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Communique

Weekly Communique # 30

05 November, 2020

WEEK IN REVIEW

Bromhexine hydrochloride added to list of ‘only in clinical trials’

The Disease-Modifying Treatment and Chemoprophylaxis Panel has reviewed two new trial results for bromhexine hydrochloride (commonly used in over-the-counter cough medicines) concluding that there is insufficient evidence to recommend its use outside the context of a randomised trial with appropriate ethical approval.

(Please see below for important additional information accompanying the recommendation.)

New preferences and values for respiratory support in adults

The Taskforce Consumer Panel has reviewed the key information provided for recommendations on respiratory support in adults, including:

  • High-flow nasal oxygen therapy
  • Non-invasive ventilation
  • Respiratory management of the deteriorating patient
  • Videolaryngoscopy
  • Neuromuscular blockers
  • Positive end-expiratory pressure
  • Prone positioning
  • Recruitment manoeuvres
  • Extracorporeal membrane oxygenation

The Consumer Panel believes that in line with available evidence, most informed patients would agree with the recommendations regarding these treatments for COVID-19. The Panel also believes that most informed patients would agree that infection control precautions are optimised to minimise the risk of infection for others.

New pre-print trial published for hydroxychloroquine

The Taskforce notes the pre-print publication of a new hydroxychloroquine trial: A placebo-controlled double blind trial of hydroxychloroquine in mild-to-moderate COVID-19, published on medRxiv on October 21. This study is currently under review and the relevant recommendations will be updated in a future version of the guideline.

Have you used the Australian guidelines for care of people with COVID-19?

The Taskforce is interested in understanding how our guidance is being used. We are keen to talk to people who have used guidance developed by the Taskforce, either individually or in their organisations, or who have developed materials adapted from the guidance.

If you have recommendations of good examples of the use of our guidance, or people we should talk to about how our guidance is being used, please contact Dr Tari Turner at [email protected]

 


QUICK STATISTICS

COVID-19 research pipeline

  • 28,153 studies published orregistered in Cochrane COVID-19 Study Register, 1,232 added this week
  • 1,979 randomised controlled trials registered (data from Covid-nma site), 39 added this week
  • 2,475 systematic reviews registered in PROSPERO, 40 added this week
  • 112 randomised controlled trials published (data from Covid-nma site), added this week

 


LIVING GUIDELINES

Australian guidelines for the clinical care of people with COVID-19: Version 28.0

NEW RECOMMENDATIONS

  • Bromhexine hydrochloride

Do not use bromhexine hydrochloride for the treatment of COVID-19 outside of randomised trials with appropriate ethical approval.

Bromhexine hydrochloride should still be considered for other evidence-based indications in people who have COVID-19. Trials are needed in special populations, including children and adolescents, pregnant and breastfeeding women, older people living with frailty and those receiving palliative care. Until further evidence is available, do not use bromhexine hydrochloride for the treatment of COVID-19 in these populations unless they are eligible to be enrolled in trials.

UPDATES TO EXISTING GUIDANCE

  • Tocilizumab

The evidence base has been updated with no change to the strength or direction of the recommendation.

  • Umifenovir

The evidence base has been updated with no change to the strength or direction of the recommendation.

  • Hydroxychloroquine for pre-exposure prophylaxis

The words ‘or prior COVID-19’ have been removed from the recommendation. No change to the strength or direction of the recommendation.

  • Respiratory support in adults

Guiding principles of care
The information for guiding principles of care has been updated.

Preferences and values
The information on preferences and values for respiratory support in adults have been updated with no change to the strength or directions of the recommendation.

The Taskforce is continually monitoring research to update recommendations weekly as new evidence accumulates.

 


CLINICAL FLOWCHARTS

10 clinical flowcharts have been developed by the Taskforce to cover:

  • Assessment for suspected COVID-19
  • Management of adults with mild COVID-19 UPDATED
  • Management of adults with moderate to severe COVID-19 UPDATED
  • Management of adults with severe to critical COVID-19 UPDATED
  • Respiratory support for adults with severe to critical COVID-19 UPDATED
  • Management of people with COVID-19 who are older and living with frailty and/or cognitive impairment
  • Management of people with COVID-19 who are receiving palliative care
  • Preparedness for CPR during the COVID-19 pandemic
  • CPR for adults with COVID-19 in healthcare settings
  • Basic life support for adults in the community during the pandemic

Changes to the flowcharts this week include:

  • Respiratory support in adults – updated information on preferences and values
  • ‘Only in research’ medications updated to include bromhexine hydrochloride

 


EVIDENCE UNDER REVIEW

We are currently reviewing evidence to develop recommendations and flowcharts to guide practice in areas including:

  • Remdesivir for children and adolescents UPDATE
  • Immunoglobulin plus methylprednisolone UPDATE
  • Tocilizumab UPDATE
  • Care of people recovering from COVID-19/Post-viral syndrome
  • Oestrogen-containing therapies

 


NEWS & EVENTS

Cochrane

Cochrane has published a new podcast – How effective is screening for COVID-19? Lead author Meera Viswanathan looks at the evidence from a recent rapid review.

The full list of Cochrane Reviews and related content from the Cochrane Library can be found here.

NPS MedicineWise

NPS MedicineWise has published a new consumer article on the role of clinical trials in evidence-based medicine. Read here.

 


NEW TOPICS & QUESTIONS

It is a core mission of the Taskforce to engage with frontline clinicians to rapidly identify and address priority clinical questions.

Each week we collect suggestions for new clinical questions or topics for consideration by the Taskforce. A document that lists all of the suggested questions, topics and new patient groups that we have received to date is available here.

Please encourage your clinical colleagues to provide their insights via the website.

Topics