Summary of COVID-19 medicines guidance: Infection and infectious diseases

Diane Bramley, Highly Specialist Pharmacist Medicines Information, Guy's and St Thomas' NHS Foundation TrustPublished Last updated See all updates

This page summarises and signposts to medicine related guidance we’re aware of from professional and government bodies relating to coronavirus and infection and infectious diseases.

Our advice is constantly reviewed as the pandemic situation evolves.

Whilst we have tried to ensure that the information on this page is complete, please report a concern if you feel anything is omitted or inaccurate.

To see our professional guidance summaries for other clinical areas, click here

Advice in this area includes:

NICE: COVID-19 rapid guideline: managing COVID-19 (NG 191)

Published 23 March 2021, updated 4 October 2021

This comprehensive guideline covers the management of COVID-19 for children, young people and adults in all care settings. Within the section on treatment within the hospital setting there is guidance on escalating and de-escalating treatment and delivering care on critical care and respiratory support units. Therapeutic guidance and evidence overviews are provided on the use of antibiotics (not to be used unless evidence of bacterial co-infection), azithromycin (not to be used as a treatment for COVID-19), doxycycline (not to be used as a treatment for COVID-19 in the community), colchicine (not to be used), corticosteroids, low molecular weight heparin, remdesivir, tocilizumab, sarilumab and the new neutralising monoclonal antibody (nMabs) combination of casirivimab and imdevimab.

 

DHSC/MHRA: Interim Clinical Commissioning Policy: Remdesivir for patients hospitalised with COVID-19 (adults and children 12 years and over) Version 3

Published 14 June 2021

  • This policy sets out the interim clinical commissioning position for the use of remdesivir for patients with COVID-19.
  • Key changes from previous version (V2) are that patients with end stage renal disease are now eligible for treatment if they meet other eligibility criteria and that patients who are significantly immunocompromised are eligible for an extended course of treatment of up to 10 days.

 

DHSC/MHRA: Interim Clinical Commissioning Policy: IL-6 inhibitors (tocilizumab or sarilumab) for hospitalised patients with COVID-19 (adults)

Published 12 September 2021

This single policy sets out the interim clinical commissioning position for the use of  two IL-6 treatment options, tocilizumab or sarilumab, for adults aged 18 years and older hospitalised due to COVID-19. Previously there were individual policies for each IL-6 inhibitor but following a rapid NICE evidence review, updated WHO guidelines and evidence from RECOVERY and REMAP-CAP trials the recommendation is to give equal consideration to tocilizumab and sarilumab according to the criteria set out in the policy.

 

DHSC/MHRA: Interim Clinical Commissioning Policy: Casirivimab and imdevimab for patients hospitalised due to COVID-19

Published 17 September 2021

This document sets out the interim clinical commissioning position for the combination of nMabs, casiribimab and imdevimab, as a recommended treatment option for adults and children (aged 12 years and above) hospitalised with COVID-19 in accordance with set criteria.

 

DHSC/MHRA: COVID-19 rapid policy statement. Palivizumab passive immunisation against Respiratory Syncytial Virus (RSV) in at risk pre-term infants

Last updated 1 July 2021

This document sets out the interim clinical commissioning position for passive immunisation with palivizumab against respiratory syncytial virus (RSV) in at-risk pre-term infants as follows

  • Infants who meet the current JCVI recommendations will continue to be eligible for palivizumab.
  • In addition, during the COVID-19 pandemic, the following additional access criteria are permitted:
    • Infants born at ≤34+0 weeks gestation; AND
    • Diagnosed with CLD6; AND
    • Discharged from hospital on home oxygen in the 9 months prior to the start of the RSV season.

 

NICE: COVID 19 rapid evidence summary: Anakinra for COVID-19 associated secondary haemophagocytic lymphohistiocytosis [ES26]

Published date: 21 May 2020

In this review no studies were found that considered the effectiveness, safety or cost effectiveness of anakinra in adults and children with secondary haemophagocytic lymphohistiocytosis (SHLH) triggered by SARS-CoV-2 or a similar coronavirus.

However overall NICE conclude:

  • anakinra has been used (off label) for cytokine storm syndromes triggered by other viruses (such as herpes viruses), including SHLH, and is reported to be relatively well tolerated, with a favourable safety profile.
  • caution is advised when using immunomodulating therapies in critically ill people with known or suspected infections because they increase the risk of infectious complications. However, it has been proposed that anakinra may be an option if such a treatment is considered necessary because it has a relatively short half-life and can be discontinued quickly if an adverse effect or concern for worsening infection arises.
  • anakinra can be given intravenously (off label) or subcutaneously and has a large therapeutic window.
  • when anakinra is effective for cytokine storm syndromes, it reportedly works within 2 or 3 days.

