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. 2022 Mar-Apr;26(2):102347.
doi: 10.1016/j.bjid.2022.102347. Epub 2022 Mar 17.

Brazilian guidelines for the treatment of outpatients with suspected or confirmed COVID-19. A joint guideline of the Brazilian Association of Emergency Medicine (ABRAMEDE), Brazilian Medical Association (AMB), Brazilian Society of Angiology and Vascular Surgery (SBACV), Brazilian Society of Geriatrics and Gerontology (SBGG), Brazilian Society of Infectious Diseases (SBI), Brazilian Society of Family and Community Medicine (SBFMC), and Brazilian Thoracic Society (SBPT)

Maicon Falavigna  1 , Karlyse Claudino Belli  2 , Alexandre Naime Barbosa  3 , Alexandre Prehn Zavascki  4 , Ana Catharina de Seixas Santos Nastri  5 , Christiane Machado Santana  6 , Cinara Stein  2 , Débora Dalmas Gräf  2 , Flavio Adsuara Cadegiani  7 , Hélio Penna Guimarães  8 , José Tadeu Monteiro  9 , Juliana Carvalho Ferreira  10 , Luciano Cesar Pontes de Azevedo  11 , Marcelo Mihailenko Chaves Magri  5 , Marcone Lima Sobreira  12 , Maria Beatriz Gandra de Souza Dias  11 , Maura Salaroli de Oliveira  11 , Mirian de Freitas Dal Ben Corradi  13 , Regis Rosa  2 , Ricardo Souza Heinzelmann  14 , Rosemeri Maurici da Silva  15 , Rubens Belfort Junior  12 , Sergio Cimerman  16 , Verônica Colpani  2 , Viviane Cordeiro Veiga  17 , Carlos Roberto Ribeiro de Carvalho  11
Affiliations

Brazilian guidelines for the treatment of outpatients with suspected or confirmed COVID-19. A joint guideline of the Brazilian Association of Emergency Medicine (ABRAMEDE), Brazilian Medical Association (AMB), Brazilian Society of Angiology and Vascular Surgery (SBACV), Brazilian Society of Geriatrics and Gerontology (SBGG), Brazilian Society of Infectious Diseases (SBI), Brazilian Society of Family and Community Medicine (SBFMC), and Brazilian Thoracic Society (SBPT)

Maicon Falavigna et al. Braz J Infect Dis. 2022 Mar-Apr.

Abstract

Background: Several therapies have been used or proposed for the treatment of COVID-19, although their effectiveness and safety have not been properly evaluated. The purpose of this document is to provide recommendations to support decisions about the drug treatment of outpatients with COVID-19 in Brazil.

Methods: A panel consisting of experts from different clinical fields, representatives of the Brazilian Ministry of Health, and methodologists (37 members in total) was responsible for preparing these guidelines. A rapid guideline development method was used, based on the adoption and/or adaptation of recommendations from existing international guidelines combined with additional structured searches for primary studies and new recommendations whenever necessary (GRADE-ADOLOPMENT). The rating of quality of evidence and the drafting of recommendations followed the GRADE method.

Results: Ten technologies were evaluated, and 10 recommendations were prepared. Recommendations were made against the use of anticoagulants, azithromycin, budesonide, colchicine, corticosteroids, hydroxychloroquine/chloroquine alone or combined with azithromycin, ivermectin, nitazoxanide, and convalescent plasma. It was not possible to make a recommendation regarding the use of monoclonal antibodies in outpatients, as their benefit is uncertain and their cost is high, with limitations of availability and implementation.

Conclusion: To date, few therapies have demonstrated effectiveness in the treatment of outpatients with COVID-19. Recommendations are restricted to what should not be used, in order to provide the best treatment according to the principles of evidence-based medicine and to promote resource savings by aboiding ineffective treatments.

Keywords: Brazil; COVID-19; COVID-19 drug treatment; GRADE; Guideline; SARS-CoV-2.

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Conflict of interest statement

Conflicts of interest The list of participants and the declaration of conflicts of interest are presented in the Supplementary Material.

Figures

Fig 1
Fig. 1
Recommendations for drug treatment of outpatients with COVID-19. Source: the authors.
See this image and copyright information in PMC

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