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Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19 : An evidence-based clinical practice guideline (updated version)

Jin, Ying-Hui ; Zhan, Qing-Yuan ; Peng, Zhi-Yong ; Ren, Xue-Qun ; Yin, Xun-Tao ; Cai, Lin ; Yuan, Yu-Feng ; Yue, Ji-Rong ; Zhang, Xiao-Chun and Yang, Qi-Wen , et al. (2020) In Military Medical Research 7(1).
Abstract

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, coronavirus disease 2019 (COVID-19), affecting more than seventeen million people around the world. Diagnosis and treatment guidelines for clinicians caring for patients are needed. In the early stage, we have issued "A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)"; now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline. We formed a working group of clinical experts and methodologists. The steering group members proposed 29 questions that are... (More)

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, coronavirus disease 2019 (COVID-19), affecting more than seventeen million people around the world. Diagnosis and treatment guidelines for clinicians caring for patients are needed. In the early stage, we have issued "A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)"; now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline. We formed a working group of clinical experts and methodologists. The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas: chemoprophylaxis, diagnosis, treatments, and discharge management. We searched the literature for direct evidence on the management of COVID-19, and assessed its certainty generated recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement. Finally, we issued 34 statements. Among them, 6 were strong recommendations for, 14 were weak recommendations for, 3 were weak recommendations against and 11 were ungraded consensus-based statement. They covered topics of chemoprophylaxis (including agents and Traditional Chinese Medicine (TCM) agents), diagnosis (including clinical manifestations, reverse transcription-polymerase chain reaction (RT-PCR), respiratory tract specimens, IgM and IgG antibody tests, chest computed tomography, chest x-ray, and CT features of asymptomatic infections), treatments (including lopinavir-ritonavir, umifenovir, favipiravir, interferon, remdesivir, combination of antiviral drugs, hydroxychloroquine/chloroquine, interleukin-6 inhibitors, interleukin-1 inhibitors, glucocorticoid, qingfei paidu decoction, lianhua qingwen granules/capsules, convalescent plasma, lung transplantation, invasive or noninvasive ventilation, and extracorporeal membrane oxygenation (ECMO)), and discharge management (including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge). We also created two figures of these recommendations for the implementation purpose. We hope these recommendations can help support healthcare workers caring for COVID-19 patients.

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organization
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type
Contribution to journal
publication status
published
subject
in
Military Medical Research
volume
7
issue
1
article number
41
publisher
BioMed Central (BMC)
external identifiers
  • pmid:32887670
  • scopus:85090505821
ISSN
2054-9369
DOI
10.1186/s40779-020-00270-8
language
English
LU publication?
yes
additional info
Position article and Guidelines
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8390698c-5063-4b1c-8a23-6188294b4123
date added to LUP
2020-09-16 12:45:57
date last changed
2021-04-06 03:02:50
@article{8390698c-5063-4b1c-8a23-6188294b4123,
  abstract     = {<p>The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, coronavirus disease 2019 (COVID-19), affecting more than seventeen million people around the world. Diagnosis and treatment guidelines for clinicians caring for patients are needed. In the early stage, we have issued "A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)"; now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline. We formed a working group of clinical experts and methodologists. The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas: chemoprophylaxis, diagnosis, treatments, and discharge management. We searched the literature for direct evidence on the management of COVID-19, and assessed its certainty generated recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement. Finally, we issued 34 statements. Among them, 6 were strong recommendations for, 14 were weak recommendations for, 3 were weak recommendations against and 11 were ungraded consensus-based statement. They covered topics of chemoprophylaxis (including agents and Traditional Chinese Medicine (TCM) agents), diagnosis (including clinical manifestations, reverse transcription-polymerase chain reaction (RT-PCR), respiratory tract specimens, IgM and IgG antibody tests, chest computed tomography, chest x-ray, and CT features of asymptomatic infections), treatments (including lopinavir-ritonavir, umifenovir, favipiravir, interferon, remdesivir, combination of antiviral drugs, hydroxychloroquine/chloroquine, interleukin-6 inhibitors, interleukin-1 inhibitors, glucocorticoid, qingfei paidu decoction, lianhua qingwen granules/capsules, convalescent plasma, lung transplantation, invasive or noninvasive ventilation, and extracorporeal membrane oxygenation (ECMO)), and discharge management (including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge). We also created two figures of these recommendations for the implementation purpose. We hope these recommendations can help support healthcare workers caring for COVID-19 patients.</p>},
  author       = {Jin, Ying-Hui and Zhan, Qing-Yuan and Peng, Zhi-Yong and Ren, Xue-Qun and Yin, Xun-Tao and Cai, Lin and Yuan, Yu-Feng and Yue, Ji-Rong and Zhang, Xiao-Chun and Yang, Qi-Wen and Ji, Jianguang and Xia, Jian and Li, Yi-Rong and Zhou, Fu-Xiang and Gao, Ya-Dong and Yu, Zhui and Xu, Feng and Tu, Ming-Li and Tan, Li-Ming and Yang, Min and Chen, Fang and Zhang, Xiao-Ju and Zeng, Mei and Zhu, Yu and Liu, Xin-Can and Yang, Jian and Zhao, Dong-Chi and Ding, Yu-Feng and Hou, Ning and Wang, Fu-Bing and Chen, Hao and Zhang, Yong-Gang and Li, Wei and Chen, Wen and Shi, Yue-Xian and Yang, Xiu-Zhi and Wang, Xue-Jun and Zhong, Yan-Jun and Zhao, Ming-Juan and Li, Bing-Hui and Ma, Lin-Lu and Zi, Hao and Wang, Na and Wang, Yun-Yun and Yu, Shao-Fu and Li, Lu-Yao and Huang, Qiao and Weng, Hong and Ren, Xiang-Ying and Yu, Lin-Xin},
  issn         = {2054-9369},
  language     = {eng},
  month        = {09},
  number       = {1},
  publisher    = {BioMed Central (BMC)},
  series       = {Military Medical Research},
  title        = {Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19 : An evidence-based clinical practice guideline (updated version)},
  url          = {http://dx.doi.org/10.1186/s40779-020-00270-8},
  doi          = {10.1186/s40779-020-00270-8},
  volume       = {7},
  year         = {2020},
}