NIH Covid-19 treatment guidelines warn of Trump’s drug combo


The guidelines, published online, are intended to guide doctors, nurses and other health professionals treating patients with Covid-19 and will be updated in real time as more is learned. fighting the pandemic, said the NIH.

Trump has touted an antimalarial known as hydroxychloroquine, particularly in combination with an antibiotic azithromycin, to treat Covid-19, although there is no medical recommendation to use it. Although some very small studies have suggested that it may help patients recover, more and more studies have shown that the combination of drugs can do little or no good and increase the rate of other complications.

Asked about the NIH guidelines on hydroxychloroquine and azithromycin at the White House Coronavirus task force meeting on Tuesday, President Trump said, “Let’s take a look. I’m always ready to take a look. “

The guidelines give details on which drugs to use, but also when and how to provide supplemental oxygen to patients who have difficulty breathing, how to safely use the equipment on potentially infectious patients, and understand what is known about cardiac, hepatic and renal complications in patients.

The panel, made up of experts from the federal government, universities and professional medical societies, notes that no drug has yet been shown to help patients recover from Covid-19. No drug is approved by the U.S. Food and Drug Administration for the treatment of Covid-19.

“There is insufficient clinical data to recommend the use of chloroquine or hydroxychloroquine for or against the treatment of COVID-19,” said one of the recommendations.

“If chloroquine or hydroxychloroquine is used, clinicians should monitor the patient for any side effects,” he said, including an abnormal heart reading.

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“There is not enough clinical data to recommend for or against the use of remdesivir, an investigational antiviral drug for the treatment of COVID-19,” added the group.

The panel also urged caution in another treatment that hit the headlines: the use of plasma from survivors of Covid-19. “There is not enough clinical data to recommend for or against the use of convalescent plasma or hyperimmune immunoglobulins for the treatment of COVID-19,” said the report.

Survivors claim to donate blood in the hope that antibodies produced by their immune systems can help new patients recover quickly from infection, but no one has completed a clinical trial to show if treatment actually helps and , if so, the quantity of plasma to be used or which antibodies to filter and administer.

Likewise, the group recommends caution in the use of drugs to suppress the immune response in patients at risk for cytokine storms, and warned against the use of certain immunosuppressive drugs such as Janus inhibitors. kinase or JAK inhibitors, often used for rheumatoid drugs. arthritis and other autoimmune diseases.

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The committee specifically recommends that the combination of hydroxychloroquine and the antibiotic azithromycin not be used due to potentially toxic side effects, except in the context of a clinical trial. He also recommends that you not combine the anti-HIV drugs lopinavir and ritonavir with other anti-HIV drugs that stop the viruses from replicating.

Covid-19 can cause septic shock and an excessive immune response known as a cytokine storm, says the NIH panel. And several reports show that around 20% of critically ill patients suffer from inflammation of the heart and its surrounding tissues known as myocarditis, as well as dysfunction of the heart rate and other injuries to the heart. Liver and kidney problems are also common in very ill patients, with a report that 15% of patients with severe disease require an intense form of dialysis known as continuous renal replacement therapy.

There are also recommendations to help the overwhelmed lungs of patients with pneumonia and acute respiratory distress from Covid-19, called ARDS.

“There is currently no evidence that ventilator management of patients with ARDS due to Covid-19 should differ from that of patients with viral pneumonia caused by influenza or other respiratory viruses”, a said the panel.

Despite some reports of patients receiving treatment that uses a pump to circulate their blood through an artificial outer lung, called extracorporeal membrane oxygenation or ECMO, there is not enough evidence to recommend it, said the group.

And health workers should be sure to wear appropriate protective equipment, such as N95 respirators tested for fit, when performing certain procedures that may throw tiny particles of airborne material into the air. viruses, called aerosols.

CNN’s Maegan Vazquez contributed to this report.


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