Philippines’ Treatments, Clinical Practice Guidelines for COVID-19 cases

Philippines' COVID-19 Treatments Clinical Guidelines
The University of the Philippines National Institutes of Health – Institute of Clinical Epidemiology (UP NIH-ICE) and the Philippine Society for Microbiology and Infectious Diseases (PSMID) released these updated guidelines on the prevention and treatment of COVID-19. Photo from UP NIH.

Here are the Philippines’ updated treatments and clinical practice guidelines for the prevention and treatment of COVID-19 cases released by the University of the Philippines National Institutes of Health – Institute of Clinical Epidemiology (UP NIH-ICE) and the Philippine Society for Microbiology and Infectious Diseases (PSMID).

While Filipino scientists continue to develop new medicines and treatments and investigate existing ones to see how these can help cure the Coronavirus disease (COVID-19), reported cases have decreased and increased again since the outbreak of the coronavirus disease in the Philippines in 2020.

The published recommendations to prevent or treat the infectious coronavirus disease can help make health workers and Filipinos more aware of the effective management and control of the spread of the COVID-19 in the nation.

Below is the updated list of the treatments and clinical practice guidelines (CPG) for coronavirus in the Philippines. The Philippine COVID-19 Living Recommendations are based on scientific evidence and expert opinion and are regularly updated as more data become available.

Effective Treatments for COVID-19

Tocilizumab

The addition of tocilizumab to systemic steroids is recommended for patients who are:

  • showing rapid respiratory deterioration
  • requiring high doses of oxygen (high-flow nasal cannula, noninvasive or invasive mechanical ventilation)
  • with elevated biomarkers of inflammation (CRP)

Tocilizumab is not recommended for COVID-19 patients who do not require oxygen supplementation.

Critical Care and Respiratory Management for COVID-19 Patients

Systemic Corticosteroids

Dexamethasone is recommended for patients with COVID-19 infection who need supplementary oxygenation (i.e., high-flow system, non-invasive, invasive mechanical ventilation, and ECMO).

Systemic corticosteroids are not advised for patients with COVID-19 who do not need oxygen supplementation.

Anticoagulation

Prophylactic anticoagulation can be used in hospitalized patients with COVID-19 infection unless there are contraindications.

Health experts suggest the use of prophylactic dose anticoagulation over therapeutic anticoagulation in critically ill patients with COVID-19 infection.

Fluid Management

Conservative fluid management is suggested over the liberal fluid management strategy in mechanically ventilated adult COVID-19 patients with acute respiratory distress syndrome who are adequately resuscitated (without tissue hypoperfusion and fluid responsiveness).

Proning in Non-Intubated Patients

Self-proning is suggested to improve oxygenation status of non-intubated hospitalized patients with COVID19 infection requiring oxygen supplementation.

High Flow Nasal Cannula

The use of high-flow nasal cannula oxygenation is suggested over non-invasive ventilation (e.g., helmet CPAP, mask NIV) in patients with COVID-19 infection and acute hypoxemic respiratory failure who do not respond
to conventional oxygen therapy.

Mechanical Ventilation

Should lung-protective ventilation, high PEEP and driving pressure-limited strategies be used in the management of adult patients with COVID-19-associated acute respiratory distress syndrome?

It is suggested to use a lung-protective ventilation strategy (tidal volume 4-8 mL/kg predicted body weight and plateau pressure less than 30 cmH2O in patients with COVID-19 infection and ARDS.

There is insufficient evidence to recommend the use of a higher PEEP strategy.

Guidelines suggested to individualize PEEP or employ a PEEP strategy on respiratory mechanics (i.e., compliance) in patients with COVID-19
infection.

There is insufficient evidence to recommend a driving pressure-limited strategy in patients with COVID-19 infection. Current guidelines suggest keeping the driving pressure ≤ 14 cmH2O.

Non-Pharmacologic COVID-19 Interventions

Masks

Even health workers who are not directly caring for COVID-19 patients and other people who are at high risk of COVID-19 exposure should use properly fitted surgical masks rather than cloth masks.

Well-fitted cloth masks made of at least two layers of cotton (e.g. t-shirt fabric) or non-woven nylon with an aluminum nose bridge may be worn by the general public with a low risk of exposure to COVID-19 in outdoor or indoor areas.

High-Efficiency Particulate Air (HEPA) Filter

HEPA filters can be used as an option to improve air quality for COVID-19 prevention and control in indoor spaces with inadequate ventilation.

COVID Vaccines

The following vaccines are recommended to prevent symptomatic SARS-CoV-2 infection among adults:

  • BNT162b2 (given as 0.3ml (30ug) intramuscular injections, in 2 doses, 21 days apart)
  • mRNA-1273 (given as 0.5ml (100ug) intramuscular injections, in 2 doses, 28 days apart)
  • ChAdOx1 (given as 0.5 ml (5 x 106 vp) intramuscular injections, in 2 doses, at least 12 weeks apart)
  • Gam-COVID-Vac (given as 0.5ml rAd-26S 0.5ml intramuscular injection, then rAd-5S 0.5ml intramuscular injection 21 days after)

The use of these vaccines is recommended in older adults (>64-year-old) to prevent symptomatic SARS- CoV-2 Infection.

