COVID-19: NIH guidelines warn against prophylaxis outside clinical trials

  • National Institutes of Health
  • National Institutes of Health
  • 22 Apr 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • The US National Institutes of Health (NIH) COVID-19 treatment guidelines recommend against use of any agents for prophylaxis outside of a clinical trial.

Why this matters

  • Agency cautions that “no drug has been proven to be safe and effective for treating COVID-19.”
  • Evidence is "insufficient" for/against any antiviral or immunomodulatory therapy for disease of any severity.

Key points

  • Nasopharyngeal testing recommended, with priority given to:
    • Hospitalized patients, symptomatic health care workers.
    • Symptomatic persons, age >65 years or with comorbidities, residing in long-term care facilities; symptomatic first responders.
    • Communities experiencing high COVID-19 hospitalizations: symptomatic, critical infrastructure workers, health care workers, first responders, persons with mild symptoms.
  • Treatment: none recommended outside clinical trial.
  • Management:
    • Pre/asymptomatic: self-isolate for 7 days after first test (if tested); no further testing/treatment recommended.
    • Mild: manage in ambulatory or telemedicine settings.
      • Data are insufficient for/against antiviral, immunomodulatory treatment.
    • Moderate: admit to hospital for close observation; administer empiric antibiotic if bacterial pneumonia or sepsis is strongly suspected.
      • Conduct initial imaging, labs.
    • Severe: SpO2 93% at sea level, respiratory rate >30, PaO2/FiO2 50%. 
      • Use aerosol-generating procedures, conduct imaging/labs.
    • Critical: see guidelines.
  • Special considerations (pregnancy, postdelivery, pediatric cases): see guidelines
  • Concomitant medications: see guidelines