6.3 Drug treatment

6.3.1 Antiviral treatment
At present, there is no evidence from RCT to support specific drug treatment against the new coronavirus in suspected or confirmed cases.
The α-interferon atomization inhalation can be considered (5 million U per time for adults in sterile injection water, twice a day) (Weak recommendation); lopinavir/ritonavir orally, 2 capsules each time, twice a day, can be also considered (Weak recommendation).
Low-level evidences included retrospective cohort, historically controlled studies, case reports, and case series revealed that lopinavir/ritonavir alone or in combination with antivirals produced certain benefits in the treatment of SARS and MERS, such as reducing the incidence or mortality of ARDS [26–29]. A recently systematic review showed that lopinavir/ritonavir’s anti-coronavirus effect was mainly seen in its early application, for reducing patient mortality and reduced glucocorticoid consumption. However, if the early treatment window is missed, there will be no significant effect in their late application [30]. Real-world study stills need to further explore the clinical effects of its early use in 2019-nCoV infected pneumonia.
The effectiveness of the combined use of antivirals is still controversial [31–34].

6.3.2 Antibiotic therapy
Principles. Avoid blind or inappropriate use of antibacterial drugs, especially the combination of broad-spectrum antibacterial drugs. Enhancement of bacteriological surveillance should be performed and promptly given appropriate antibacterial drugs when it occurs secondary bacterial infection.
According to the clinical manifestations of patients, if the accompanying bacterial infection cannot be ruled out, mild patients can take antibacterial drugs against community-acquired pneumonia, such as amoxicillin, azithromycin, or fluoroquinolones; empirical antibacterial treatment in severe patients should cover all possible pathogens, deescalating therapy until the pathogenic bacteria are clarified.

6.3.3 Corticosteroid therapy
The use of corticosteroids for severe ARDS is controversial; therefore, systemic use of glucocorticoids needs to be cautious. Methylprednisolone can be used as appropriate for patients with rapid disease progression or severe illness. According to the severity of the disease, 40 to 80 mg of methylprednisolone per day can be considered, and the total daily dose should not exceed 2 mg/kg (Weak recommendation).
SARS management related researches showed that timely use of non-invasive continuous positive airway pressure and corticosteroids is an effective strategy for increased lung shadows and increased dyspnea. Appropriate use of glucocorticoids is able to significantly improve the clinical symptoms of patients with SARS, reduce the degree of disease progression, and accelerate the absorption of lung lesions; but it cannot shorten the length of hospital stay [35, 36]. Be cautious that hormone therapy has some incidence of adverse reactions [37].

6.3.4 Other medications
Symptomatic treatment of fever. When the temperature is higher than 38.5 ℃, ibuprofen can be used for antipyretic (oral, 0.2 g per time, it can be used every 4–6 h in continuous fever, but no more than 4 times in 24 h), and the temperature below 38 ℃ is acceptable. Much lower body temperature is not conducive to antiviral treatment.
Nutrition support treatment. Inpatients are screened for nutrition risk based on the NRS2002 score when they are admitted to the hospital. The recommended plan for patients with different nutrition risk scores are as follows:
First, if the total score is < 3 points, it is recommended to eat protein-rich foods (such as eggs, fish, lean meat, dairy products) and carbohydrate-containing diets. The supposed ideal energy intake is 25–30 kcal / (kg∙d) and the protein mass are 1.5 g / (kg∙d).
Second, if the total score is ≥3 points, the patient should be given nutritional support as early as possible. It is recommended to increase protein intake by oral nutrition supplement, 2–3 times/day (≥ 18 g protein/time). In order to reach the mount of 18 g protein/time, protein powder can be added on the basis of standard whole protein preparations. Enteral nutrition tube should to be placed when the patient cannot intake supplemental nutrition by oral routine.
Reduce the incidence of stress ulcers and gastrointestinal bleeding. Use H2 receptor antagonists or proton pump inhibitors in patients with gastrointestinal bleeding risk factors. The risk factors for gastrointestinal bleeding include mechanical ventilation ≥48 h, coagulation dysfunction, renal replacement therapy, liver disease, various complications, and a higher score of organ failure.
Reduce the secretion of lung glands and improve the respiratory function. For patients with dyspnea, cough, wheeze, and respiratory distress syndrome due to the increased respiratory gland secretion, it is recommended to use selective (M1, M3) receptor anticholinergic drugs to reduce the secretion, relax the smooth muscle in airway, relieve airway spasm and improve the pulmonary ventilation.
Reduce the incidence of venous embolism. Evaluate the risk of venous embolism in patients and use low-molecular-weight heparin or heparin in high-risk patients without contraindications.