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Care for adults with COVID-19: living guidelines from the National COVID-19 Clinical Evidence Taskforce
Heath White1, Steve J McDonald1, Bridget Barber2
1Cochrane Australia, Monash University, Melbourne, VIC.
Insights
The Australian COVID-19 Clinical Evidence Taskforce provides updated treatment guidelines for coronavirus disease 2019 (COVID-19). Recommendations cover drug therapies, respiratory support, and preventative measures for non-pregnant adults with varying disease severity.
Area of Science:
- Infectious Diseases
- Clinical Medicine
- Public Health
Background:
- The Australian National COVID-19 Clinical Evidence Taskforce was established in March 2020 to provide up-to-date recommendations for COVID-19 treatment.
- The guideline has evolved significantly, expanding from nine to 176 recommendations since its inception.
- This process involves rapid identification, appraisal, and analysis of clinical trial findings, followed by expert panel review.
Purpose of the Study:
- To describe the COVID-19 treatment recommendations for non-pregnant adults as of August 1, 2022 (version 61.0).
- To outline specific recommendations for managing mild, severe, and critical COVID-19.
- To detail recommendations for disease severity definitions, therapy, prophylaxis, respiratory support, and supportive care.
Main Methods:
- Systematic review and expert consensus of clinical trial data.
- Continuous updating and expansion of treatment recommendations.
- Categorization of recommendations based on disease severity and need for supplemental oxygen.
Main Results:
- Eight drug treatments are recommended for patients not requiring supplemental oxygen, and six for those requiring it.
- Ten drug treatments are not recommended due to limited benefit; 42 others are recommended only within randomized trials.
- Recommendations also include continuous positive airway pressure, prone positioning, endotracheal intubation, and prophylactic anticoagulation.
Conclusions:
- The Taskforce provides comprehensive, evidence-based guidelines for COVID-19 management in non-pregnant adults.
- Recommendations are continuously updated to reflect the latest clinical evidence.
- These guidelines aim to optimize treatment strategies and patient outcomes for coronavirus disease 2019.
Introduction:
The Australian National COVID-19 Clinical Evidence Taskforce was established in March 2020 to maintain up-to-date recommendations for the treatment of people with coronavirus disease 2019 (COVID-19). The original guideline (April 2020) has been continuously updated and expanded from nine to 176 recommendations, facilitated by the rapid identification, appraisal, and analysis of clinical trial findings and subsequent review by expert panels.
Main Recommendations:
In this article, we describe the recommendations for treating non-pregnant adults with COVID-19, as current on 1 August 2022 (version 61.0). The Taskforce has made specific recommendations for adults with severe/critical or mild disease, including definitions of disease severity, recommendations for therapy, COVID-19 prophylaxis, respiratory support, and supportive care.
Changes In Management As A Result Of The Guideline:
The Taskforce currently recommends eight drug treatments for people with COVID-19 who do not require supplemental oxygen (inhaled corticosteroids, casirivimab/imdevimab, molnupiravir, nirmatrelvir/ritonavir, regdanvimab, remdesivir, sotrovimab, tixagevimab/cilgavimab) and six for those who require supplemental oxygen (systemic corticosteroids, remdesivir, tocilizumab, sarilumab, baricitinib, casirivimab/imdevimab). Based on evidence of their achieving no or only limited benefit, ten drug treatments or treatment combinations are not recommended; an additional 42 drug treatments should only be used in the context of randomised trials. Additional recommendations include support for the use of continuous positive airway pressure, prone positioning, and endotracheal intubation in patients whose condition is deteriorating, and prophylactic anticoagulation for preventing venous thromboembolism. The latest updates and full recommendations are available at www.covid19evidence.net.au.
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