquine 200 mg BDIf parenchymal involvement. Recommendations based on data in SARS and MERS. First line treatment chosen because readily availableAdvises against ribavarin owing to inconclusive data
NetherlandsIn moderate disease: first line chloroquine 600 mg PO, then 300 mg for 5 days; second line lopinavir/ritonavir 400/100 mg BD for 14 daysNoting that very little information is available, makes no definitive recommendations. Acknowledges lack of phase I data for remdesivirAdvises against use of ribavirin alone owing to toxicity at required doses. Notes poor evidence for interferon in combination with ribavirin. Oseltamivir not recommended
In severe disease: remdesivir + chloroquine or lopinavir/ritonavir + chloroquine
SpainFirst line: lopinavir/ritonavir 400/100 mg BD PO until disappearance of fever for maximum 14 days; second line: interferon β1b 0.25 mg SC every 48 h for 14 days or interferon α2b 5 million units in 2 mL of sterile serum, BD INHOnly for severe pneumonia, CURB >65, SpO2 <90%Notes in-vitro studies and ongoing Chinese trials. Oseltamivir not recommended
Remdesivir 200 mg IV, then 100 mg IV OD for 9 daysFor compassionate use only in severe disease
ChinaAlpha-interferon (5 million units or equivalent dose BD INH) or lopinavir/ritonavir (200/50 mg × 2 BD for ≤10 days); or ribavirin (used jointly with interferon or lopinavir/ritonavir, 500 mg IV TID for adults, for ≤10 days); or chloroquine phosphate (500 mg BD for ≤10 days); or arbidol (200 mg TID for adults, for ≤10 days)Does not recommend using three or more antiviral drugs at same time
GermanyNumerous antiviral therapies are used in the context of SARS-CoV-2. Too little data are currently available to make a therapy recommendation in Germany. Even for severe forms of COVID-19 there is insufficient evidence to recommend therapy
JapanNo specific therapy recommended. Lopinavir/ritonavir, anti-influenza drug favipiravir, remdesivir, and ciclesonide, an inhaled steroid used in asthma, are listed as potential therapeutic agentsAdvises these agents may be future therapeutic agents pending trials
South KoreaLopinavir/ritonavir 400/100 mg BD for 7-10 days; or hydroxychloroquine 400 mg OD; or interferon can be administered in combination with lopinavir/ritonavirRemdesivir only to be used in clinical trialsRibavirin not recommended owing to adverse reactions

BD=twice daily; ICU=intensive care unit; INH=inhalation; IV=intravenous; MERS=Middle East respiratory syndrome; NGT=nasogastric tube; OD=once daily; PO=oral; SARS-CoV-2=severe acute respiratory disorder coronavirus 2; SC=subcutaneous; TID=three times daily;