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Title: Differences between Clinical Protocols for the Treatment of Coronavirus Disease 2019 (COVID-19) in Andalusia, Spain
Authors: Pérez-Belmonte, Luis M.
López-Carmona, María D.
Quevedo-Marín, Juan L.
Ricci, Michele
Martín-Carmona, Jesica
Sanz-Cánovas, Jaime
López-Sampalo, Almudena
Martín-Escalante, María D.
Bernal-López, M. Rosa
Gómez-Huelgas, Ricardo
metadata.dc.contributor.authoraffiliation: [Pérez-Belmonte,LM; López-Carmona,MD; Ricci,M; Martín-Carmona,J; Sanz-Cánovas,J; López-Sampalo,A; Bernal-López,MR; Gómez-Huelgas,R] Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain. [Pérez-Belmonte,LM] Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain. [Quevedo-Marín,JL] Departamento de Bioquímica, Universidad Rey Juan Carlos, Madrid, Spain. [Martín-Escalante,MD] Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Spain. [Bernal-López,MR; Gómez-Huelgas,R] Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.
Keywords: Coronavirus disease 2019;Management;Clinical protocol;Differences;Antiviral agent;Corticosteroids;Anakinra;Heparin;Infecciones por coronavirus;Corticosteroides;Andalusia;Antivirales;Protocolos Clínicos;Heparina;Proteína Antagonista del Receptor de Interleucina 1;Andalucía
metadata.dc.subject.mesh: Medical Subject Headings::Chemicals and Drugs::Biological Factors::Intercellular Signaling Peptides and Proteins::Cytokines::Interleukin 1 Receptor Antagonist Protein
Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Antiviral Agents
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Clinical Protocols
Medical Subject Headings::Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections
Medical Subject Headings::Chemicals and Drugs::Pharmaceutical Preparations::Drug Combinations
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Health Care::Environment and Public Health::Public Health::Disease Outbreaks::Epidemics::Pandemics
Medical Subject Headings::Geographical Locations::Geographic Locations::Europe::Spain
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome
Issue Date: 19-Sep-2020
Publisher: MDPI
Citation: Pérez-Belmonte LM, López-Carmona MD, Quevedo-Marín JL, Ricci M, Martín-Carmona J, Sanz-Cánovas J, et al. Differences between Clinical Protocols for the Treatment of Coronavirus Disease 2019 (COVID-19) in Andalusia, Spain. Int J Environ Res Public Health. 2020 Sep 19;17(18):6845.
Abstract: Our objective was to compare clinical protocols for the treatment of the novel coronavirus disease 2019 (COVID-19) among different hospitals in Andalusia, Spain. We reviewed the current COVID-19 protocols of the 15 largest hospitals in Andalusia. Antiviral treatment, empirical antibacterial agents, adjunctive therapies, anticoagulant treatment, supportive care, hospital organization, and discharge recommendations were analyzed. All protocols included were the latest updates as of July 2020. Hydroxychloroquine in monotherapy was the most frequent antiviral drug recommended for mild respiratory illness with clinical risk factors (33.3%). Combined hydroxychloroquine with azithromycin or lopinavir/ritonavir was found in 40% of protocols. The recommended treatment for patients with mild and moderate pneumonias was different antiviral combinations including hydroxychloroquine plus azithromycin (93.3%) or hydroxychloroquine plus lopinavir/ritonavir (79.9%). Different combinations of hydroxychloroquine and lopinavir/ritonavir (46.7%) and triple therapy with hydroxychloroquine, azithromycin, and lopinavir/ritonavir (40%) were the most recommended treatments for patients with severe pneumonia. There were five corticosteroid regimens, which used dexamethasone, methylprednisolone, or prednisone, with different doses and treatment durations. Anakinra was included in seven protocols with six different regimens. All protocols included prophylactic heparin and therapeutic doses for thromboembolism. Higher prophylactic doses of heparin for high-risk patients and therapeutic doses for patients in critical condition were included in 53.3% and 33.3% of protocols, respectively. This study showed that COVID-19 protocols varied widely in several aspects (antiviral treatment, corticosteroids, anakinra, and anticoagulation for high risk of thrombosis or critical situation). Rigorous randomized clinical trials on the proposed treatments are needed to provide consistent evidence.
metadata.dc.identifier.doi: 10.3390/ijerph17186845
ISSN: 1660-4601 (Online)
Appears in Collections:01- Artículos - APES Costa del Sol
01- Artículos - Hospital Regional de Málaga
01- Artículos - IBIMA. Instituto de Investigación Biomédica de Málaga

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