ABSTRACT
Objective: Several therapies are being used or proposed for COVID-19, and many lack appropriate evaluations of their effectiveness and safety. The purpose of this document is to develop recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: A group of 27 experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Sixteen recommendations were generated. They include strong recommendations for the use of corticosteroids in patients using supplemental oxygen, the use of anticoagulants at prophylactic doses to prevent thromboembolism and the nonuse of antibiotics in patients without suspected bacterial infection. It was not possible to make a recommendation regarding the use of tocilizumab in patients hospitalized with COVID-19 using oxygen due to uncertainties regarding the availability of and access to the drug. Strong recommendations against the use of hydroxychloroquine, convalescent plasma, colchicine, lopinavir + ritonavir and antibiotics in patients without suspected bacterial infection and also conditional recommendations against the use of casirivimab + imdevimab, ivermectin and rendesivir were made. Conclusion: To date, few therapies have proven effective in the treatment of hospitalized patients with COVID-19, and only corticosteroids and prophylaxis for thromboembolism are recommended. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and promote economical resource use. © 2022 Associacao de Medicina Intensiva Brasileira - AMIB. All rights reserved.
ABSTRACT
The beginning of 2020 was marked by the emergence of COVID-19 in China, with its spreading around the world, which lead the World Health Organization to declare a pandemic. The disease, caused by the coronavirus, reached several countries like Italy, Spain and the United States of America. These countries had their health systems overloaded and collapsed in a few days due to the delay in actions to control the spread of contamination. In Brazil, it is estimated that the disease arrived in late February, spreading to the states in a short time. In this process, several actions regarding policies to combat COVID-19 were observed by different government entities. This meant differentiated approaches, instigating the analysis of the context of the Metropolitan Region of Belo Horizonte, as its integrating towns adopted divergent measures. While strong social isolation measures were determined in Belo Horizonte, in surrounding areas, including neighboring ones, there was a loosening of such measures on April 23, 2020. The analysis of the number of contaminated and dead people published by the Minas Gerais State Health Department allowed some inferences about the current situation of COVID-19 in the making it possible to make some comparisons of the pandemic between Belo Horizonte and the rest of the state of Minas Gerais and, also, between Brazil and the rest of the world.