Severe COVID-19 with hypoxia

COVID-19 with hypoxaemia (SpO2 below 94 % on room air, need for supplemental oxygen) or critical illness (mechanical ventilation, ECMO). In this group, anti-inflammatory corticosteroid therapy reduces mortality – demonstrated in RECOVERY (NEJM 2021). Managed in hospital.

ICD-10 U07.12 drugs

Also known as: Hospitalized COVID-19, Oxygen-dependent COVID-19

Drugs used for this condition

APrednisoloneFirst line · GlucocorticoidsIn patients with COVID-19 and hypoxaemia or critical illness, corticosteroids reduce mortality. The RECOVERY trial (NEJM 2021, 6,425 participants) showed dexamethasone 6 mg daily for 10 days reduced mortality by 17 % on oxygen therapy and by 35 % on mechanical ventilation. Prednisolone 40–50 mg daily is used as the dexamethasone 6 mg equivalent (anti-inflammatory potency ratio 1:7). WHO Living Guidelines and Russian Ministry of Health guidelines classify systemic corticosteroids as a strong recommendation for severe and critical disease. In outpatients without hypoxaemia, there is no benefit and potential harm: increased risk of secondary infections and delayed viral clearance.

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

DAzoximer bromideNot recommended · Other immunostimulants (local classification)Polyoxidonium for COVID-19 is not mentioned in the WHO Therapeutics and COVID-19 Living Guideline or NIH COVID-19 Treatment Guidelines. In hospitalized patients with hypoxemia, evidence-based therapies include dexamethasone, remdesivir, and tocilizumab in specific groups. In high-risk outpatients: nirmatrelvir/ritonavir within the first 5 days.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit