Table 3 Summary of national guidelines in the use of investigational adjunctive treatments in COVID-19

Mild

Symptomatic treatment

Other general treatments:

• Interferon-alpha (5 million units or equivalent dose added to 2 ml sterile water, delivered via nebulizer bid)

• Lopinavir-ritonavir (400 mg/100 mg bid; not > 10 days)

• Ribavirin (500 mg bid/tid, not > 10 days)(recommended in combination with interferon or lopinavir-ritonavir)

• Chloroquine phosphate (500 mg bid for 7 days in adults 18–65 years and body weight > 50 kg; 500 mg bid for days 1–2, followed by 500 mg od for days 3–7 in adults < 50 kg)

• Umifenovir (200 mg tid, not > 10 days)

Symptomatic treatment

In age > 70 years old and/or co-morbidities

• Consider lopinavir-ritonavir (400 mg/ 100 mg bid) + Chloroquine (500 mg bid) or HCQ (200 mg bid) for 5–20 days)

Alternatives to lopinavir-ritonavir:

• Darunavir + ritonavir (800 mg/ 100 mg od), or

• Darunavir + cobicistat (800 mg/ 150 mg od)

Symptomatic treatment

Symptomatic treatment

• Consider starting HCQ (400 mg at diagnosis, then 400 mg 12 h later, followed by 200 mg bid up to day 5)

or

• chloroquine base (10 mg/kg at diagnosis, 5 mg/kg 12 h later, followed by 5 mg/kg bid up to day 5)

or

• chloroquine phosphate (1000 mg at diagnosis, then 500 mg bid, followed by 300 mg bid up to day 5)

(including age > 65 years and/or underlying end-organ dysfunction)

Pneumonia

• Lopinavir-ritonavir (400 mg/100 mg bid) + Chloroquine (500 mg bid) or HCQ (200 mg bid) for 5–20 days)

BCRSS^* score ≥ 2, consider adding:

- Dexamethasone 20 mg/day for 5 days, then 10 mg/d for 10 days (discuss with intensivist)

and/or

- Tocolizumab

Nil

Severe

• Convalescent plasma

• Tocolizumab (extensive lung disease, increased IL-6; prohibited in active tuberculosis)(IV, 4–8 mg/kg, maximum 2 cumulative doses)

• Glucocorticoids (not exceeding equivalent of methylprednisolone 1–2 mg/(kg·d), for 3–5 days)

• Xuebijing (TCM)(100 ml bid)

• Probiotics

Nil mentioned

• Chloroquine (600 mg loading dose, 300 mg 12 h later, followed by 300 mg bid on days 2–5

or

• HCQ (400 mg bid loading dose, then 200 mg bid on days 2–5)

Consider switching or adding remdesivir if insufficient response or clinical deterioration

• Prophylactic LMWH

• Start HCQ or chloroquine (above dose)

• Consider lopinavir-ritonavir (400 mg/100 mg bd for 14 days) only if HCQ/ chloroquine is contraindicated and if it can be administrated with 12 days of symptom onset

Critical

• Remdesivir (IV 200 mg loading dose on day 1, maintenance dose 200 mg/d from day 2–10) + chloroquine/HCQ (above dose)

or

• Lopinavir-ritonavir + chloroquine/HCQ (above dose)

ARDS:

• Dexamethasone 20 mg/d for 5 days, then 10 mg/d for 5 days; to initiate within 24 h of ARDS diagnosis (discuss with intensivist)

and/or

• Tocilizumab

• Chloroquine/ HCQ + remdesivir (200 mg loading dose on day 1, then 100 mg daily for days 2–9)

or

• Remdesivir alone

• Remdesivir (200 mg loading dose within 30 min, followed by 100 mg daily for 2–10 days)

• Consider HCQ/ chloroquine if remdesivir unavailable

• IL-6 inhibitors should only be used in clinical trials