 

NICE: COVID-19 rapid guideline: vitamin D

Issued 17 December 2020

NICE encourages people to follow UK government advice to take a Vitamin D supplement. They do not support the use of Vitamin D to either treat or prevent Covid-19 infection except as part of a clinical trial.

 

NICE: COVID-19 rapid evidence summary: acute use of non-steroidal anti-inflammatory drugs (NSAIDs) for people with or at risk of COVID-19

Evidence summary [ES23]

Published 14 April 2020

 The available evidence suggests that, although the anti-inflammatory effects of NSAIDs reduce acute symptoms (such as fever), they may either have no effect on, or worsen, long-term outcomes, possibly by masking symptoms of worsening acute respiratory tract infection. Further evidence is needed to confirm this, and to determine whether these results also apply to infections such as COVID-19.

 

NICE. COVID-19 rapid evidence summary: Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) for people with or at risk of COVID-19

Evidence summary [ES25]

Published date: 21 May 2020

No evidence was found to suggest that people taking NSAIDs for a long-term condition should be advised to stop treatment in the context of COVID‑19. Stopping or switching NSAID treatment could have a negative impact on some people.

 

NICE. COVID-19 rapid evidence summary: angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in people with or at risk of COVID-19. Evidence summary [ES24]

Published date: 21 May 2020

Despite biological plausibility for the role of ACEIs and ARBs in both increasing and decreasing the risk of COVID-19 and its complications, this evidence review has not found any observational or experimental data to support these hypotheses. However, the risks of stopping treatment with an ACEI or an ARB, such as worsening heart failure or hypertension, are well understood.

 

MHRA. CAS Alert:   Corticosteroids in the treatment of suspected or confirmed COVID-19

Issued 3 Sept 2020

Based on the results of the REMAP-CAP trial for hydrocortisone and a meta-analysis of corticosteroids (that included results from 7 RCTs including REMAP-CAP and the RECOVERY study of dexamethasone). The MHRA has advised that corticosteroids have been demonstrated to have a clear place in the management of patients with severe or critical COVID-19 disease (as defined by WHO – definitions provided within CAS) but should not be used in patients with non-severe disease. It is stated the guidance applies primarily to patients who are hospitalised and receiving supplemental oxygen but may apply to some non-hospitalised patients.

The following dose regimens for adults are recommended

  • The recommended regimen in adults is dexamethasone 6mg (orally or by injection) once daily for 7-10 days or hydrocortisone 50mg (by injection) three times daily for 7 -10 days. Treatment should stop if discharged from hospital within 10 days.
  • A longer low-dose hydrocortisone regimen (lasting up to 28 days) may be considered for use in patients with septic shock.
  • Prescribers are referred to relevant SPC for use in children, pregnancy or breastfeeding women.
  • Co- prescription of a PPI should be considered for gastroprotection according to local policies
  • Interaction advice wrt to remdesivir updated to state: “Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely”

 

British HIV Association: Coronavirus (COVID-19) and HIV – Responses to common questions

Last updated 19 March 2020

  • Recommended treatment with antiretrovirals should be continued at the same dose. Dose increases do not help protect against Covid-19 or make the infection less severe and could be harmful.
  • Do not share antiretrovirals with anyone who has Covid-19 or is worried about catching it.
  • The antiretrovirals used in PREP are not active against coronavirus.

 

British Infection Association: Links to national guidance, academic publications and professional societies

  • A series of links to useful resources about the treatment of Covid-19 but no specific advice.

 

 

Change history

  1. Updated interim clinical commissioning policies for tocilizumab, sarilumab, and nMab combination casirivimab and imdevimab. Removed CTAG position statements as references have expired.
  1. Updated NICE Guideline NG 191 2 Sept 2021 with reference to doxycycline not recommended as a treatment for COVID-19 in community.
  1. Link updated for reporting a concern.
  1. Updated to include updated interim commissioning policy on palivizumab
  1. Updated to include revised interim commissioning policy on remdesivir.
  1. Updated to highlight new recommendations from NICE on colchicine and azithromycin and the revised guidance on remdesivir.
  1. Updated to include comprehensive COVID treatment guideline from NICE and any superseded guidance deleted.
  1. Published