BWH QUICK-REFERENCE GUIDE

COVID-19 Drugs & Treatment Version 112020.1

For more information on therapeutics, visit https://covidprotocols.org/protocols/therapeutics.

See also: Inpatient, Outpatient, and ICU Patient guides at https://covidprotocols.org/quick-guides
ANTIBIOTICS ANTIHYPERTENSIVES
• Use only if concerned for bacterial co-infection • ACEIs/ARBs: use as normal (no additional risk)
‫ ظ‬procalcitonin not reliable in cytokine storm • CCBs: use as normal
• Azithromycin: use only if indicated for bacterial infection
ANTI-INFLAMMATORIES / IMMUNOSUPPRESSANTS
ANTICOAGULATION Page prescribing physician to discuss before changing home
• Therapeutic AC: if otherwise indicated; currently immunosuppression (some can be safely held, others cannot).
not recommended for treatment of COVID alone • Steroids: recommended if on supplemental oxygen
• Prophylactic AC: given increased VTE risk, COVID ICU ‫ ظ‬Dexamethasone 6 mg IV or PO daily × 10 days,
patients need higher prophylaxis or alternative equivalents:
‫ ظ‬hold if PLT < 25 K, neurosurgery, hemorrhage, etc. » Hydrocortisone 50 mg IV q8h × 10 days
‫ ظ‬PTT may not be reliable due to coagulopathy, » Methylprednisolone 15 mg IV BID × 10 days
in some patients consider anti-Xa monitoring » Prednisone 40 mg PO daily × 10 days
» Goal peak for VTE ppx is between 0.2 and 0.5 • Anti-IL1, Anti-IL6: do not use unless in consultation with
(measured 4 – 6 hours after 3 – 4 injections) Rheum or Pulmonary
‫ ظ‬outpatients: no prophylaxis unless otherwise • Hydroxychloroquine: do not use
indicated, recommend frequent ambulation • NSAIDS: use as normal
Inpatient ppx (normal dose) ANTITUSSIVES AND EXPECTORANTS
Weight CrCl ≥ 3 0 ml/min CrCl < 3 0 ml/min • Guaifenesin may help with secretions
Low (< 50 k g) Enoxaparin UFH 5,000 units • Dextromethorphan, Benzonatate, Codeine for cough
30 mg daily BID or TID
ANTIVIRALS
Standard Enoxaparin UFH
40 mg daily 5,000 units q8h ID follows inpatients for clinical trials and current Tx.
(See Therapeutics Summary at covidprotcols.org)
Obese Enoxaparin UFH
(≥ 120 kg 40 mg BID or 7,500 units q8h • Remdesivir recommended if patient meets criteria
or BMI ≥ 35) 0.5 mg/kg daily • Convalescent Plasma: unclear benefit, likely depends on
(max 100 mg daily) titer and neutralizing Ab; available under EUA
• Monoclonal Antibodies: consider in early disease if
ICU / post-ICU ppx until discharge (high dose) available, detailed recommendations coming soon
Weight CrCl ≥ 3 0 ml/min CrCl < 3 0 ml/min • No convincing evidence for: Interferon, IVIG, Lopinavir/
Ritonavir, Ribavirin, Zinc, Vitamin C
Low (< 60 kg) Enoxaparin UFH
30 mg BID 7,500 units q8h
BRONCHODILATORS/INHALERS
Standard Enoxaparin UFH • Bronchodilators if patient has asthma or COPD, but not
40 mg BID 7,500 units q8h routinely indicated for COVID
Obese Enoxaparin UFH • Use MDIs if possible (less aerosolizing), treat nebulizers
(≥ 120 kg 0.5 mg/kg BID 10,000 units q8h as AGP unless ventilated (in-line closed circuit neb)
or BMI ≥ 35) (max 100 mg BID)
INTRAVENOUS HYDRATION
• Conservative boluses as needed (LR preferred) with
dynamic measures of response (delta BP, UOP, PPV, CVP)
• Avoid maintenance IVF due to hypoxemia risk

See https://covidprotocols.org/ for current full manual.