Pharmacotherapy Considerations in Hospitalized Patients With COVID-19 Pneumonia

William Pruett, MD; Lee E. Morrow, MD, MSc, FCP, FCCP, FCCM, ATSF; Mark A. Malesker, PharmD, FCCP, FCCP, FCCM, FASHP, BCPS

Disclosures

US Pharmacist. 2020;45(44020):HS9-HS16. 

In This Article

Corticosteroids

The use of systemic steroids is controversial in many critical-care disease states. Similarly, recommendations regarding the use of corticosteroids to blunt the cytokine storm and/or treat ARDS in COVID-19 are inconsistent across the various guidelines. The Surviving Sepsis Campaign suggests early corticosteroid use in patients who have ARDS secondary to COVID-19.[5] This recommendation is extrapolated from a study of patients with ARDS not caused by COVID-19.[21] In contrast, the WHO, the Infectious Diseases Society of America, the National Institutes of Health (NIH), and the VHA recommend against the use of corticosteroids in COVID-19 patients until more definitive data are obtained and out of concern that steroids may prolong viral shedding.[15,17,22,23] The American Thoracic Society makes no recommendation for or against corticosteroids.[24] Equally daunting is the fact that there is no clearly defined protocol for steroid prescription: Current strategies differ significantly regarding the timing of initiation, duration, dose, and withdrawal of steroid therapy. If steroids are being used, an argument has been made to avoid agents with significant mineralocorticoid activity in order to minimize sodium retention, thereby reducing fluid overload and the risk of ARDS. The pharmacist should be mindful of these pros and cons and should ensure that appropriate glycemic monitoring takes place when steroid therapy is prescribed.

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