The 4th Version of Belgian Guidance for COVID 19 Management Published 19/3/2020

The 4th version of Belgian guidance for COVID 19 is published today (19th March 2020). It is one of the most precise guidelines published yet.

Key points:

1. Chloroquine is found to have a good efficacy in vitro and it reduces the duration of viral shedding . But the drug has narrow therapeutic window and cardiac toxicity is the most limiting side effect.

2. Hydeoxychloroquine is more potent and is superior to chloroquine according to the very recent Gautret’ study.

3. Azithromycin may have a viral suppressive effect but this needs to be proved as it was noticed accidentaly in 6 patients of Gautret’ study. But i thing it is a good choice for coverage of bacterial pneumonia.

4. Lopinavir/Ritonavir recently shown not to provide clinical benefit in hospitalized
patients with COVID-19. It may reduce ICU stay if given within 10 days of infection but not beyond.

5. Remdesivir is promising but the studies are ongoing. Also the availabilty is a key issue.

6. Corticosteroids are not recommended as a systemic adjunctive treatment.

7. Paracetamol is the first line analgesic and antipyretic over NSAIDs wich are used with caution.

8. No need to stop ACEIs/ARBs in non hospitalised patients. CONSIDER changing ACEIs/ARBs to another equivalent antihypertensive in hospitalised patients.

9. Antiviral therapy is not indicated in all patients with suspected/confirmed COVID19. There are tables inside the guidelines clarify the protocols.

For the entire policy, check here

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