Acute COVID-19, Clinical Pathway — All Settings

Therapies We DO NOT Recommend

The therapies listed below have been demonstrated to be ineffective or harmful. They should not be used at CHOP for the treatment of COVID-19.

Therapy Rationale for recommendation
Convalescent plasma
  • Multiple studies have demonstrated that convalescent plasma is not effective in the treatment of COVID-19. Use of convalescent plasma is therefore not recommended, and further, convalescent plasma is no longer being supplied as of 9/1/2021.
CytoSorb
  • There are no published studies that support use of CytoSorb in COVID-19. Further, a small single-center randomized trial of adults on VV-ECMO demonstrated higher mortality in those treated with CytoSorb compared to those not treated with CytoSorb therapy. Given no evidence of benefit and possible signal for harm, use is not recommended.
Hydroxychloroquine
  • Multiple published observational studies and large randomized clinical trials have shown that hydroxychloroquine is not effective for treatment of COVID-19.
  • There is also a FDA safety warning related to potential arrhythmias.
Azithromycin + Hydroxychloroquine
  • Multiple studies have demonstrated that this combination is not effective and QTc prolongation occurs in up to 30%, given additive side effects of azithromycin and hydroxychloroquine.
Ribavirin
  • Ribavirin has not been shown to have in vitro activity against SARS-CoV-2 at clinically relevant concentrations.
  • Further, there is little biologic basis for efficacy based on mechanism.
  • Finally, there are significant adverse drug reactions (e.g., hemolytic anemia) that may be particularly deleterious in severely/critically ill patients.
Ivermectin
  • Multiple studies have demonstrated that ivermectin is ineffective in the treatment of COVID-19. While it may inhibit viral replication in vitro, the concentrations needed to inhibit viral replication are not achievable in humans.
Lopinavir-ritonavir
  • Large randomized clinical trials have demonstrated no difference in clinical outcomes for patients treated with lopinavir-ritonavir as compared to standard therapy.