Última revisão: 30 Mai 2022
Última atualização: 12 Mai 2022
12 May 2022

A OMS recomenda fortemente o Paxlovid® para as pessoas com alto risco de doença grave

A Organização Mundial da Saúde (OMS) atualizou suas diretrizes dinâmicas sobre a terapêutica da COVID-19 para incluir uma forte recomendação para o antiviral oral nirmatrelvir/ritonavir (disponível como Paxlovid®). A OMS recomenda esse medicamento para os pacientes com doença não grave que correm maior risco de hospitalização, chamando-o de melhor escolha terapêutica para os pacientes de alto risco até o momento. A recomendação é baseada em novos dados que mostram que o nirmatrelvir/ritonavir reduz o risco de hospitalização em 85% neste grupo de pacientes.

Consulte a seção Novidades para obter mais informações.

Ver Tratamento: novidades

Fonte original da atualização

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • febre
  • tosse
  • dispneia
  • olfato/paladar alterados

Outros fatores diagnósticos

  • cefaleia
  • faringite
  • rinorreia/congestão nasal
  • espirros
  • fadiga
  • mialgia ou artralgia
  • produção de escarro/expectoração
  • constrição torácica
  • sintomas gastrointestinais
  • tontura
  • sintomas neurológicos
  • sintomas oculares
  • sintomas audiovestibulares
  • dor torácica
  • hemoptise
  • murmúrios brônquicos
  • taquipneia
  • taquicardia
  • cianose
  • estertores na ausculta
  • sintomas cutâneos
  • lesões na mucosa oral
  • sintomas do trato urinário inferior

Fatores de risco

  • contato com um caso provável ou confirmado
  • residência/trabalho/viagem para local com alto risco de transmissão
  • idade avançada
  • sexo masculino
  • etnia
  • residência em unidade de cuidados de longa permanência
  • presença de comorbidades
  • obesidade
  • doença cardiovascular
  • diabetes
  • doença respiratória crônica
  • doença renal crônica
  • doença hepática crônica
  • gestação
  • tabagismo
  • neoplasia maligna
  • doença cerebrovascular
  • transtornos de saúde mental
  • transplante de órgão sólido ou de células-tronco hematopoiéticas
  • deficiências
  • demência
  • imunossupressão
  • Infecção pelo vírus da imunodeficiência humana (HIV)
  • distúrbios da hemoglobina
  • hipertensão
  • transtornos relacionados ao uso de substâncias
  • crianças com certas condições subjacentes
  • deficiência de vitamina D
  • uso de inibidor da bomba de prótons
  • doença autoimune
  • doença tireoidiana
  • Doença de Parkinson
  • sedentarismo
  • gota
  • dislipidemia
  • cirurgia
  • grupos sanguíneos A e B
  • disbiose intestinal
  • fatores ambientais

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • reação em cadeia da polimerase via transcriptase reversa (RT-PCR) em tempo real
  • oximetria de pulso
  • gasometria arterial
  • Hemograma completo
  • perfil metabólico completo
  • testes da função tireoidiana
  • nível glicêmico
  • coagulograma
  • biomarcadores cardíacos
  • proteína C-reativa sérica
  • velocidade de hemossedimentação sérica
  • concentração sérica de lactato desidrogenase
  • nível sérico de interleucina (IL)
  • procalcitonina sérica
  • nível de ferritina sérica
  • nível de amiloide A sérica
  • creatinoquinase e mioglobina séricas
  • hemoculturas e culturas de escarro
  • radiografia torácica

Investigações a serem consideradas

  • tomografia computadorizada (TC) torácica
  • testes rápido de antígeno
  • sorologia

Novos exames

  • ultrassonografia do pulmão
  • amplificação isotérmica mediada por ciclo de transcrição reversa (RT-LAMP)
  • Diagnósticos baseados em CRISPR
  • bafômetros
  • calprotectina

Algoritmo de tratamento

Colaboradores

Consultores especialistas

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

Declarações

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

Declarações

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

Declarações

RF declares that he has no competing interests.

Revisores

William A. Petri, Jr., MD, PhD

Professor

Division of Infectious Diseases and International Health

University of Virginia

Charlottesville

VA

Declarações

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

Declarações

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

Declarações

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

Declarações

AM declares that he has no competing interests.

Irene Chiwele,

Lead Section Editor, BMJ Best Practice

Declarações

IC declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Declarações

JC declares that she has no competing interests.

Consultores especialistas: comorbidades

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

Declarações

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

Declarações

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

Declarações

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

Declarações

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

Declarações

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

Declarações

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

Declarações

AA and MJ declare that they have no competing interests.

Revisores: comorbidades

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

Declarações

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

Declarações

AA declares that he has no competing interests.

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