To the editor
Due to new research results and decisions of drug registration institutions as well as our own experience, it became necessary to amend the recommendations for the management of SARS-CoV-2 infection by the Polish Association of Epidemiologists and Infectiologists, published on April 26, 2021.1 The introduced changes relate primarily to the basic treatment (Table 1) and are a consequence of the rapid accumulation of knowledge about the effectiveness of the considered therapeutic options. The results of subsequent studies justify the use of molnupiravir or kasirivimab / imdevimab in stage 1 and 2, and baricitinib in stage 3 of the disease.2-5 On the other hand, the recommendation to use convalescent plasma was discontinued due to the negative results of the research.6,7 Due to lack of scientific evidence on the effectiveness, the following drugs are still not recommended for use in COVID-19: lopinavir / ritonavir, chloroquine, hydrochloroquine, azithromycin, favipiravir, amantadine, oseltamivir, or ivermectin.
Stage 1: mildly symptomatic
The commencement of antiviral therapy is recommended up to 5 days after the onset of symptoms, with particular emphasis on patients at risk of a severe courseb and under direct medical supervision during the qualification and monitoring of treatment. These drugs should not be used in pregnant and lactating women.
Stage 2: fully symptomatic
The initiation of antiviral therapy with each of the following drugs is recommended up to 5 days after the onset of symptoms.
Stage 3: respiratory failure (cytokine storm)
and / or
Stage 4: acute respiratory distress syndrome (ARDS)
and / or
a Detailed information on the posology and restrictions on use is provided in the Summary of Product Characteristics (SmPC) for the European Union / Poland. Pending European Union registration and availability of the Polish SmPC, it is appropriate for molnupiravir to use the SmPC issued by the Medicines and Healthcare products Regulatory Agency (United Kingdom), and for kasirivimab / imdevimab, by the Food and Drug Administration (United States).
b Age >60 years, obesity, diabetes mellitus, neoplastic disease, chronic heart failure, chronic respiratory failure, chronic kidney disease, immunodeficiency, immunosuppression
c According to the manufacturer’s information, 6 or 8 mg/ml of dexamethasone phosphate in the available injection solutions corresponds to 4.95 or 6.6 mg/ml of dexamethasone
Abbreviations: ALT, alanine aminotransferase; BW, body weight; eGFR, estimated glomerular filtration rate; ICU, intensive care unit; IL, interleukin, SpO2, oxygen saturation
Robert Flisiak, Andrzej Horban, Jerzy Jaroszewicz, Dorota Kozielewicz, Agnieszka Mastalerz-Migas, Radosław Owczuk, Miłosz Parczewski, Małgorzata Pawłowska, Anna Piekarska, Krzysztof Simon, Krzysztof Tomasiewicz, Dorota Zarębska-Michaluk (RF: Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Białystok, Poland; AH: Department of Infectious Diseases for Adults, Medical University of Warsaw, Warsaw, Poland; Hospital for Infectious Diseases in Warsaw, Warsaw, Poland; JJ: Department of Infectious Diseases in Bytom, Medical University of Silesia, Katowice, Poland; DK and M. Pawłowska: Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland; AM-M: Department of Family Medicine, Wroclaw Medical University, Wrocław, Poland; RO: Department of Anesthesiology and Intensive Care Unit, Medical University of Gdansk, Gdańsk, Poland; M. Parczewski: Department of Infectious, Tropical Diseases and Acquired Immunodeficiency, Pomeranian Medical University, Szczecin, Poland; AP: Department of Infectious Diseases and Hepatology, Medical University of Lodz, Łódź, Poland; KS: Department of Infectious Diseases and Hepatology, Wroclaw Medical University, Wrocław, Poland; KT: Department of Infectious Diseases and Hepatology, Medical University of Lublin, Lublin, Poland; DZ-M: Department of Infectious Diseases, Jan Kochanowski University, Kielce, Poland)
RF received research grants from Gilead and honoraria for lectures from Gilead, MSD, Roche; JJ received honoraria for lectures from Gilead, MSD, Roche, Bausch; DK and DZ-M received honoraria for lectures from Gilead; M. Parczewski and M. Pawłowska received honoraria for lectures from Gilead, MSD, Roche; AP, KS, and KT received honoraria for lectures from Gilead, MSD, Roche; other authors declare no conflict of interest.
Flisiak R, Horban A, Jaroszewicz J. Diagnosis and therapy of SARS-CoV-2 infection: recommendations of the Polish Association of Epidemiologists and Infectiologists as of November 12, 2021. Annex no. 1 to the Recommendations of April 26, 2021. Pol Arch Intern Med. 2021; 131: 16140. doi:10.20452/pamw.16140
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