Enfermedad de coronavirus 2019 (COVID-19)
La OMS recomienda encarecidamente Paxlovid® para las personas con alto riesgo de enfermedad grave
La Organización Mundial de la Salud (OMS) ha actualizado sus guías de práctica clínica vivas sobre la terapéutica del COVID-19 para incluir una recomendación firme sobre el antiviral oral nirmatrelvir/ritonavir (disponible como Paxlovid®). La OMS recomienda el fármaco para los pacientes con enfermedad no grave y con mayor riesgo de ingreso hospitalario y lo considera la mejor opción terapéutica para los pacientes de alto riesgo hasta la fecha. La recomendación se basa en nuevos datos que muestran que nirmatrelvir/ritonavir reduce el riesgo de ingreso hospitalario en un 85% en este grupo de pacientes.
Consulte la sección de Emergentes para más información.
Resumen
Definición
Anamnesis y examen
Otros factores de diagnóstico
- cefalea
- dolor de garganta
- rinorrea/congestión nasal
- estornudos
- fatiga
- mialgia o artralgia
- producción de esputo/expectoración
- opresión en el pecho
- síntomas gastrointestinales
- mareos
- síntomas neurológicos
- síntomas oculares
- síntomas audio-vestibulares
- dolor torácico
- hemoptisis
- sonidos de respiración bronquial
- taquipnea
- taquicardia
- cianosis
- crepitaciones/estertores durante la auscultación
- síntomas cutáneos
- lesiones de la mucosa oral
- síntomas del tracto urinario inferior
Factores de riesgo
- contacto con el caso probable o confirmado
- residencia/trabajo/viajes en lugares con alto riesgo de transmisión
- edad avanzada
- sexo masculino
- grupo étnico
- residencia en un centro de cuidados a largo plazo
- presencia de comorbilidades
- obesidad
- enfermedad cardiovascular
- diabetes
- enfermedad respiratoria crónica
- enfermedad renal crónica
- hepatopatía crónica.
- embarazo
- tabaquismo
- neoplasia maligna
- enfermedad cerebrovascular
- trastornos de salud mental
- trasplante de órgano sólido o de células madre
- discapacidades
- demencia
- inmunosupresión
- Infección por VIH
- trastornos de la hemoglobina
- hipertensión
- trastornos por consumo de sustancias
- niños con ciertas afecciones subyacentes
- deficiencia de vitamina D
- uso de inhibidores de la bomba de protones
- enfermedad autoinmune
- enfermedad tiroidea
- Enfermedad de Parkinson
- inactividad física
- gota
- dislipidemia
- cirugía
- grupos sanguíneos A y B
- Disbiosis intestinal
- Factores ambientales
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- Reacción en cadena de la polimerasa de transcripción inversa en tiempo real (RT-PCR)
- oximetría de pulso
- GSA
- hemograma completo (HC)
- perfil metabólico completo (PMC)
- pruebas de función tiroidea
- nivel de glucemia
- cribado de coagulación
- biomarcadores cardíacos
- proteína C-reactiva sérica
- velocidad de sedimentación globular en suero
- lactato deshidrogenasa en suero
- nivel de interleucina (IL) en suero
- procalcitonina sérica
- nivel de ferritina en suero
- amiloide sérico nivel A
- creatina-cinasa y mioglobina en suero
- cultivos de esputo y hemocultivos
- radiografía de tórax
Pruebas diagnósticas que deben considerarse
- Tomografía computarizada (TC) de tórax
- prueba rápida de antígenos
- serología
Pruebas emergentes
- ultrasonido de pulmón
- amplificación isotérmica mediada por bucles de la transcripción inversa (RT-LAMP)
- Diagnóstico basado en CRISPR
- alcoholímetros
- calprotectina
Algoritmo de tratamiento
Colaboradores
Consejeros especializados
Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, DCH, DTM&H
Consultant and Emeritus Professor of Tropical and Infectious Diseases
Royal Liverpool University Hospital and Liverpool School of Tropical Medicine
Liverpool
UK
Divulgaciones
NJB is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with the UK Health Security Agency (UKHSA; formerly Public Health England), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or UKHSA.
Tom E. Fletcher, MBE, PhD, MBChB, MRCP, DTM&H
Senior Clinical Lecturer and Defence Consultant in Infectious Diseases
Royal Liverpool University Hospital and Liverpool School of Tropical Medicine
Liverpool
UK
Divulgaciones
TEF is a consultant/expert panel member to the World Health Organization, and is funded by the UK Surgeon General, the NHS, and Liverpool School of Tropical Medicine. TEF is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with the UK Health Security Agency (UKHSA; formerly Public Health England), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. He has received research grants from the Wellcome Trust, Medical Research Council, and the UK Public Health Rapid Support Team (UK-PHRST). The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or UKHSA.
Robert Fowler, MDCM, MS (Epi), FRCP(C)
H. Barrie Fairley Professor of Critical Care
University Health Network and Interdepartmental Division of Critical Care Medicine
Director
Clinical Epidemiology and Health Care Research
Institute of Health Policy, Management and Evaluation
Dalla Lana School of Public Health
University of Toronto
Chief
Tory Trauma Program
Sunnybrook Hospital
Toronto
Canada
Divulgaciones
RF declares that he has no competing interests.
