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2025, Number 2

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Enf Infec Microbiol 2025; 45 (2)

Recommendations for outpatient management of COVID-19 in Central America. Is it possible to apply them in daily practice?

Rodríguez-Taveras C, Chaverri-Murillo J, Carles-FreireTH, Castillo B, De Luna D, Escaño C, Quesada-Loria M, Rojas-Fermin RA

Language: Spanish
References: 33
Page: 72-85
PDF size: 295.09 Kb.


ABSTRACT

Introduction: COVID-19 has had a tremendous social and economic impact. This paper presents the position of a Central American Expert Group on the proposed recommendations for managing COVID-19 and the barriers faced in their countries in adhering to these recommendations.
Materials and methods: nine specialists of Panama, Costa Rica, and the Dominican Republic were formed to define the topics to be developed. The available evidence was evaluated in detail, focusing on practical recommendations regarding diagnosis, vaccines, and treatment for COVID-19. The information was presented and discussed for voting.
Results and discussion: this paper presents a series of recommendations for diagnosis, management of complications, use of vaccines, and treatment in patients with COVID-19. It includes individualized recommendations for Panama, the Dominican Republic, and Costa Rica and possible measures to help overcome barriers to care in these countries.
Conclusions: the management of patients with COVID-19 should be standardized. However, multiple obstacles make achieving adequate and general adherence to the guidelines challenging, such as low knowledge of the actors involved in this area, the authorities’ understanding of the problem, available resources, and local priorities.


REFERENCES

  1. Organización Panamericana de la Salud, “Actualizaciónepidemiológica semanal de covid-19 en las Américas 2023”, ops, 2023. Disponible en: https://temas.sld.cu/vigilanciaensalud/2023/03/10/33322/.

  2. Comisión Económica para América Latina y el Caribe,“Dos años de pandemia de covid-19 en América Latinay el Caribe, 2023”, cepal, 2023. Disponible en: https://www.cepal.org/es/notas/anos-pandemia-covid-19-america-latina-caribe-reflexiones-avanzar-sistemas-salud-proteccion.

  3. Hanson, K.E., Caliendo, A.M., Arias, C.A., Hayden, M.K.,Englund, J.A., Lee, M.J. et al., “The Infectious DiseasesSociety of America Guidelines on the Diagnosisof covid-19: molecular diagnostic testing”, Clin InfectDis, 2021, 22: ciab048. doi: 10.1093/cid/ciab048. pmid:33480973; pmcid: pmc7929045.

  4. Organización Mundial de la Salud, “Información básicasobre la covid-19, 2023”, oms, 2023. Disponible en:https://www.who.int/es/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19.

  5. Gila, R., Bitar, P., Deza, C., Dreyse, J., Florenzano, M., Ibarra,C. et al., “Cuadro clínico del covid-19”, Rev Med ClinCondes, 2021, 32: 20-29. Disponible en: https://www.journals.elsevier.com/revista-medica-clinica-las-condes.

  6. Oliva-Sánchez, P., Vadillo-Ortega, F., Bojalil-Parra, R.,Martínez-Kobeh, J., Pérez-Pérez, J. y Pérez-Ávalos, J., “Factoresde riesgo para complicaciones graves de covid-19,comparando tres olas epidemiológicas. Un enfoquedesde la atención primaria en México”, Aten Primaria,2022, 54: 102469. doi: 10.1016/j.aprim.2022.102469.Epub 13 de septiembre de 2022. pmid: 36244180; pmcid:PMC9468309.

  7. Sethuraman, N., Jeremiah, S.S. y Ryo, A., “Interpretingdiagnostic tests for sars-cov-2”, jama, 2020, 323: 2249-2251. doi: 10.1001/jama.2020.8259.

  8. Organización Panamericana de la Salud, “Institutionalrepository for information sharing (Iris). Nirmatrelvir andritonavir”, información para profesionales de la salud. Disponibleen: https://iris.paho.org/handle/10665.2/56786.

