Table 2 Guidelines for the use of corticosteroids in COVID-19 patients
From: Corticosteroids for treatment of COVID-19: effect, evidence, expectation and extent
S. No. | Class of COVID-19 | Symptom | Corticosteroids treatment guideline/protocol |
|---|---|---|---|
01 | Asymptomatic/Presymptomatic Infection of COVID-19 | No symptoms | Do not use corticosteroids The patients suffer from other disease already receiving dexamethasone or another corticosteroid should continue therapy as directed by doctor |
02 | Mild Infection of COVID-19 | Fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhea, loss of taste and smell | Do not use corticosteroids The patients suffer from other disease already receiving dexamethasone or another corticosteroid should continue therapy as directed by doctor |
03 | Moderate Infection of COVID-19 | Lower respiratory disease (SpO2). 90% to < 93% on room air at sea level. Respiratory rate > 24/min, breathlessness but not require supplemental oxygen High-risk patients at deterioration requiring hospitalization and supplemental oxygen | Isolation is necessary. Do not use corticosteroids Dexamethasone 6 mg/Prednisone 40 mg/Methylprednisolone 32 mg/Hydrocortisone 160 mg Dexamethasone plus remdesivir |
04 | Severe Infection of COVID-19 | Obstructed or absent breathing, severe respiratory distress, shock, coma and/or convulsions. The patients have SpO2 < 90% on room air at sea level. The patients treated with high-flow nasal oxygen (HFNO) systems or noninvasive ventilation The patients who have recently hospitalized rapidly increasing oxygen needs, require high-flow oxygen or noninvasive ventilation and have increased markers of inflammation | Dexamethasone 6 mg/Prednisone 40 mg/Methylprednisolone 32 mg/Hydrocortisone 160 mg Dexamethasone plus remdesivir Add baricitinib or tocilizumab (within 3 days of hospital admission) one of the two options above |
05 | Critical Infection of COVID-19 | Respiratory failure, septic shock and/or multiple organ dysfunction. Patients who require invasive mechanical ventilation or extracorporeal membrane oxygenation | Dexamethasone 6Â mg/Prednisone 40Â mg/Methylprednisolone 32Â mg/Hydrocortisone 160Â mg Dexamethasone plus Tocilizumab for patients who are within 24Â h of admission to the ICU |