Journal of Korean Society of Health-System Pharmacists

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Table. 1.

Table. 1.

코로나19 가이드라인 권고사항

Institute (Last updated) Recommendation
WHO*(March, 2021) ①Hospitalized patients with COVID-19 infection, regardless of disease severity
-Remdesivir: We suggest against administering remdesivir in addition to usual care
②For patients with severe or critical COVID-19-infection
-Systemic corticosteroids: We recommend systemic corticosteroids rather than no corticosteroids
NIH (June, 2021) ①Not hospitalized, mild to moderate COVID-19
-Bamlanivimab + Etesevimab (AIIa)
-Casirivimab + Imdevimab (AIIa)
②Hospitalized and requires supplemental oxygen
-Remdesivir (e.g., for patients who require minimal supplemental oxygen) (BIIa)
-Dexamethasone + Remdesivir (e.g., for patients who require increasing amounts of supplement oxygen) (BII)
-Dexamethasone (when combination therapy with remdesivir cannot be used or is not available) (BI)
-If the rare circumstances when corticosteroids cannot be used, Baricitinib + Remde-sivir can be used (BIIa)
-Baricitinib should not be used without remdesivir
③Hospitalized and requires oxygen delivery through a high-flow device or noninvasive ventilation
-Dexamethasone (AI)
-Dexamethasone + Remdesivir (BIII)
-For patients who were recently hospitalized with rapidly increasing oxygen needs and systemic inflammation: Add either baricitinib (BIIa) or tocilizumab (BIIa) to one of the two options above
④Hospitalized and requires invasive mechanical ventilation or ECMO(extracorporeal membrane oxygenation)
-Dexamethasone (AI)
-For patients who are within 24 hours of admission to the ICU: Dexamethasone + Tocilizumab (BIIa)
ISDA (June, 2021) ①Glucocorticoids
-Hospitalized critically ill§ patients with COVID-19: Dexamethasone (Strong recom-mendation, Moderate certainty of evidence)
-Hospitalized patients with severe∥, but non-critical, COVID-19: Dexamethasone.(Conditional, Moderate)
②Interleukin-6 Inhibitors (e.g., tocilizumab)
-Hospitalized adults with progressive severe∥ or critical§ COVID-19 who have elevated markers of systemic inflammation: Tocilizumab in addition to standard of care (i.e., steroids) (Conditional, Low)
-Hospitalized patients with severe∥ COVID-19: Remdesivir (Conditional, Moderate)
-In patients on supplemental oxygen but not on mechanical ventilation or ECMO: Treatment with five days of remdesivir rather than 10 days of remdesivir (Condi-tional, Low)
ISDA(June, 2021) ④Neutralizing Antibodies
-Ambulatory patients with mild to moderate COVID-19 at high risk for progression to severe disease: Bamlanivimab/etesevimab, casirivimab/imdevimab, or sotrovimab (Conditional, Moderate)
-Hospitalized adults with severe∥ COVID-19 having elevated inflammatory markers but not on invasive mechanical ventilation: Baricitinib (Conditional, Moderate)
-Hospitalized patients with severe∥ COVID-19 who cannot receive a corticosteroid (which is standard of care) because of a contraindication: Baricitinib with remdesi-vir rather than remdesivir alone (Conditional, Low)
대한감염학회 (March, 2021) ①Remdesivir: 산소치료가 필요하지만 인공호흡기 또는 ECMO를 사용하지 않는 코로나19 환자에게 렘데시비르를 사용할 수 있다.(근거수준: 중등도, 권고등급: B)
②Steroids: 코로나19로 인한 중증(severe) 또는 심각(critical) 환자에게 스테로이드 투여를 권고한다 .(중등도, A)
③IL-6 inhibitors (토실리주맙, 살리루맙 등): 코로나19 중증 이상 환자에게 인터루킨-6 (Interleu-kin-6, IL-6) 억제제는 임상시험 범위 내에서 사용할 수 있다.(중등도, B)

*WHO (World Health Organization) 세계보건기구, NIH(National Institutes of Health) 미국 국립 보건원, IDSA(Infectious Diseases Society of America) 미국 감염학회, § critical illness: patients on mechanical ventilation and ECMO, Critical illness includes end organ dysfunction as is seen in sepsis/septic shock. In COVID-19, the most commonly reported form of end organ dysfunction is ARDS, ∥severe: patients with SpO2 ≤94% on room air, including patients on supplemental oxygen

J. Kor. Soc. Health-syst. Pharm. 2021;38:377-91
© 2021 J. Kor. Soc. Health-syst. Pharm.