What are the recommended treatment and precautions for a patient admitted with Covid pneumonia?

Treatment and Precautions for COVID-19 Pneumonia Admission

Patients admitted with COVID-19 pneumonia should receive dexamethasone 6mg daily for up to 10 days if requiring oxygen, remdesivir if within 7 days of symptom onset, appropriate respiratory support, and infection control precautions including isolation. 1

Medical Treatment

Antiviral Therapy

• Remdesivir:
  • Initiate as soon as possible after diagnosis and within 7 days of symptom onset 1, 2
  • Dosing regimen:
    • Loading dose: 200mg IV on day 1
    • Maintenance dose: 100mg IV daily 2
  • Duration:
    • For hospitalized patients not requiring mechanical ventilation/ECMO: 5 days
    • For hospitalized patients requiring mechanical ventilation/ECMO: 10 days
    • For non-hospitalized high-risk patients: 3 days 2
  • Monitor hepatic function and prothrombin time before and during treatment 2

Immunomodulatory Therapy

• Dexamethasone:
  • 6mg IV or oral daily for up to 10 days for patients requiring oxygen 1
  • Do not use in patients not requiring oxygen as it may be harmful in mild disease 1

Antibiotic Management

• Empiric antibiotics are not routinely recommended for all patients with confirmed COVID-19 pneumonia 3, 1
• Consider empiric antibiotics if:
  • Clinical suspicion of bacterial co-infection
  • Elevated procalcitonin
  • Clinical deterioration after initial improvement 3, 1
• If antibiotics are initiated:
  • Obtain blood and sputum cultures
  • For low-risk inpatients: β-lactam (ampicillin-sulbactam, ceftriaxone, or cefotaxime) plus either a macrolide or doxycycline OR a respiratory fluoroquinolone as monotherapy 3
  • For high-risk inpatients (ICU): β-lactam plus macrolide OR β-lactam plus fluoroquinolone 3
  • Limit duration to 5 days if no evidence of bacterial infection 3, 1

Anticoagulation

• Evaluate risk of venous thromboembolism in all patients 3, 1
• Use low-molecular-weight heparin or unfractionated heparin for thromboprophylaxis in high-risk patients without contraindications 3, 1

Respiratory Support

Oxygen Therapy

• Provide appropriate oxygen support based on severity:
  • Low-flow oxygen for mild hypoxemia
  • High-flow nasal cannula (HFNC) for moderate hypoxemia
  • Consider prone positioning to improve oxygenation 1
  • For severe respiratory distress: mechanical ventilation with lung-protective strategy (6 mL/kg predicted body weight) 1

Monitoring

• Monitor oxygen saturation, respiratory rate, work of breathing
• Watch for signs of increased work of breathing despite noninvasive support, which may indicate need for intubation 1, 4

Nutritional Support

• Screen all hospitalized patients using NRS2002 score 3
• For patients with score <3 points:
  • Provide protein-rich foods (eggs, fish, lean meat, dairy products)
  • Target energy intake: 25-30 kcal/kg/day
  • Target protein intake: 1.5 g/kg/day 3
• For patients with score ≥3 points:
  • Provide nutritional support as early as possible
  • Increase protein intake with oral supplements (≥18g protein/time, 2-3 times/day)
  • Consider enteral nutrition tube if unable to meet requirements orally 3

Gastrointestinal Protection

• Use H2 receptor antagonists or proton pump inhibitors in patients with risk factors for gastrointestinal bleeding:
  • Mechanical ventilation ≥48 hours
  • Coagulation dysfunction
  • Renal replacement therapy
  • Liver disease
  • Multiple organ failure 3

Infection Control Precautions

• Implement isolation precautions according to institutional protocols
• Ensure proper environmental disinfection 3
• Healthcare workers should use appropriate personal protective equipment

Common Pitfalls to Avoid

1. Delayed antiviral therapy: Remdesivir shows greatest benefit when initiated early in disease course, particularly within 7 days of symptom onset 1

2. Inappropriate steroid use: Dexamethasone benefits patients requiring oxygen but may be harmful if used in mild disease not requiring oxygen 1

3. Overuse of antibiotics: Avoid routine use of antibiotics without evidence of bacterial co-infection; consider procalcitonin to guide antibiotic use 3, 1

4. Delayed escalation of care: Don't delay intubation if patient shows signs of increased work of breathing despite noninvasive support 1, 4

5. Inadequate thromboprophylaxis: COVID-19 is associated with hypercoagulability; ensure appropriate anticoagulation unless contraindicated 3, 1