On December 27, the Health Commission of Guangdong Province published the medication instructions for the high-risk population infected with COVID-19, clearing that asymptomatic infections do not need additional medication. COVID-19 mild infections with fever, fatigue, smell, and taste disorder can use antipyretic, analgesic, antitussive, and diarrhea drugs.
(Photo: Nanfang Plus)
The high-risk population
Children who have one of the following symptoms:
1. Continuous high fever for more than 3 days.
2. Shortness of breath (less than 2 months, respiratory rate (RR)≥60 beats/min; 2 to 12 months, RR≥50 times/min; 1-5 years old, RR≥40 times/min; > 5 years old, RR≥30 times/min).
3. Oxygen saturation≤93% when resting.
4. Assisted breathing (nasal flapping, three concave signs).
5. Drowsiness and convulsion.
6. Having difficulties in feeding and dehydration signs.
Adults who are:
1. Over 60 years old.
2. Having cardiovascular and cerebrovascular diseases (including hypertension).
3. Having chronic lung diseases, diabetes, chronic liver and kidney diseases, tumors, and other underlying diseases.
4. Having immune deficiency.
5. Obesity (body mass index≥30).
6. Third trimester and perinatal women (28 weeks after pregnancy and one week after delivery).
7. Heavy smokers.
COVID-19 severe infections may develop dyspnea or hypoxemia in one week, and rapidly progress to acute respiratory distress syndrome, septic shock, metabolic acidosis, coagulation dysfunction and multiple organ failure.
If severe and critical patients have symptoms such as having fever for several days, chest tightness, shortness of breath, dyspnea, palpitation, significant physical decline or worsening of underlying diseases should seek for medical treatment immediately.
The elderly should pay attention to daily blood oxygen monitoring. When the peripheral oxygen saturation≤93%, the elderly should seek medical treatment and prevent “silent hypoxia” (slow response to hypoxia, chest tightness, and dyspnea.)
Drugs that severe and critical patients can use: Azfudine, Nematavir tablets/Ritonavir tablets, and Abidol, which can inhibit viral replication and reduce cell and tissue damage. However, these drugs have specific adverse reactions. Patients are advised to use them under the guidance of pharmacists.
Medication instruction for the elderly
The elderly without the underlying disease can choose one of the antipyretic drugs from acetaminophen, ibuprofen, and loxoprofen. Suppose the elderly have serious underlying diseases such as severe liver and kidney dysfunction. In that case, they are recommended to consult pharmacists for medication and pay attention to blood pressure monitoring after using drugs.
Patients with a high fever for over 3 days are advised to use Angong Niuhuang Wan (安宫牛黄丸), 0.5 pills each time, 2-4 times per day.
Medication instruction for children
Antipyretic drugs are not recommended for infants within 2 months. Infants over 3 months with body temperature > 38.5 ℃ can use Acetaminophen. Infants over 6 months can use both Acetaminophen and Ibuprofen. Parents should choose one type of antipyretic drug and avoid mix-used.
1) Acetaminophen
The dosage of Acetaminophen should be 10-15mg/kg each time. The period between the two doses should be at least 4-6 hours and no more than 4 times within 24 hours. Maximum daily dose not exceeding 2.0g or 60mg/kg/d under 2 years old, 75mg/kg/d between 2 and 12 years old. Children over 6 years old can use acetaminophen tablets.
(2) Ibuprofen
Ibuprofen dosage is 5-10mg/kg each time. Two medication intervals should be at least 6-8 hours, no more than 4 times within 24 hours. The maximum daily dose shall not exceed 40mg/kg or 1.2g. Children over 12 years old may use ibuprofen tablets.
Medication instruction for pregnant and lactating women
Pregnant women with fever prefer acetaminophen. Acetaminophen is relatively safe to use during pregnancy. There is no consensus on the risks of ibuprofen in early pregnancy. However, ibuprofen should be contraindicated after 30 weeks of pregnancy because they may cause premature closure of fetal ductus arteriosus.
Lactating women can use acetaminophen or ibuprofen with a single component that does not affect lactation. The interval of 2 doses is 4-6 hours and, at most 4 times within 24 hours. Antipyretic drugs such as aspirin are not recommended.
There is no evidence that COVID-19 can transmit through breast milk. However, lactating women should pay attention to hand hygiene before and after breastfeeding, wear an N95 mask when feeding, and regularly clean and disinfect surfaces to reduce the risk of infection for infants.
If lactating women have apparent symptoms during the period of COVID-19 infection. In that case, it is recommended to follow the doctor's advice to take medicine immediately after breastfeeding. Wait 2-4 hours before breastfeeding for the next time. Lactating women should also observe the baby's reaction after medication. Symptoms that should pay attention to include drowsiness and diarrhea.
Authors | Clarice, He Yang (intern)
Editors | Wing, Nan, Will, Jerry
