Коронавирусная болезнь 2019 (COVID-19)
ВОЗ настоятельно рекомендует Paxlovid® для людей с высоким риском развития тяжелой формы заболевания
Всемирная организация здравоохранения (ВОЗ) обновила свое действующее руководство по препаратам для лечения COVID-19, включив строгую рекомендацию о новом противовирусном препарате –сочетании нирматрелвир/ритонавир (представлена на рынке препаратом Paxlovid®). ВОЗ рекомендует этот препарат пациентам с нетяжелым заболеванием с наивысшим риском госпитализации, называя его наилучшим выбором для медикаментозной терапии пациентов с высоким риском в настоящее время. Рекомендация основана на новых данных, которые показывают, что сочетание нирматрелвир/ритонавир снижает риск госпитализации на 85% в этой группе пациентов.
Для получения дополнительной информации смотрите раздел «Инновационные методы лечения».
Резюме
Определение
Анамнез и осмотр
Другие диагностические факторы
- головная боль
- боль в горле
- ринорея/заложенность носа
- чихание
- утомляемость
- миалгия или артралгия
- выработка мокроты/отхаркивание
- ощущение сжатия в груди
- симптомы поражения ЖКТ
- головокружение
- неврологические симптомы
- глазные симптомы
- аудио-вестибулярные симптомы
- боль в груди
- кровохарканье
- бронхиальное дыхание
- тахипноэ
- тахикардия
- цианоз
- влажные хрипы / хрипы при аускультации
- кожные симптомы
- поражения слизистой оболочки полости рта
- симптомы нижних мочевыводящих путей
Факторы риска
- контакт с вероятным или подтвержденным случаем
- проживание/работа/путешествие в места с высоким риском передачи
- пожилой возраст
- мужской пол
- этничность
- проживание в учреждениях длительного ухода
- Наличие сопутствующих заболеваний
- ожирение
- сердечно-сосудистые заболевания
- диабет
- хронические респираторные заболевания
- хроническое заболевание почек
- хроническое заболевание печени
- беременность
- курение
- злокачественное новообразование
- цереброваскулярное заболевание
- расстройства психического здоровья
- трансплантация паренхиматозных органов или стволовых клеток периферической крови
- инвалидность
- деменция
- иммуносупрессия
- ВИЧ-инфекция
- дефекты гемоглобина
- артериальная гипертензия
- Нарушения, связанные с употреблением запрещенных веществ
- дети с определенными основными заболеваниями
- дефицит витамина D
- применение ингибиторов протонной помпы
- аутоиммунное заболевание
- заболевания щитовидной железы
- болезнь Паркинсона
- отсутствие физической активности
- подагра
- дислипидемия
- хирургическое вмешательство
- группы крови А (ІІ) и В (ІІІ)
- дисбиоз кишечника
- факторы окружающей среды
Диагностические исследования
Исследования, которые показаны в первую очередь
- полимеразная цепная реакция с обратной транскриптазой в режиме реального времени (RT-PCR)
- пульсоксиметрия
- Определение газового состава артериальной крови
- развернутый анализ крови
- комплексный биохимический анализ крови
- исследование функции щитовидной железы
- уровень глюкозы в крови
- коагулограмма
- сердечные биомаркеры
- C-реактивный белок сыворотки
- определение скорости оседания эритроцитов
- лактатдегидрогеназа сыворотки
- уровень интерлейкина (IL) в сыворотке
- сывороточный прокальцитонин
- уровень ферритина в сыворотке крови
- уровень амилоида А в сыворотке крови
- сывороточная креатинкиназа и миоглобин
- бактериологическое исследование крови и мокроты
- рентгенография органов грудной клетки
Исследования, проведение которых нужно рассмотреть
- компьютерная томография (КТ) органов грудной клетки
- экспресс-тест для определения антигена
- серологическое исследование
Неотложные исследования
- УЗИ легких
- петлевая изотермическая амплификация с обратной транскрипцией (RT-LAMP)
- CRISPR-диагностика
- анализаторы состава выдыхаемого воздуха
- кальпротектин
Алгоритм лечения
Составители
Эксперты-консультанты
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
Раскрытие информации
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
Раскрытие информации
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
Раскрытие информации
RF declares that he has no competing interests.
Рецензенты
William A. Petri, Jr., MD, PhD
Professor
Division of Infectious Diseases and International Health
University of Virginia
Charlottesville
VA
Раскрытие информации
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
Раскрытие информации
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
Раскрытие информации
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.
Редакторы
Adam Mitchell,
Section Editor (Infectious Diseases)/Drug Editor, BMJ Best Practice
Раскрытие информации
AM declares that he has no competing interests.
Irene Chiwele,
Lead Section Editor, BMJ Best Practice
Раскрытие информации
IC declares that she has no competing interests.
Julie Costello,
Comorbidities Editor, BMJ Best Practice
Раскрытие информации
JC declares that she has no competing interests.
Эксперты-консультанты: сопутствующие заболевания
Martyn Patel, BMBcH, FRCP, MA
Consultant, Older People's Medicine
Norfolk and Norwich University Hospitals
NHS Foundation Trust
Norwich
UK
Раскрытие информации
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
Раскрытие информации
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
Раскрытие информации
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
Раскрытие информации
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
Раскрытие информации
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
Раскрытие информации
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
Раскрытие информации
AA and MJ declare that they have no competing interests.
Рецензенты: сопутствующие заболевания
Martyn Patel, BMBcH, FRCP, MA
Consultant, Older People's Medicine
Norfolk and Norwich University Hospitals
NHS Foundation Trust
Norwich
UK
Раскрытие информации
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
Раскрытие информации
AA declares that he has no competing interests.
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