COVID-19 pneumonia - in-patient & requiring supplemental oxygen
- Consider prescribing CORTICOSTEROIDS in patients who require supplemental oxygen to maintain prescribed oxygen saturation levels:
- Dexamethasone 6mg (base) daily po or iv for 10 days or until discharge, whichever is sooner.
- In pregnancy or breastfeeding women, prednisolone 40 mg administered by mouth (or intravenous hydrocortisone 80 mg twice daily) should be used instead of dexamethasone.
- Consider need for thromboprophylaxis, see Interim OUH Primary VTE Prevention Guidance for Patients with suspected or proven COVID-19
- Review need for specific COVID-19 treatments discussed below:
Patient requires Non-invasive or invasive Mechanical Ventilation
Discuss patient with Micro/ID.
Patient requires Low-Flow Oxygen
CRP 75 or over:
- Tocilizumab* (See monograph Tocilizumab for in-patients for eligibility criteria and dosing information)
*Baricitinib may be considered in people who cannot have tocilizumab OR when there is clinical deterioration despite treatment with tocilizumab it may be appropriate to add baricitinib. These patients MUST be discussed with Micro/ID
CRP less than 75:
- Baricitinib. Discuss with Micro/ID. See monograph Baricitinib for in-patients for dosing information)
Patient is significantly immunosuppressed:
- Discuss with Micro/ID who may recommend remdesivir. See monograph Remdesivir for in-patients for dosing information.
Patient requires High-Flow oxygen
CRP 75 or over:
- Tocilizumab* (See monograph Tocilizumab for in-patients for eligibility criteria and dosing information)
*Baricitinib may be considered in people who cannot have tocilizumab OR when there is clinical deterioration despite treatment with tocilizumab it may be appropriate to add baricitinib. These patients MUST be discussed with Micro/ID.
CRP less than 75:
- Baricitinib. Discuss with Micro/ID. See monograph Baricitinib for in-patients for dosing information
Patient is significantly immunosuppressed:
- Discuss with Micro/ID who may recommend remdesivir. See monograph Remdesivir for in-patients for dosing information.
Discharging patients
Patients who are discharged from hospital after receiving the above treatments should have this clearly stated on their discharge letter.
References
- National Institute for Health and Care Excellence. Casirivimab plus imdevimab, nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for treating COVID-19.Technology Appraisal guidance TA878 available at: Link.Last updated 12/03/24.