Table 5

Recommendations for use of corticosteroids for covid-19 in global guidelines produced early in pandemic

OriginCorticosteroid recommendationsEvidence baseAntimicrobials notes
WHOCorticosteroid therapy contraindicatedStockman LJ et al,27 Rodrigo C et al,28 Delaney et al,29 Arabi YM et al30Give empirical antimicrobials to treat all likely pathogens causing SARI
ItalyNot recommended for confirmed covid-19 patients, but low dose dexamethasone may be considered in patients with confirmed ARDS on ICU clinicians’ indicationWorld Health Organization interim guidance,9 Villar J et al31Add antibiotic (empirical or targeted) according to clinical indications, health policies, or protocols in use
US CDCCorticosteroids should be avoided unless indicated for other reasons (eg, COPD exacerbation or septic shock)Zumla A et a,l32 Arabi YM et al,30 Russell et al,33 Metlay JP et al34
IndiaNot recommended for viral pneumonia or ARDS outside of clinical trials, unless indicated for other reasonNo link to supporting evidence providedAntibiotics not recommended/covered
TurkeyNot recommended routinelyNo link to supporting evidence providedGive empirical antimicrobials to treat all likely pathogens causing SARI
South KoreaSteroids not indicated in general but may be considered for other conditions, such as septic shockNo link to supporting evidence providedEmpirical antimicrobials for possible pathogens are recommended
FranceSteroids not indicated for SARS-CoV-2 infection aloneStockman LJ et al27Routine use of antibiotics for treatment of covid-19 not recommended. However, antibiotics may be used if accompanying bacterial infection is suspected
BrazilNot recommended for viral pneumonia or ARDS outside of clinical trials, unless indicated for other reasonsNo link to supporting evidence provided
TaiwanNot recommended for viral pneumonia or ARDS outside of clinical trials, unless indicated for other reasonsNo link to supporting evidenceSystematic coverage of bacterial infection/superinfection recommended in severe forms
IndonesiaNot recommended for viral pneumonia or ARDS outside of clinical trials, unless indicated for other reasonsNo clear link to supporting evidence
SpainNot recommendedNo clear link to supporting evidenceGive empirical antimicrobials to treat all likely pathogens that cause SARS
MalaysiaNot recommended unless indicated for other reasons (eg, COPD, septic shock)No clear link to supporting evidenceConsider giving empirical antibiotics to treat other possible bacterial infection
GermanyNot recommended without clear indicationNo clear link to supporting evidenceGive empirical antibiotics based on likely aetiology

ARDS=acute respiratory distress syndrome; COPD=chronic obstructive pulmonary disease; ICU=intensive care unit; SARI=severe acute respiratory illness; SARS-CoV-2=severe acute respiratory syndrome coronavirus 2.