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.
Highlights
The global pandemic of the novel coronavirus disease 2019 (COVID-19) caused by a newly emergent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was firstly recognized inWuhan (China) in December 2019
Patients could be treated with monotherapy using hydroxychloroquine or lopinavir/ritonavir; dual therapy with hydroxychloroquine plus azithromycin or lopinavir/ritonavir; or triple therapy with hydroxychloroquine, azithromycin, and lopinavir/ritonavir
Hydroxychloroquine could be used in four different regimens, and lopinavir/ritonavir could be used in two different regimens, with varied dosages and duration of treatment—either a short (5-day) regimen or long (10-day) regimen
Summary
The global pandemic of the novel coronavirus disease 2019 (COVID-19) caused by a newly emergent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was firstly recognized in. It quickly became a global pandemic, spreading worldwide [1]. Spain is one of the most affected countries, with more than 593,000 confirmed cases and more than. Andalusia—one of the 17 autonomous communities of Spain and the most populous of them, with a total population of over eight million—has officially registered around 42,640 cases Of total confirmed cases nationwide) and 1552 deaths (5.2% of total deaths nationwide) [2]. Efficacy has not been fully established for any drug therapy for SARS-CoV-2. Several agents are being used in clinical trials and compassionate-use protocols based on in vitro activity against
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