MHC COVID-19 Treatment Guidelines Updated

Munson Healthcare’s Treatment Considerations in Adults and Children with Laboratory Confirmed SARS-CoV-2 (COVID-19) has updated the Tocilizumab criteria for use.

Consider Tocilizumab in addition to dexamethasone in:

1. Patients with rapidly increasing oxygen needs within 24 hours while on dexamethasone with either:
   1. HFNC > 6 L / min (FiO2 >40%), noninvasive mechanical ventilation, or mechanical ventilation within 48 hours,

OR

2. Increased markers of inflammation (i.e., CRP > 7.5 mg/dL), in addition to rapidly increasing O2 needs

Tocilizumab is NOT recommended in the following scenarios:

1. Significant immunosuppression (ANC < 500), including use of other biologic immunomodulating drugs
2. ALT > 5 x upper limit of normal
3. Platelet count <50,000 cells/µL
4. High concern for systemic bacterial or fungal co-infection
5. High-risk for GI perforation
6. Receiving mechanical ventilation for longer than 48 hours
7. Patients who significantly improve with the initiation of enhanced oxygen support or corticosteroids; monitoring such patients for 12-24 hours is reasonable
8. Unlikely to survive >48 hours