Clinical Practice Guideline Summary: Recommended Drugs and Biologics in Adult Patients with COVID-19
Bibliographic record
Abstract
Therapeutic Management of Adult Patients with COVID-19Recommendations apply to patients >18 years of age.Recommendations are based on the best available data and may change as additional data becomes available.Science Briefs can be found on the Ontario COVID-19 Science Advisory Table website. RECOMMENDATIONSDexamethasone 6 mg PO/IV daily for 10 days (or until discharge if sooner) is recommended.Tocilizumab is recommended for patients who are on recommended doses of dexamethasone therapy (or a dose-equivalent corticosteroid) AND are within 14 days of hospital admission (or within 14 days of a new COVID-19 diagnosis if the infection was nosocomially acquired). RECOMMENDATIONS FOR DRUG SHORTAGE SITUATIONSIn drug shortage situations, a single dose of tocilizumab 400 mg IV or sarilumab 400 mg IV should be used for all eligible patients.A second dose of tocilizumab or sarilumab should not be given to any patient.Baricitinib 4 mg PO/NG daily for 14 days (or until discharge if sooner) is recommended in patients who are on recommended doses of dexamethasone therapy (or a dose-equivalent corticosteroid) or who have a contraindication to corticosteroid treatment.The panel does not recommend combined use of baricitinib and IL-6 inhibitors due to absence of safety and efficacy evidence.Dexamethasone 12 mg PO/IV daily for 10 days (or until discharge if sooner) may be considered in patients who are unable to receive IL-6 inhibitors (tocilizumab, sarilumab) or baricitinib.This recommendation is based on very low certainty evidence of reduction in days alive without life support, and the need for inpatient treatment options with a reasonable safety profile during an anticipated spike in COVID-19 cases due to the Omicron variant and widespread shortages of IL-6 inhibitors and baricitinib.Prophylactic dose low molecular weight or unfractionated heparin is recommended.These patients should not receive therapeutic dose anticoagulation unless they have a separate indication for this treatment.Remdesivir is not recommended for patients receiving mechanical ventilation.Remdesivir 200 mg IV on day 1, then 100 mg IV daily for 4 days may be considered in patients requiring high-flow oxygen (i.e., oxygen by mask, oxygen by high-flow nasal cannula, or non-invasive mechanical ventilation).SARS-CoV-2 neutralizing antibodies are not recommended for critically ill patients.For symptomatic inpatients with nosocomial infection, see mildly ill recommendations for sotrovimab on page 2.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.027 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".