The vaccines are recommended for pregnant and lactating women after consultation with their healthcare provider.

The vaccines are recommended for adults who have stable medical comorbidities and are at risk for severe infection to prevent SARS-CoV-2 infection.

These vaccines are not recommended for children to prevent SARS-CoV-2 infection:

  • BNT162b2: <16 years old
  • mRNA-1273, ChAdOx1, Gam-COVID-Vac: <18 years old

These vaccines are recommended in immunocompromised patients (i.e., diagnosed with HIV, hepatitis B and C), after clearance from their physician, to prevent SARS-CoV-2 infections.

Doctors recommend against the use of these vaccines in persons with known allergies to polysorbate and/or PEG.

Prophylactic Interventions for COVID-19

Renin-Angiotensin-Aldosterone System Blockers (RAAS)

Health experts recommend continuing maintenance RAAS blockers for hypertension among patients with COVID-19 infection.

Ibuprofen

Ibuprofen may still be used as symptomatic treatment of patients with COVID-19 infection if clinically warranted. Concurrent use of ibuprofen is not associated with worsening of COVID-19 outcomes.

Non-recommended Treatments or Interventions against COVID-19

Hydroxychloroquine/Chloroquine

Hydroxychloroquine (HCQ) is not recommended for COVID-19 patients with or without azithromycin.

Experts do not recommend the use of hydroxychloroquine or chloroquine for pre-exposure prophylaxis in adults who are at high risk of exposure to COVID-19 cases.

HCQ is not recommended for use in post-exposure prophylaxis in adults who are exposed to COVID-19 cases.

Azithromycin

The use of azithromycin in the treatment of patients with COVID-19 infection is not recommended.

Ivermectin

There is insufficient evidence to recommend the use of ivermectin for the treatment of patients with COVID19 infection.

Favipiravir

There is insufficient evidence to recommend the use of favipiravir for the treatment of patients with COVID19.

Remdesivir

There is insufficient evidence for or against the use of Remdesivir in patients with COVID-19 infection who are already on high flow oxygen, non-invasive or invasive mechanical ventilation.

The antiviral drug is not recommended for patients with COVID-19 infection who have O2 saturation ≥94% and do not require oxygen supplementation.

Health experts suggest the addition of Remdesivir to dexamethasone in patients with COVID-19 infection who have O2 saturation < 94% and/or requiring oxygen supplementation.

Convalescent Plasma

There is insufficient evidence to support the use of convalescent plasma for patients with COVID-19, regardless of severity.

Convalescent plasma studies are ongoing at the UP PGH and other hospitals.

Virgin Coconut Oil

There is no evidence at this time to recommend the use of virgin coconut oil (VCO) as a treatment for patients with COVID-19 infection.

Department of Science and Technology-led clinical trials have found that the use of VCO can reduce symptoms of Covid 19.

Linhua

Experts recommend against the use of Linhua as treatment among patients with COVID-19 infection.

Hemoperfusion

There is insufficient evidence on the use of hemoperfusion at this time among patients with COVID-19 infection.

Ionizing Air Filter

The use of ionizing air filters is not recommended for the prevention and control of COVID-19 infection in public spaces.

Foot Baths

Footbaths are not recommended for the prevention and control of COVID-19 transmission.

Misting Tents

Misting tents or disinfection chambers are not recommended for the prevention and control of COVID-19 transmission.

Ultraviolet (UV) Lamps

UV lamps or other UV devices in any place outside of a controlled clinic or hospital setting are not recommended to prevent and control COVID-19 transmission.

Vitamin D

Experts recommend against the use of Vitamin D supplementation to prevent COVID-19 infection.

Zinc

Experts recommend against the use of zinc supplementation to prevent COVID-19 infection.

Lopinavir/Ritonavir

Lopinavir/ritonavir is not recommended for chemoprophylaxis in individuals exposed to COVID-19 patients.

Saline Nasal Irrigation

There is insufficient evidence to recommend the use of saline nasal irrigation (SNI) to prevent COVID-19 in healthy individuals.

Steam Inhalation

Experts recommend against the use of steam inhalation in the prevention and treatment of COVID-19.

Antiseptic Gargles

There is insufficient evidence to recommend the use of antiseptic mouthwash or gargle to prevent COVID-19 in healthy individuals.

These guidelines are lifted from the Philippine COVID-19 Living Recommendations released by the Institute of Clinical Epidemiology, National Institutes of Health, UP Manila in cooperation with the Philippine Society of Microbiology and Infectious Diseases (PSMID) as of March 30, 2021.

CHECK THIS OUT: What to do when you are suspected or confirmed to have COVID-19 in the Philippines.

SEE: Updated Guidelines on Community Quarantine in the Philippines.

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Margo Hannah De Guzman Quadra
Margo is a voracious reader - some might even say she reads too much for her own good. She majored in BS Psychology and hopes to become a forensic psychologist one day. She’s also an aspiring writer, mental health advocate, and a staunch believer of equality.