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Differences between Clinical Protocols for the Treatment of Coronavirus Disease 2019 (COVID-19) in Andalusia, Spain
Luis M Pérez-Belmonte1,2, María D López-Carmona1, Juan L Quevedo-Marín3
1Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
Insights
COVID-19 treatment protocols varied significantly across major Spanish hospitals. Key differences were observed in antiviral drug choices, corticosteroid use, and anticoagulation strategies, highlighting the need for clinical trials.
Area of Science:
- Infectious Diseases
- Clinical Medicine
- Hospital Management
Background:
- The novel coronavirus disease 2019 (COVID-19) pandemic necessitated rapid development of clinical treatment protocols.
- Variability in treatment approaches can impact patient outcomes and resource allocation.
Purpose of the Study:
- To compare clinical protocols for COVID-19 treatment across major hospitals in Andalusia, Spain.
- To analyze variations in antiviral, antibacterial, adjunctive, and supportive care strategies.
Main Methods:
- A review of the latest COVID-19 treatment protocols (as of July 2020) from the 15 largest hospitals in Andalusia.
- Analysis of antiviral treatments, empirical antibacterial agents, adjunctive therapies, anticoagulation, supportive care, and discharge recommendations.
Main Results:
- Hydroxychloroquine, often combined with azithromycin or lopinavir/ritonavir, was frequently recommended for mild to severe pneumonia.
- Significant variation was noted in corticosteroid regimens and the use of anakinra.
- All protocols included heparin for thromboembolism prophylaxis and treatment, with differing dosage strategies for high-risk and critical patients.
Conclusions:
- Substantial heterogeneity exists in COVID-19 clinical protocols among Andalusian hospitals, particularly concerning antiviral therapies, corticosteroids, and anticoagulation.
- The wide range of treatments underscores the urgent need for rigorous randomized clinical trials to establish evidence-based, consistent guidelines.
Abstract:
Our objective was to compare clinical protocols for the treatment of the novel coronavirus disease 2019 (COVID-19) among different hospitals in Andalusia, Spain. We reviewed the current COVID-19 protocols of the 15 largest hospitals in Andalusia. Antiviral treatment, empirical antibacterial agents, adjunctive therapies, anticoagulant treatment, supportive care, hospital organization, and discharge recommendations were analyzed. All protocols included were the latest updates as of July 2020. Hydroxychloroquine in monotherapy was the most frequent antiviral drug recommended for mild respiratory illness with clinical risk factors (33.3%). Combined hydroxychloroquine with azithromycin or lopinavir/ritonavir was found in 40% of protocols. The recommended treatment for patients with mild and moderate pneumonias was different antiviral combinations including hydroxychloroquine plus azithromycin (93.3%) or hydroxychloroquine plus lopinavir/ritonavir (79.9%). Different combinations of hydroxychloroquine and lopinavir/ritonavir (46.7%) and triple therapy with hydroxychloroquine, azithromycin, and lopinavir/ritonavir (40%) were the most recommended treatments for patients with severe pneumonia. There were five corticosteroid regimens, which used dexamethasone, methylprednisolone, or prednisone, with different doses and treatment durations. Anakinra was included in seven protocols with six different regimens. All protocols included prophylactic heparin and therapeutic doses for thromboembolism. Higher prophylactic doses of heparin for high-risk patients and therapeutic doses for patients in critical condition were included in 53.3% and 33.3% of protocols, respectively. This study showed that COVID-19 protocols varied widely in several aspects (antiviral treatment, corticosteroids, anakinra, and anticoagulation for high risk of thrombosis or critical situation). Rigorous randomized clinical trials on the proposed treatments are needed to provide consistent evidence.
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