Revisores por pares
William A. Petri, Jr., MD, PhD
Professor
Division of Infectious Diseases and International Health
University of Virginia
Charlottesville
VA
Divulgaciones
WAP declares that he has no competing interests.
Xin Zhang, MD, PhD
Attending Physician
The Fifth Medical Center of PLA General Hospital
Clinical Division and Research Center of Infectious Disease
Beijing
China
Divulgaciones
XZ declares that he has no competing interests.
Ran Nir-Paz, MD
Associate Professor in Medicine
Department of Clinical Microbiology and Infectious Diseases
Hadassah Hebrew University Medical Center
Jerusalem
Israel
Divulgaciones
RNP has received research grants from US-Israel Binational Science Foundation, Hebrew University, Rosetrees Trust, and SpeeDx. He is chair of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC). RNP is a consultant for and has stocks in eDAS Healthcare. He is also chairperson of the Israeli Society for Infectious Diseases guidelines committee.
Editores
Adam Mitchell,
Section Editor (Infectious Diseases)/Drug Editor, BMJ Best Practice
Divulgaciones
AM declares that he has no competing interests.
Irene Chiwele,
Lead Section Editor, BMJ Best Practice
Divulgaciones
IC declares that she has no competing interests.
Julie Costello,
Comorbidities Editor, BMJ Best Practice
Divulgaciones
JC declares that she has no competing interests.
Consejeros especializados: comorbilidades
Martyn Patel, BMBcH, FRCP, MA
Consultant, Older People's Medicine
Norfolk and Norwich University Hospitals
NHS Foundation Trust
Norwich
UK
Divulgaciones
MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare virtual conference in November 2020, for which he received no fee. MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018).
Andrew Lewington, BSc (Hons), MBBS, MEd, MD, FRCP
Consultant Renal Physician
Honorary Associate Professor
Nephrology Department
Leeds Teaching Hospitals NHS Trust
Leeds
UK
Divulgaciones
AL is Associate Clinical Director of NIHR Leeds In-Vitro Diagnostics Co-operative, Co-Chair of UK Kidney Research Consortium Renal Clinical Study Group, Member of Kidney Research UK Research Grant Committee, Committee Member of NICE Kidney Injury Clinical Guideline Update 2018-20, Committee Member of NICE Diagnostic Assessment for Point of Care Creatinine Testing 2018-19. AL attended the Acute Dialysis Quality Initiative Meeting in San Diego 2018 (accommodation expenses); AL was a speaker at the AKI & CRRT Conference in San Diego 2019 (travel and accommodation expenses), the AKI Conference in Coventry 2019 (travel expenses), and the NIHR AKI and Sepsis Meeting in Leeds 2019 (no expenses).
Martin Cowie, MD, MSc, FRCP, FRCP (Ed), FESC, FHFA, FACC
Professor of Cardiology
Imperial College London (Royal Brompton Hospital)
London
UK
Divulgaciones
MC is chair of the European Society of Cardiology Digital Health Committee and a trustee of the Atrial Fibrillation Society. He has previously been a non-executive director of the National Institute for Health and Care Excellence. MC provides consultancy advice to AstraZeneca, Servier, Abbott, Medtronic, Boston Scientific, and Genomics PLC. MC declares that none of these interests is directly related to topics advised on for this project.
Rachael Evans, MBChB, FRCP (UK), PhD
Associate Professor (Clinical)
University of Leicester
Honorary Consultant Respiratory Physician
Glenfield Hospital
Leicester
UK
Divulgaciones
RAE has given lectures for non-promotional industry-led sessions on COPD management, including for GSK and Chiesi for individual payment and travel expenses totalling <£2,000.
Gerry Rayman, MD, FRCP
Consultant Physician and Head of Service
Diabetes and Endocrine Centre and the Diabetes Research Unit
Ipswich Hospitals NHS Trust
Ipswich
UK
Divulgaciones
GR has been paid for advisory board meetings with the following companies: Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Bayer. GR has received lecture fees from Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Novonordisk, Napp Pharmaceuticals Ltd.
Sotiris Posporelis, MD, MRCPsych
Consultant Liaison Neuropsychiatrist
King’s College Hospital
South London and Maudsley NHS Foundation Trust
Honorary Senior Clinical Lecturer
Institute of Psychiatry, Psychology & Neuroscience
King’s College London
London
UK
Divulgaciones
SP declares that he has no competing interests.
Acknowledgements,
BMJ Best Practice would like to gratefully acknowledge Dr Matthew Jones for his advice on a section of the stroke comorbidity content.
Matthew Jones, MD, FRCP
Consultant Neurologist
Greater Manchester Neurosciences Centre
Salford Royal Foundation Trust
Honorary Senior Lecturer
University of Manchester
Manchester
UK
Divulgaciones
AA and MJ declare that they have no competing interests.
Revisores por pares: comorbilidades
Martyn Patel, BMBcH, FRCP, MA
Consultant, Older People's Medicine
Norfolk and Norwich University Hospitals
NHS Foundation Trust
Norwich
UK
Divulgaciones
MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare virtual conference in November 2020, for which he received no fee. MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018).
Asangaedem Akpan, MPH, FRCP
Consultant Geriatrician
Liverpool University Hospitals NHS Foundation Trust
Visiting Professor
University of Cumbria
Carlisle
Honorary Clinical Associate Professor
University of Liverpool
Liverpool
UK
Divulgaciones
AA declares that he has no competing interests.
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