  9. University of Liverpool, “The Drug Interaction Group.covid-19 drug interactions”. Disponible en: https://www.covid19-druginteractions.org/checker.

  10. Organización Mundial de la Salud, “Clinical managementof covid-19 interim guidance”, oms, 2020. Disponible en:https://www.who.int/publications-detail-redirect/clinical-management-of-covid-19.

  11. Vázquez, J.B., Menchén, D.A., Martín Llorens, M.M.y Moreno, J.S., “Manifestaciones sistémicas y extrapulmonaresen la covid-19”, Medicine, 2022, 13 (55):3235-3245. doi: 10.1016/j.med.2022.05.004. Epub 12 demayo de 2022. pmid: 35582699; pmcid: pmc9097973.

  12. Wang, K., Wang, X., Du, J., Liu, C., Jiang, Y., Zhang, H.et al., “Relationship between changes in the course ofcovid-19 and ratio of neutrophils-to-lymphocytes and relatedparameters in patients with severe vs. commondisease”, Epidemiol Infect, 2021, 149: e81. doi: 10.1017/S0950268821000674. pmid: 33775266; pmcid: pmc8027554.

  13. Gao, Y.D., Ding, M, Dong, X. et al., “Risk factors forsevere and critically ill covid-19 patients: a review”,Allergy, 2021, 76: 428-455. Disponible en: https://doi.org/10.1111/all.14657.

  14. Kaleemi, R., Hilal, K., Arshad, A., Martins, R.S., Nankani,A., Tu, H. et al., “The association of chest radiographicfindings and severity scoring with clinical outcomesin patients with covid-19 presenting to the emergencydepartment of a tertiary care hospital in Pakistan”, plosOne, 2021, 16. doi: 10.1371/journal.pone.0244886. pmid:33400723; pmcid: pmc7785233.

  15. Leeflang, M.M., Hooft, L., Pol, C.B., Prager, R., Hare, S.S.,Dennie, C. et al., “Cochrane covid-19 Diagnostic TestAccuracy Group. Thoracic imaging tests for the diagnosisof covid-19”, Cochrane Database Syst Rev, 2021,3. Disponible en: https://doi.org/10.1002/14651858.CD013639.pub4.

  16. Kanne, J.P., Bai, H, Bernheim, A. et al., “covid-19 imaging:what we know now and what remains unknown”,Radiology, 2021, 299: E262-E279. doi: 10.1148/radiol.2021204522. Epub 9 de febrero de 2021.

  17. Dennie, C., Hague, C., Lim, R.S., Manos, D., Memauri,B.F., Nguyen, E.T. y Taylor, J. “Canadian Society ofThoracic Radiology/Canadian Association of Radiologistsconsensus statement regarding chest imaging insuspected and confirmed covid-19”, Can Assoc Radiol J,2020, 71: 470-481.

  18. Frank Wong, H.Y., Hiu Yin, L.S., Ho-Tung Fong, A., TingLeung, S., Wing-Yan Chin T., Shing Yen Lo, C. et al., “Frequencyand distribution of chest radiographic findingsin patients positive for covid-19”, Radiology, 2020, 296.doi: 10.1148/radiol.2020201160. Epub 27 de marzo de2020. pmid: 32216717; pmcid: pmc7233401.

  19. Gupta, A., Madhavan, M., Sehgal, K., Nair, N., Mahajan,S., Sehrawat, T. et al., “Extrapulmonary manifestationsof covid-19”, Nat Med, 2020, 26: 1017-1032. doi:10.1038/s41591-020-0968-3. Epub 10 de julio de 2020.pmid: 32651579.

  20. Morejón-Barragán, P., “Coagulopatía y covid-19”, SociedadInteramericana de Cardiología (siac), 2020. Disponibleen: https://www.siacardio.com/novedades/covid-19/coagulopatia-y-covid-19/.

  21. Center for Disease Control and Prevention, “covid-19vaccine effectiveness”, cdc, 2023. Disponible en: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness/work.html.

