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.
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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