https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management

Summary: Don't use steroids, no meaningful evidence yet to support the efficacy or benefit:risk of HCQ, HCQ/azithro, toci or Kaletra and they should be utilized only in hospitalized patients ideally in the context of a clinical trial to help ascertain efficacy.

No steroids? Does that include asthma medication such as Symbicort; isn't that basically a steroid?

It appears to be referencing use of steroid specifically in the Covid treatment protocol. No steroid for pneumonia but recommended for ARDS

VegasAg98 said:

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Damn the torpedoes. I want smart qualified doctors with experience to make the call if/when the time comes. Maybe it works, maybe it doesn't. That's where we're at with this.

Unfortunately that's not how the world works. Rant over.

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From OP:

Quote:

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Summary: Don't use steroids, no meaningful evidence yet to support the efficacy or benefit:risk of HCQ, HCQ/azithro, toci or Kaletra and they should be utilized only in hospitalized patients ideally in the context of a clinical trial to help ascertain efficacy.

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Have at it cowboy.

Pelayo said:

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Guidelines like these can be taken as a standard of care where none yet really exist, putting physicians who deviate at some risk.

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In response to "Have at it cowboy"

My post was a commentary on the portion of the quote above regarding the unfortunate reality that potential litigation plays a very real part in a doctor's decision-making process.

As one who has a deep respect and appreciation for the scientific process, I can assure you my statement was not meant to exude a cavalier attitude towards the use of pharmaceuticals that haven't been thoroughly vetted for particular treatment.

The problem is there are no drugs with such a pedigree for COVID 19 at this time. I want my doctor to make decisions based on sound science, peer-reviewed studies (if they exist), etc. What I don't want, and the reason for my post, is civil liability exposure to enter the equation.

I bet you and I are actually of similar minds when it comes to the importance of clinical trials, proper vetting and ultimately practice guidelines. But I can assure you that plaintiff's lawyer look at guidelines first to argue a standard a care from a liability standpoint - which is not why such guidelines were created in the first place.

Thanks, Infection Ag. Sometimes, Guidelines seem like they are written more for the benefit of Trial Lawyers (scum of the earth) than for doctors.

I keep in regular contact with the ID doctors in my "neck of the woods", last communication I had with them (yesterday) was "I think early steroid use when patients are progressing with shortness of breath or worsening CXR findings or increasing O2 requirements is the best way to prevent ARDS".

Thoughts?

Marcus Aurelius said:

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I get it. Scientific method. The Ivory Tower wants TIMI level RPCTs before they cast guidelines. Meanwhile this thing is slaughtering certain people. I see both sides. The question is - what would any doctors who make up that society want if they personally were entering COVID-19 cytokine storm?

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I'm sure they wouldn't want anything not proven efficacious by a series of dbRCT and approved by a professional society first.

Kool said:

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Thanks, Infection Ag. Sometimes, Guidelines seem like they are written more for the benefit of Trial Lawyers (scum of the earth) than for doctors.

I keep in regular contact with the ID doctors in my "neck of the woods", last communication I had with them (yesterday) was "I think early steroid use when patients are progressing with shortness of breath or worsening CXR findings or increasing O2 requirements is the best way to prevent ARDS".

Thoughts?

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Sometimes it seems that way.

Thanks, Infection. The slide below was from the UGA/WuHan Hospital webinar I watched this week, with the slide being from the Chinese doctors. It's amazing how rapidly things are changing with this disease.

I think they'd want toci off label and would not give a f about a RCT

Marcus Aurelius said:

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I get it. Scientific method. The Ivory Tower wants TIMI level RPCTs before they cast guidelines. Meanwhile this thing is slaughtering certain people. I see both sides. The question is - what would any doctors who make up that society want if they personally were entering COVID-19 cytokine storm?

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I'd want toci, and if my procal were significantly elevated empiric antibiotic coverage.