04+IDSA指南COVID19患者的治疗和管理.docx

04+IDSA指南COVID19患者的治疗和管理.docx

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04+IDSA指南COVID19患者的治疗和管理

DownloadedfrombyKangwonNationalUniversity,SamcheokCampususeron29April2020

InfectiousDiseasesSocietyofAmericaGuidelinesontheTreatmentand

ManagementofPatientswithCOVID-19

AdarshBhimraj1,RebeccaL.Morgan2,AmyHirschShumaker3,ValeryLavergne4,LindseyBaden5,VincentChi-ChungCheng6,KathrynM.Edwards7,RajeshGandhi8,WilliamJ.Muller9,JohnC.O,Horo10,ShmuelShoham11,M.HassanMurad12,ReemA.Mustafa13,ShahnazSultan14,YngveFalck-Ytter3departmentofInfectiousDiseases,ClevelandClinic,Cleveland,Ohio

2DepartmentofHealthResearchMethods,EvidenceandImpact,McMasterUniversity,Hamilton,Ontario

3VANortheastOhioHealthcareSystem,CaseWesternReserveUniversitySchoolofMedicine,Cleveland,Ohio

4DepartmentofPathologyandLaboratoryMedicine,VancouverGeneralHospital,Vancouver,

BritishColumbia,Canada

5BrighamandWomen,sHospital,Boston,Massachusetts

6QueenMaryHospital,DepartmentofMicrobiology,LiKaShingFacultyofMedicine,The

UniversityofHongKong,HongKongSpecialAdministrativeRegion,China

7DivisionofInfectiousDiseases,DepartmentofPediatrics,VanderbiltUniversityMedicalCenter,Nashville,Tennessee

8InfectiousDiseasesDivision,DepartmentofMedicine,MassachusettsGeneralHospital,Boston,Massachusetts

9DivisionofPediatricInfectiousDiseases,NorthwesternUniversity,Chicago,Illinois

10DivisionofInfectiousDiseases,JointAppointmentPulmonaryandCriticalCareMedicine,

MayoClinic,Rochester,Minnesota

©TheAuthor（s）2020.PublishedbyOxfordUniversityPressfortheInfectiousDiseases

SocietyofAmerica.Allrightsreserved.Forpermissions,e-mail:

journals.permissions@.

©TheAuthor（s）2020.PublishedbyOxfordUniversityPressfortheInfectiousDiseasesSocietyofAmerica.Allrightsreserved.Forpermissions,e-mail:

journals.permissions@.

11JohnsHopkinsUniversitySchoolofMedicine,Baltimore,Maryland12DivisionofPreventiveMedicine,MayoClinic,Rochester,Minnesota13DivisionofNephrologyandHypertension,DepartmentofInternalMedicine,UniversityofKansasMedicalCenter,KansasCity,Kansas14DivisionofGastroenterology,Hepatology,andNutrition,UniversityofMinnesota,MinneapolisVAHealthcareSystem,Minneapolis,Minnesota

CorrespondingAuthor:

AdarshBhimraj

PanelMembers:

AdarshBhimraj（lead）,LindseyBaden,VincentChi-ChungCheng,KathrynM.Edwards,RajeshGandhi,WilliamJ.Muller,JohnC.O,Horo,ShmuelShoham,AmyHirschShumaker

DownloadedfrombyKangwonNationalUniversity,SamcheokCampususeron29April2020

Methodologists:

YngveFalck-Ytter（lead）,RebeccaL.Morgan,ValeryLavergne,M.HassanMurad,ReemA.Mustafa,ShahnazSultan

Abstract

Background:

TherearemanypharmacologictherapiesthatarebeingusedorconsideredfortreatmentofCOVID-19.Thereisaneedforfrequentlyupdatedpracticeguidelinesontheiruse,basedoncriticalevaluationofrapidlyemergingliterature.

Objective:

Developevidence-basedrapidguidelinesintendedtosupportpatients,cliniciansandotherhealth-careprofessionalsintheirdecisionsabouttreatmentandmanagementofpatientswithCOVID-19.

Methods:

IDSAformedamultidisciplinaryguidelinepanelofinfectiousdiseaseclinicians,pharmacists,andmethodologistswithvariedareasofexpertise.Processfollowedarapidrecommendationchecklist.Thepanelprioritizedquestionsandoutcomes.Thenasystematicreviewofthepeer-reviewedandgreyliteraturewasconducted.TheGradingofRecommendationsAssessment,DevelopmentandEvaluation（GRADE）approachwasusedtoassessthecertaintyofevidenceandmakerecommendations.

Results:

TheIDSAguidelinepanelagreedon7treatmentrecommendationsandprovidednarrativesummariesofothertreatmentsundergoingevaluations.

DownloadedfrombyKangwonNationalUniversity,SamcheokCampususeron29April2020

Conclusions:

Thepanelexpressedtheoverarchinggoalthatpatientsberecruitedintoongoingtrials,whichwouldprovidemuchneededevidenceontheefficacyandsafetyofvarioustherapiesforCOVID-19,giventhatwecouldnotmakeadeterminationwhetherthebenefitsoutweighharmsformosttreatments.

