¹ NIH 2022. COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Last update 3/8/23. Accessed 3/9/23

² NIH 2022. Give COVID pts inactivated influenza vaccine. Tx of pregnant pts should be based on shared decision-making.

³ IDSA 2022. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients With COVID-19. Last update 2/8/23. Accessed 2/9/23

⁴ IDSA 2022. Rates of co-infxn w/ COVID-19 have been low, but data limited; super-infxns more common w/ immunomodulators; prolonged empiric antimicrobials increases risk of resistance.

⁵ WHO 2021. COVID-19 Clinical Management: Living Guidance. World Health Organization. Last update 11/23/21. Accessed 12/9/21

Therapeutics and COVID-19: Living Guideline. World Health Organization. Last updated 1/13/23. Accessed 2/9/23

Corticosteroids for COVID-19: Living Guidance. World Health Organization. Last updated 9/2/20. Accessed 9/4/20

⁶ WHO 2021. In severe COVID-19, empiric antimicrobials to treat all likely pathogens, based on clinical judgment, pt host factors, and local epidemiology, should be started ASAP, w/in 1h of initial assessment if possible, ideally w/ blood cx obtained first. Assess daily for de-escalation.

⁷ NIH/IDSA recommended DEX dose: 6 mg per day for up to 10 days; WHO recommended doses: DEX 6 mg/day or hydrocortisone 50 IV q8h x7-10 day.

⁸ Equivalent daily glucocorticoid dose may be substituted if DEX (6 mg/day) unavailable: methylprednisolone 32 mg/day, prednisone 40 mg/day, or hydrocortisone 150-160 mg/day.

⁹ WHO 2021. Pregnant pts: benefit may outweigh risk if mild COVID-19 and risk for preterm birth (24-34wk gest).

¹⁰ IE for repeated dosing; avoid use if significant immunosuppression, GI perforation risk, uncontrolled non-SARS-CoV-2 infxn, ALT ≥5x ULN, ANC <500, or Plt <50,000.

¹¹ May use sarilumab IV as an alternative when tocilizumab IV is not available or not feasible to use.

¹² May use tofacitinib as an alternative when baricitinib is not available or not feasible to use.

¹³ May consider tofacitinib or ruxolitinib only if baricitinib, tocilizumab, or sarilumab not available.

¹⁴ NIH: Not expected to be effective due to high proportion of non-susceptible variant. IDSA: May use if predominant regional variant is susceptible.