Doctors should not use a drug combination strongly pushed by President Donald Trump to treat patients with coronavirus infections, a National Institutes of Health panel says in new guidelines published Tuesday. And any other experimental drugs should only be tried as part of a clinical trial, the panel said.
The guidelines, published online, are meant to guide doctors, nurses and other medical professionals treating patients with Covid-19 and will be updated in real time as more is learned in fighting the pandemic, the NIH said.
Trump has touted an antimalarial drug known as hydroxychloroquine, especially in combination with an antibiotic azithromycin, for treating Covid-19 even though there has been no medical recommendation to use it. Although a few very small studies have suggested it might help patients recover, more and more studies have shown that the drug combination may do little or no good and may increase the rate of other complications.
Asked about the NIH guidance on hydroxychloroquine and azithromycin during Tuesday’s White House coronavirus task force meeting, President Trump said, “we’ll take a look at that. I’m always willing to take a look.”
The guidelines give details on which drugs should be used, but also when and how to provide extra oxygen to patients struggling to breathe, how to safely use equipment on potentially infectious patients and include what’s known about heart, liver and kidney complications in patients.
The panel, made of up experts from the federal government, universities and professional medical societies, notes that no drug has yet been shown to help patients recover from Covid-19. No drugs are approved by the US Food and Drug Administration for treatment of Covid-19.
“There are insufficient clinical data to recommend either for or against using chloroquine or hydroxychloroquine for the treatment of COVID-19,” one of the recommendations reads.
“If chloroquine or hydroxychloroquine is used, clinicians should monitor the patient for adverse effects,” it adds – including an abnormal heart reading.
“There are insufficient clinical data to recommend either for or against using the investigational antiviral drug remdesivir for the treatment of COVID-19,” the group adds.
The panel also urges caution in another treatment making headlines: the use of plasma from Covid-19 survivors. “There are insufficient clinical data to recommend either for or against the use of convalescent plasma or hyperimmune immunoglobulin for the treatment of COVID-19,” it said.
Survivors have been clamoring to donate blood in the hope that antibodies produced by their immune systems could help new patients recover from quickly from infection, but no one has finished a clinical trial to show whether the treatment actually helps and if so, how much plasma to use or which antibodies to filter out and administer.
Likewise, the group recommends caution in the use of drugs aimed at tamping down the immune response in patients at risk of cytokine storms, and it warned against using some immune-suppressing drugs such as Janus kinase inhibitors or JAK-inhibitors, often used for rheumatoid arthritis and other autoimmune conditions.
The panel specifically recommends against using the combination of hydroxychloroquine plus the antibiotic azithromycin because of potential toxic side-effects, except as part of a clinical trial. It also recommends against a combination of the HIV drugs lopinavir and ritonavir and other HIV drugs that stop viruses from replicating.
Covid-19 can cause septic shock and an immune overreaction known as a cytokine storm, the NIH panel points out. And several reports show about 20% of critically ill patients suffer an inflammation of the heart and its surrounding tissue known as myocarditis, as well as heart rhythm dysfunction and other injuries to the heart. Liver and kidney problems are also common among very sick patients, with one report that 15% of patients with critical disease need an intense form of dialysis known as continuous renal replacement therapy.
There are recommendations also for helping the burdened lungs of Covid-19 patients with pneumonia and acute respiratory distress syndrome, known as ARDS.
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“Currently there is no evidence that ventilator management of patients with ARDS due to Covid-19 should differ from management of patients with viral pneumonia due to influenza or other respiratory viruses,” the panel said.
Despite a few reports about patients who get a treatment that uses a pump to circulate their blood through an artificial exterior lung, called extracorporeal membrane oxygenation or ECMO, there’s not enough evidence to recommend it, the group said
And health workers should be careful to wear the correct protective gear, such as fit-tested N95 respirator masks, when performing certain procedures that can shoot tiny particles of virus-carrying material, known as aerosols, into the air.
CNN’s Maegan Vazquez contributed to this report.