IDSADisclaimer

Itisimportanttorealizethatguidelinescannotalwaysaccountforindividualvariationamongpatients.Theyareassessmentsofcurrentscientificandclinicalinformationprovidedasaneducationalservice;arenotcontinuallyupdatedandmaynotreflectthemostrecentevidence（newevidencemayemergebetweenthetimeinformationisdevelopedandwhenitispublishedorread）;shouldnotbeconsideredinclusiveofallpropertreatmentsmethodsofcare,orasastatementofthestandardofcare;donotmandateanyparticularcourseofmedicalcare;andarenotintendedtosupplantphysicianjudgmentwithrespecttoparticularpatientsorspecialclinicalsituations.Whetherandtheextenttowhichtofollowguidelinesisvoluntary,withtheultimatedeterminationregardingtheirapplicationtobemadebythephysicianinthelightofeachpatient'sindividualcircumstances.WhileIDSAmakeseveryefforttopresentaccurate,complete,andreliableinformation,theseguidelinesarepresented“asis"withoutanywarranty,eitherexpressorimplied.IDSA（anditsofficers,directors,members,employees,andagents）assumenoresponsibilityforanyloss,damage,orclaimwithrespecttoanyliabilities,includingdirect,special,indirect,orconsequentialdamages,incurredinconnectionwiththeseguidelinesorrelianceontheinformationpresented.

TheguidelinesrepresenttheproprietaryandcopyrightedpropertyofIDSA.Copyright2020InfectiousDiseasesSocietyofAmerica.Allrightsreserved.Nopartoftheseguidelinesmaybereproduced,distributed,ortransmittedinanyformorbyanymeans,includingphotocopying,recording,orotherelectronicormechanicalmethods,withoutthepriorwrittenpermissionofIDSA.Permissionisgrantedtophysiciansandhealthcareproviderssolelytocopyandusetheguidelinesintheirprofessionalpracticesandclinicaldecision-making.Nolicenseorpermissionisgrantedtoanypersonorentity,andpriorwrittenauthorizationbyIDSAisrequired,tosell,distribute,ormodifytheguidelines,ortomakederivativeworksoforincorporatetheguidelinesintoanyproduct,includingbutnotlimitedtoclinicaldecisionsupportsoftwareoranyothersoftwareproduct.Exceptforthepermissiongrantedabove,anypersonorentitydesiringtousetheguidelinesinanywaymustcontactIDSAforapprovalinaccordancewiththetermsandconditionsofthird-partyuse,inparticularanyuseoftheguidelinesinanysoftwareproduct.

ExecutiveSummary

COVID-19isapandemicwitharapidlyincreasingincidenceofinfectionsanddeaths.Manypharmacologictherapiesarebeingusedorconsideredfortreatment.Giventherapidityofemergingliterature,IDSAidentifiedtheneedtodevelopliving,frequentlyupdatedevidence-basedguidelinestosupportpatients,cliniciansandotherhealth-careprofessionalsintheirdecisionsabouttreatmentandmanagementofpatientswithCOVID-19.

DownloadedfrombyKangwonNationalUniversity,SamcheokCampususeron29April2020

SummarizedbelowaretherecommendationswithcommentsrelatedtotheclinicalpracticeguidelineforthetreatmentandmanagementofCOVID-19.Adetaileddescriptionofbackground,methods,evidencesummaryandrationalethatsupporteachrecommendation,andresearchneedscanbefoundonlineinthefulltext.Inbrief,perGRADEmethodology,recommendationsarelabeled

as"strong"or"conditional”.Theword"recommend"indicatesstrongrecommendationsand"suggest"indicatesconditionalrecommendations.Insituationswherepromisinginterventionswerejudgedtohaveinsufficientevidenceofbenefittosupporttheiruseandwithpotentialappreciableharmsorcosts,theexpertpanelrecommendedtheiruseinthecontextofaclinicaltrial.Theguidelinepanelusedtheword"only"inrecommendationsabouttherapeuticagentswithhigheruncertaintyand/ormorepotentialforharm.Theserecommendationsacknowledgethecurrent“knowledgegap”andaimatavoidingprematurefavorablerecommendationsforpotentiallyineffectiveorharmfulinterventions.

Recommendation1.AmongpatientswhohavebeenadmittedtothehospitalwithCOVID-19,theIDSAguidelinepanelrecommendshydroxychloroquine/chloroquineinthecontextofaclinicaltrial.（Knowledgegap）

Recommendation2.AmongpatientswhohavebeenadmittedtothehospitalwithCOVID-19,theIDSAguidelinepanelrecommendshydroxychloroquine/chloroquineplusazithromycinonlyinthecontextofaclinicaltrial.（Knowledgegap）

Recommendation3.AmongpatientswhohavebeenadmittedtothehospitalwithCOVID-19,theIDSAguidelinepanelrecommendsthecombinationoflopinavir/ritonavironlyinthecontextofaclinicaltrial.（Knowledgegap）

Recommendation4.AmongpatientswhohavebeenadmittedtothehospitalwithCOVID-19pneumonia,theIDSAguidelinepanelsuggestsagainsttheuseofcorticosteroids.（Conditionalrecommendation,verylowcertaintyofevidence）

Recommendation5.AmongpatientswhohavebeenadmittedtothehospitalwithARDSduetoCOVID-19,theIDSAguidelinepanelrecommendstheuseofcorticosteroidsinthecontextofaclinicaltrial.（Knowledgegap）

Recommendation6.AmongpatientswhohavebeenadmittedtothehospitalwithCOVID-19,theIDSAguidelinepanelrecommendstocilizumab