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Clin Microbiol Infect . ESCMID COVID-19 guidelines: update on treatment for patients with mild/moderate disease

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  • Clin Microbiol Infect . ESCMID COVID-19 guidelines: update on treatment for patients with mild/moderate disease


    Clin Microbiol Infect


    . 2022 Aug 23;S1198-743X(22)00429-3.
    doi: 10.1016/j.cmi.2022.08.013. Online ahead of print.
    ESCMID COVID-19 guidelines: update on treatment for patients with mild/moderate disease


    Michele Bartoletti 1 , Ozlem Azap 2 , Aleksandra Barac 3 , Linda Bussini 4 , Onder Ergonul 5 , Robert Krause 6 , Alejandro Martin-Quiros 7 , José Ramón Paño-Pardo 8 , Nicholas Power 9 , Marcella Sibani 10 , Balint Gergely Szabo 11 , Sotirios Tsiodras 12 , Ines Zollner-Schwetz 6 , Jesús Rodríguez-Baño 13



    AffiliationsFree PMC article

    Abstract

    Scope: Despite the large availability of vaccines coronavirus disease 2019 (COVID-19) induced by SARS-CoV-2 continues to be a major threat for healthcare and fragile people. A number of options are now available for outpatients with mild to moderate COVID-19 at risk for disease progression to prevent deaths or hospitalization.
    Methods: An ESCMID COVID-19 guidelines task force was established by the ESCMID Executive Committee. A small group was established, half appointed by the chair, and the remaining selected with an open call. Each panel met virtually once a week. For all decisions, a simple majority vote was used. A long list of clinical questions using the PICO (population, intervention, comparison, outcome) format was developed at the beginning of the process. For each PICO, two panel members performed a literature search with a third panelist involved in case of inconsistent results. Voting was based on the GRADE approach.
    Questions addressed by the guideline and recommendations: In this update we focus on antivirals, monoclonal antibodies and other treatments proposed for patients with mild or moderate COVID-19 at risk for hospitalization or death. While the use of antivirals is recommended, especially nirmatrelvir/ritonavir and remdesivir or alternatively molnupirarvir, the administration of monoclonal antibodies (mAbs) against Spike protein strictly depends on the circulating variants or ability to test timely for variants and subvariants. At the time of writing (April-June 2022) the only active mAb is tixagevimab/cilgavimab given the predominance of Omicron BA.2, BA.3, BA.4 and BA.5 sublineages in Europe. However, considering that the epidemiological scenario is extremely dynamic, constant monitoring of variants of concern is mandatory.


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