Key pharmacological recommendations for hospitalised COVID‑19 patients: A German national treatment guidance

Key pharmacological recommendations for hospitalised COVID‑19 patients: A German national treatment guidance

1500 1000 Noreen Hussain, PharmD

During the current coronavirus 2019 disease (COVID-19) pandemic, research is being developed and disseminated at an accelerated pace.1 The constant influx of data can be of varying quality and reliability often making clinical decision-making challenging.1 To assess rapidly changing evidence, scientific medical societies have collaborated to develop a living treatment guideline for hospitalised patients with COVID-19.1 This endeavour is supported by Association of the Scientific Medical Societies in Germany (AWMF) and the COVID-19 Evidence Ecosystem Project (CEOsys).1 Using the Grading of recommendations assessment, development and evaluation (GRADE) Evidence to Decision Framework, the German living guideline proposes 11 key recommendations for the most pertinent drug interventions.1


Key recommendations: Immunomodulatory therapy

COVID-19 elicits a host inflammatory response and triggers a cytokine storm resulting in the need for immunomodulatory agents to quell the onset of inflammation and ultimately hinder disease progression.2 Patients with severe or critical COVID-19 should be treated with dexamethasone as several randomised controlled trials (RCTs) demonstrated a decrease in mortality.1 RCTs also highlighted a clinical benefit in administering tocilizumab to patients using high dose supplemental oxygen progressing to severe COVID-19.1 Tocilizumab should not be used in patients with no or low supplemental oxygen requirements and in those on invasive ventilation.1


Key recommendations: Antiviral therapy

Since the beginning of the pandemic several types of antiviral therapies have been studied for COVID-19.1 No fundamental recommendations based on recent RCTs can be made neither for nor against therapy with remdesivir in non-ventilated patients with COVID-19 pneumonia and oxygen demand.1 Based on current evidence in hospitalised patients with COVID-19, convalescent plasma should not be used and recommendations cannot be made for specific subgroups.1 Other potential antiviral therapies include neutralising monoclonal antibodies and evidence emphasises the need for early intervention.3 In early SARS-CoV-2-infected hospitalised patients without respiratory COVID-19 symptoms with at least one risk factor for a severe course of disease, SARS-CoV-2 specific nMAB may be utlisied.1 With that being said, bamlanivimab should not be administered to treat patients hospitalised due to moderate to severe COVID-19.1


Key recommendations: Anticoagulation therapy

Patients with COVID-19 have demonstrated a change in blood coagulation levels, associating COVID-19 with a prothrombotic state.1,4 This prothrombotic state warrants the need for hospitalised patients with COVID-19 to receive prophylactic anticoagulation with standard dose low molecular weight heparin in the absence of contraindications–with the alternative being fondaparinux.1 If hospitalised patients have additional risk factors for venous thromboembolism, intensified anticoagulation may be used if there is a low bleeding risk.1


Evaluating incoming research

Based on current data, the German treatment guidance provided recommendations on immunomodulatory, antiviral and anticoagulation therapies.1 The guidance also commented on several miscellaneous drugs (i.e. azithromycin, ivermectin and vitamin D3 should not be administered in hospitalised patients with COVID-19).1 In order to stay abreast of current research and streamline clinical recommendations, the living guidance will be updated as new evidence develops.1


  1. Malin JJ et al. Infection. 2021;1–14
  2. Rizk JG et al. Drugs. 2020;80:1267–92
  3. Taylor PC et al. Nat Rev Immunol. 2021;21:382–93
  4. Han H et al. Clin Chem Lab Med. 2020;58:1116–20
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