IDSA guideline updates recommendations on dexamethasone, remdesivir, other drugs

The Infectious Diseases Society of America (IDSA) updated its recommendations on treatment and management of inpatients with COVID-19. An article by mental health experts offered guidance on talking with bereaved family members.

The Infectious Diseases Society of America (IDSA) recently made several updates to its guidelines on treatment and management of COVID-19, which were released on April 11 and summarized in the April 15 ACP Hospitalist Weekly.

In a June 25 update, the IDSA suggested glucocorticoids for hospitalized patients with severe COVID-19, defined as oxygen saturation of 94% or less on room air or a need for supplemental oxygen, mechanical ventilation, or extracorporeal mechanical oxygenation (ECMO). Specifically, the guideline mentioned oral or IV dexamethasone, 6 mg, for 10 days (or until discharge if earlier) or, if unavailable, an equivalent glucocorticoid dose (methylprednisolone, 32 mg, or prednisone, 40 mg). Previously, the IDSA recommended steroids in the context of a clinical trial for patients with acute respiratory distress syndrome due to COVID-19. The group still suggested against glucocorticoids for patients without hypoxemia requiring supplemental oxygen.

The IDSA added new recommendations on remdesivir to the guidelines on June 22. It now suggests remdesivir for hospitalized patients with severe COVID-19. For those who are on supplemental oxygen but not mechanical ventilation or ECMO, the IDSA panel suggested treatment with five days of remdesivir rather than 10 days. In patients on mechanical ventilation or ECMO, the duration of treatment is 10 days. If supply of the drug is limited, clinicians should consider that the most benefit has been demonstrated in patients on supplemental oxygen rather than mechanical ventilation or ECMO, the panel noted.

The IDSA also updated recommendations on several other potential therapies. The group now recommends hydroxychloroquine/chloroquine only in the context of a clinical trial and suggested against hydroxychloroquine/chloroquine plus azithromycin outside of trials. The guideline on COVID-19 convalescent plasma also changed; the experimental therapy is recommended for inpatients only in the context of a clinical trial. The IDSA also added a recommendation to address the use of famotidine, suggesting against using it for the sole purpose of treating COVID-19 outside the context of a clinical trial.

Other COVID-19 guidance came from mental health experts from a cancer center, who provided a framework for offering condolences and referrals to bereaved family members in an Ideas and Opinions article published June 23 by Annals of Internal Medicine. “Front-line physicians are uniquely positioned to provide critically needed psychosocial support to bereaved family members,” they wrote. Recognizing that this task is challenging during the pandemic for many reasons, including the volume of deaths, communication barriers from infection precautions, time pressures, compassion fatigue, and mental and physical exhaustion, they offered example scripts and referral guidance. The advice is categorized into three instructions: communicate compassionately, assess risk for acute bereavement challenges, and refer when appropriate and educate about resources.