Matteo Bassetti1,2, Daniele Roberto Giacobbe3,4, Paolo Bruzzi5, Emanuela Barisione6, Stefano Centanni7, Nadia Castaldo8, Silvia Corcione9,10, Francesco Giuseppe De Rosa9, Fabiano Di Marco11, Andrea Gori12,13,14, Andrea Gramegna13,15, Guido Granata16, Angelo Gratarola17, Alberto Enrico Maraolo18, Malgorzata Mikulska19,20, Andrea Lombardi12,13, Federico Pea21,22, Nicola Petrosillo16,23, Dejan Radovanovic24, Pierachille Santus24,25, Alessio Signori26, Emanuela Sozio8, Elena Tagliabue6, Carlo Tascini8, Carlo Vancheri27,28, Antonio Vena19, Pierluigi Viale21,29, Francesco Blasi13,15. 1. Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi, 10, 16132, Genoa, Italy. matteo.bassetti@unige.it. 2. Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. matteo.bassetti@unige.it. 3. Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi, 10, 16132, Genoa, Italy. danieleroberto.giacobbe@unige.it. 4. Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. danieleroberto.giacobbe@unige.it. 5. Clinical Epidemiology Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy. 6. Interventional Pulmonology, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy. 7. Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy. 8. Infectious Diseases Clinic, Santa Maria Misericordia Hospital, Udine, Italy. 9. Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy. 10. Tufts University School of Medicine, Boston, MA, USA. 11. Department of Health Sciences, University of Milan, Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy. 12. Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 13. Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy. 14. Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy. 15. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy. 16. Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy. 17. Department of Emergency and Urgency, San Martino Policlinico Hospital, IRCCS, Genoa, Italy. 18. First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy. 19. Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi, 10, 16132, Genoa, Italy. 20. Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. 21. Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy. 22. SSD Clinical Pharmacology Unit, University Hospital, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy. 23. Infection Control and Infectious Disease Service, University Hospital "Campus-Biomedico", Rome, Italy. 24. Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy. 25. Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy. 26. Department of Health Sciences, Section of Biostatistics, University of Genoa, Genoa, Italy. 27. Regional Referral Centre for Rare Lung Diseases-University Hospital "Policlinico G. Rodolico", Catania, Italy. 28. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy. 29. Infectious Diseases Unit, University Hospital IRCCS Policlinico Sant'Orsola, Bologna, Italy.
Abstract
INTRODUCTION: The Italian Society of Anti-Infective Therapy (SITA) and the Italian Society of Pulmonology (SIP) constituted an expert panel for developing evidence-based guidance for the clinical management of adult patients with coronavirus disease 2019 (COVID-19) outside intensive care units. METHODS: Ten systematic literature searches were performed to answer ten different key questions. The retrieved evidence was graded according to the Grading of Recommendations Assessment, Development, and Evaluation methodology (GRADE). RESULTS AND CONCLUSION: The literature searches mostly assessed the available evidence on the management of COVID-19 patients in terms of antiviral, anticoagulant, anti-inflammatory, immunomodulatory, and continuous positive airway pressure (CPAP)/non-invasive ventilation (NIV) treatment. Most evidence was deemed as of low certainty, and in some cases, recommendations could not be developed according to the GRADE system (best practice recommendations were provided in similar situations). The use of neutralizing monoclonal antibodies may be considered for outpatients at risk of disease progression. For inpatients, favorable recommendations were provided for anticoagulant prophylaxis and systemic steroids administration, although with low certainty of evidence. Favorable recommendations, with very low/low certainty of evidence, were also provided for, in specific situations, remdesivir, alone or in combination with baricitinib, and tocilizumab. The presence of many best practice recommendations testified to the need for further investigations by means of randomized controlled trials, whenever possible, with some possible future research directions stemming from the results of the ten systematic reviews.
INTRODUCTION: The Italian Society of Anti-Infective Therapy (SITA) and the Italian Society of Pulmonology (SIP) constituted an expert panel for developing evidence-based guidance for the clinical management of adult patients with coronavirus disease 2019 (COVID-19) outside intensive care units. METHODS: Ten systematic literature searches were performed to answer ten different key questions. The retrieved evidence was graded according to the Grading of Recommendations Assessment, Development, and Evaluation methodology (GRADE). RESULTS AND CONCLUSION: The literature searches mostly assessed the available evidence on the management of COVID-19patients in terms of antiviral, anticoagulant, anti-inflammatory, immunomodulatory, and continuous positive airway pressure (CPAP)/non-invasive ventilation (NIV) treatment. Most evidence was deemed as of low certainty, and in some cases, recommendations could not be developed according to the GRADE system (best practice recommendations were provided in similar situations). The use of neutralizing monoclonal antibodies may be considered for outpatients at risk of disease progression. For inpatients, favorable recommendations were provided for anticoagulant prophylaxis and systemic steroids administration, although with low certainty of evidence. Favorable recommendations, with very low/low certainty of evidence, were also provided for, in specific situations, remdesivir, alone or in combination with baricitinib, and tocilizumab. The presence of many best practice recommendations testified to the need for further investigations by means of randomized controlled trials, whenever possible, with some possible future research directions stemming from the results of the ten systematic reviews.
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