  22. Organización Mundial de la Salud, “Roadmap forprioritizing uses of covid-19 vaccines: an approachto optimize the global impact of covid-19 vaccines,based on public health goals, global and nationalequity, and vaccine access and coverage scenarios”,oms, 2022. Disponible en: https://reliefweb.int/report/world/who-sage-roadmap-prioritizing-uses-covid -19-vaccines -approach- o p t imize-globalimpact?gad_source=1&gclid=Cj0KCQiAr8eqBhD3ARIsAIe-buM6KnF1_38d1FgekF-BPQFXkWvIxqL4bVYETvFjxTgGZtAxDCi4uoIaAvJGEALw_wcB.

  23. National Institutes of Health (nih), “covid-19 TreatmentGuidelines Panel. Coronavirus disease 2019 (covid-19)Treatment Guidelines”, nih, 2023. Disponible en: https://www.covid19treatmentguidelines.nih.gov/.

  24. Bhimraj, A., Morgan, R.L., Hirsch Shumaker, A., Baden,L. et al., “idsa guidelines on the treatment and managementof patients with covid-19”, idsa, 2023. Disponibleen: https://www.idsociety.org/practice guideline/COVID-19-guideline-treatment-and-management.

  25. Mani, S. y Weitkamp, J.H., Textbook of sars-cov-2 andcovid-19: Epidemiology, etiopathogenesis, immunology,clinical manifestations, treatment, complications,and preventive measures, Ámsterdam, Elsevier, HealthSciences Division, 2022.

  26. Pereta, I., Morancho, A., López, N., Ibáñez, B., Salas, C.,Moreno, L. et al., “Hospital at home treatment with remdesivirfor patients with covid-19: real-life experience”,Int ijid, 2023, 127:124-128. Disponible en: https://doi.org/10.1016/j.ijid.2022.12.011.

  27. Gottlieb, R.L., Vaca, C., Paredes, R., Mera, J., Webb,B.J., Pérez, G. et al., “Early remdesivir to prevent progressionto severe covid-19 in outpatients”, N Engl JMed, 2022, 386: 305-315. Disponible en: https://doi.org/10.1056/NEJMoa2116846.

  28. Attena, E., Caturano, A., Annunziata, A., Maraolo, A.E.,Rosa, A., Fusco, F.M. et al., “Remdesivir treatment andclinical outcome in non-severe hospitalized covid-19 patients:a propensity score matching multicenter Italianhospital experience”, Eur J Clin Pharmacol, 2023, 79:967-974.

  29. Lewnard, J.A., McLaughlin, J.M., Malden, D., Hong,V., Puzniak, L., Ackerson, B.K. et al., “Effectiveness ofnirmatrelvir–ritonavir in preventing hospital admissionsand deaths in people with covid-19: a cohort study in alarge US health-care system”, Lancet Infect Dis, 2023,23: 806-815. Disponible en: https://doi.org/10.1016/S1473-3099(23)00118-4.

  30. Agencia Europea de Medicamentos, “Paxlovid. Productinformation requirements. ema”, 2024. Disponible en:https://www.ema.europa.eu/en/human-regulatory-overview/marketing-authorisation/product-information-requirements

  31. Focosi, D., McConnell, S., Casadevall, A., Cappello,E.G.V. y Tuccori, M., “Monoclonal antibody therapiesagainst sars-cov-2”, Lancet Infect Dis, 2022, 22: e311-326.

  32. Conti, P., Pregliasco, F.E., Calvisi, V., Caraffa, A., Gallenga,C.E., Kritas, S.K. et al., “Monoclonal antibody therapyin covid-19”, J Biol Regul Homeost Agents, 2021, 35:423-427.

  33. Agencia Europea de Medicamentos, “Emergency taskforce (etf) statement on the loss of activity of anti-spikeprotein monoclonal antibodies due to emerging sarscov-2 variants of concern”, ema, 2022.




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