Dexamethasone was recommended in eight protocols with two different regimens: 20 mg (5/8, 62
Dexamethasone was recommended in eight protocols with two different regimens: 20 mg (5/8, 62.5%) or 40 mg (3/8, 37.5%) daily. with moderate and moderate pneumonias was different antiviral combinations including hydroxychloroquine plus azithromycin (93.3%) or hydroxychloroquine plus lopinavir/ritonavir (79.9%). Different combinations of hydroxychloroquine and lopinavir/ritonavir (46.7%) and triple therapy with hydroxychloroquine, azithromycin, and lopinavir/ritonavir (40%) were the most recommended treatments for patients with severe pneumonia. There were five corticosteroid regimens, which used dexamethasone, methylprednisolone, or prednisone, with different doses and treatment durations. Anakinra was included in seven protocols with six different regimens. All protocols included prophylactic heparin and therapeutic doses for thromboembolism. Higher prophylactic doses of heparin for high-risk patients and therapeutic doses for patients in crucial condition were included in 53.3% and 33.3% of protocols, respectively. This study showed that COVID-19 protocols varied widely in several aspects (antiviral treatment, corticosteroids, anakinra, and anticoagulation for high risk of thrombosis or crucial situation). Rigorous randomized clinical trials around the proposed treatments are needed to provide consistent evidence. strong class=”kwd-title” Keywords: coronavirus disease 2019, management, clinical protocol, differences, antiviral agent, corticosteroids, Chloroxine anakinra, heparin 1. Introduction The global pandemic of the novel coronavirus disease 2019 (COVID-19) caused by a newly emergent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was firstly acknowledged in Wuhan (China) in December 2019. It quickly became a global pandemic, spreading worldwide [1]. Spain is one of the most affected countries, with more than 593,000 confirmed cases and more than 29,700 deaths. Andalusiaone of the 17 autonomous communities of Spain and the most populous of them, with a total populace of over eight millionhas officially registered around 42,640 cases (7.2% of total confirmed cases nationwide) and 1552 deaths (5.2% of total deaths nationwide) [2]. Currently, efficacy has not been fully established for any drug therapy for SARS-CoV-2. Several brokers are being used in clinical trials and compassionate-use protocols based on in vitro activity against SARS-CoV-2 or related viruses, and Chloroxine on limited clinical experience [3]. Early detection and optimized supportive care to relieve symptoms and support organ function in more severe presentations are the mainstay of management. Where possible, moderate to severely ill patients should be managed in a hospital setting [4]. There are hundreds of clinical protocols around the world adapted locally to patient characteristics, prevention steps, diagnostic tests, availability of potential therapy options, and possibility of follow-up. The use of clinical protocols in health care aims to provide practitioners with locally agreed information about what is currently the recommended approach for a specific practice. Such protocols should be systematically developed and based on an evaluation of the current best evidence. Thus, they also have the potential advantage of MAFF reducing unnecessary variations in care and contributing to evidence-based health care [5]. Based on this premise, we conducted this study, whose main objective was to compare updated clinical protocols for treatment of COVID-19 among the largest university hospitals in Chloroxine Andalusia, Spain. We hypothesized that clinical protocols could vary in several aspects among Andalusian Hospitals, regardless of whether they belong to the same local health system administration and have comparable resources. 2. Materials and Methods In this study, we used the clinical information provided in the COVID-19 protocols of the largest university hospitals in Andalusia. In Andalusia, hospitals are stratified into 4 categories according to support area and number of medical and surgical specialties [6]: (1) regional university hospitals (referral hospital in the whole autonomous community with all specialties available); (2) specialized university hospitals (referral hospital in a province and with wide number of specialties available); (3) basic general hospitals (referral hospital in a region and with all basic specialties available); (4) highly-specialized hospitals (referral hospital in a local area and with all basic specialties available). We included 6 regional university hospitals and 9 specialized university hospitals: Hospital Universitario Reina Sofa (Crdoba), Hospital Universitario Juan Ramn Jimnez (Huelva), Hospital Universitario Virgen del Roco (Sevilla), Hospital Universitario Virgen Macarena (Sevilla), Hospital Virgen de Valme (Sevilla), Complejo Hospitalario Torrecrdenas (Almera), Hospital Universitario de Jerez de la Frontera (Jerez de.