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SARS-CoV-2: therapeutic recommendations

In order to update  its 5 March 2020 statement on the management of confirmed cases of Covid-19, in light of the publication of new data, the French High Council for Public Health (Haut Conseil de la santé publique, HCSP) is issuing new recommendations. These have been written in conjunction with a number of scientific  societies with a view to securing the broadest possible consensus. Accordingly, the HCSP particularly recommends that:

  1. All practitioners be strongly encouraged to include all patients with Covid-19 in the clinical trials.
  2. All prescribers bear in mind the very limited knowledge currently available and be mindful of their accountability when off-label prescribing a medicinal product, outside the context of clinical trials. If they do make such a prescription, this should be subject to clear, fair and appropriate information, the decision should be made collectively, and the patients should be included in the French Covid-19 cohort in order that data concerning management can become available as swiftly as possible.

Moreover, the HCSP gives a reminder that courses of action should be based on the clinical symptoms of patients with Covid-19.

No specific treatment has been recommended for Covid-19 patients with few symptoms or uncomplicated respiratory tract infections, although medical monitoring should nevertheless be implemented in such situations, as there is currently no data available to inform clinical guidance on the off-protocol use of hydroxychloroquine for prophylaxis of SARS-CoV-2 infection.

Once the infection requires uptake of oxygen therapy (including low-dose), hospitalisation becomes necessary. Where there are serious symptoms, treatment may be considered: in this context, antiviral agents (such as the combination of lopinavir and ritonavir, or even Remdesivir in the most severe cases) or, failing that, hydroxychloroquine. Such prescriptions must be made according to the above-mentioned guidelines.

Finally, in inflammatory forms with acute respiratory distress syndrome (ARDS), beyond the usual treatment for an ARDS, the treatment options must be discussed on a case-by-case basis.

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