Coronavirus — Treatment — Clinical Pathway

Treatment

Ibuprofen

Per the US FDA and World Health Organization US FDA, there are no known scientific data connecting the use of NSAIDs including ibuprofen to worsening COVID-19 symptoms. Regulatory agencies will continue to monitor this. Not all fevers require pharmacologic therapy; however, if a fever is treated, many antipyretics are available, including NSAIDS and acetaminophen. For those on chronic NSAID therapy who wish to use an alternative, this should be discussed with the prescribing healthcare provider before any changes are made.

FDA advises patients on use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19  

Steroids

Steroids are not routinely indicated in the treatment of patients with COVID-19 given lack of benefit and possible harms in related viral infections. However, steroids may be warranted to treat exacerbations of co-existing medical conditions (e.g., asthma exacerbations) or adrenal insufficiency in patients with suspected or documented COVID-19, where benefits outweigh risks. Please also see WHO. In patients who are receiving chronic steroid therapy, any modifications to the baseline steroid regimen in patients with suspected or documented COVID-19 infection should be guided by the primary service prescribing this therapy (e.g., oncology, rheumatology, bone marrow transplant, etc).”

WHO: Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected

In addition to the guidance for ibuprofen/steroids, could we also include the following:

The current standard of care for treatment of SARS-CoV-2 is supportive care. There are no high-quality data supporting the efficacy of any antiviral medication in humans with SARS-CoV-2. The decision to pursue treatment with an antiviral medication should be considered on a case-by-case basis, weighing the risk/benefit ratio of administering an experimental therapy to an individual patient, using the guidance provided here. An infectious diseases consultation is required for all patients with SARS-CoV-2 for whom treatment is being considered.