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. 2023 Aug 7;22(1):67.
doi: 10.1186/s12941-023-00623-w.

Pan-American Guidelines for the treatment of SARS-CoV-2/COVID-19: a joint evidence-based guideline of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API)

Alexandre Naime Barbosa  1   2 , Alberto Chebabo  3   4 , Carlos Starling  5 , Clevy Pérez  6 , Clóvis Arns Cunha  4   7 , David de Luna  8 , Estevão Portela Nunes  9 , Gabriela Zambrano  10   11 , Juliana Carvalho Ferreira  12   13 , Julio Croda  14 , Maicon Falavigna  15 , Monica Maria Gomes-da-Silva  16 , Monica Thormann  17 , Sergio Cimerman  4   18 , Suena Medeiros Parahiba  15 , Suzana Tanni  19 , Wanderley Marques Bernardo  20 , Alfonso J Rodriguez-Morales  21   22   23   24
Affiliations

Pan-American Guidelines for the treatment of SARS-CoV-2/COVID-19: a joint evidence-based guideline of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API)

Alexandre Naime Barbosa et al. Ann Clin Microbiol Antimicrob. .

Abstract

Background: Since the beginning of the COVID-19 pandemic, therapeutic options for treating COVID-19 have been investigated at different stages of clinical manifestations. Considering the particular impact of COVID-19 in the Americas, this document aims to present recommendations for the pharmacological treatment of COVID-19 specific to this population.

Methods: Fifteen experts, members of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API) make up the panel responsible for developing this guideline. Questions were formulated regarding prophylaxis and treatment of COVID-19 in outpatient and inpatient settings. The outcomes considered in decision-making were mortality, hospitalisation, need for mechanical ventilation, symptomatic COVID-19 episodes, and adverse events. In addition, a systematic review of randomised controlled trials was conducted. The quality of evidence assessment and guideline development process followed the GRADE system.

Results: Nine technologies were evaluated, and ten recommendations were made, including the use of tixagevimab + cilgavimab in the prophylaxis of COVID-19, tixagevimab + cilgavimab, molnupiravir, nirmatrelvir + ritonavir, and remdesivir in the treatment of outpatients, and remdesivir, baricitinib, and tocilizumab in the treatment of hospitalised patients with severe COVID-19. The use of hydroxychloroquine or chloroquine and ivermectin was discouraged.

Conclusion: This guideline provides recommendations for treating patients in the Americas following the principles of evidence-based medicine. The recommendations present a set of drugs that have proven effective in the prophylaxis and treatment of COVID-19, emphasising the strong recommendation for the use of nirmatrelvir/ritonavir in outpatients as the lack of benefit from the use of hydroxychloroquine and ivermectin.

Keywords: COVID-19; Guidelines; SARS-CoV-2; Therapy; Treatment.

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Conflict of interest statement

MF received consulting fees related to COVID-19 from Pfizer and MSD outside the context of the present study. AJRM received support from API to participate at on-site meetings in Brazil, also from Gilead Brazil for the 2023 meeting. CP, DL, GZ, JCF, MT, SMP, ST, and WMB have no direct financial interests.

Figures

Fig. 1
Fig. 1
Summary of recommendations for the pharmacological treatment of COVID-19. Tixa + cilga stands for tixagevimab + cilgavimab. Source: manuscript’ authors
See this image and copyright information in PMC

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