Treatment Guidelines for adult patients with SARS
(Hospital Authority)
(updated, 11 February 2004)
A.
Treatment guidelines for SARS
Clinical
Status
Treatment
Remarks
1) Patient fulfills
WHO clinical
case
definition of
SARS.
1) Broad-spectrum antibiotics Anti-pneumococcal
(3rd/4th generation
quinolones for penicillin
cephalosporin + macrolide if allergic patients
not penicillin allergic)
2) General supportive care
2) Patient fulfills Clinical
WHO clinical condition is
and
stable.
laboratory
case
definitions of
SARS
Placebo-controlled
Patients who refuse to
double-blinded randomized trial enter the trial will be
with 2 arms:
given the following
treatment choices with
Anti-viral arm consists of
clear informed consent
Ribarivin and Kaletra (K+R) in
of all known risks and
combination*.
benefits**:
 Best medical care
Placebo arm consists of best
w/o anti-viral
medical care w/o anti-viral
therapy
therapy, and includes the use of
 Anti-viral therapy
broad-spectrum antibiotics,
(K+R or
oxygen and ventilatory support.
interferon+R)
 TCM***
1
At any time
during
patient’s
illness, “acute
lung injury”
range of gas
exchange
impairment is
demonstrated,
i.e. PaO2/FIO2
ratio between
26.7 and 40
kPa (200-300
mmHg)
1) Prednisolone 1.0-1.5
mg/kg/day orally for 5
days or more. When
clinical improvement is
demonstrated, dosage is
gradually tapered down
every 5 days by 0.5
mg/kg-decrements till
off, or
Methylprednisolone
(MP) 3 mg/Kg/day IV for
5 days and tapered by 1
mg/Kg every 5 days,
further stepping down
using oral Prednisolone
for a total of 2 weeks.
2) In patients with
underlying cardiac or
respiratory condition,
consider initiation of
non-invasive ventilation
(NIV) (CPAP or BIPAP)
following infection
control guidelines for the
use of NIV.
The patient is
suffering from
“critical SARS”
defined as a
PaO2/FIO2
ratio of <26.7
kPa (200
mmHg) AND
progressive
chest x-ray
deterioration
Recommendations for
NIV setting:
CPAP at 4-6 cm H2O
OR
BIPAP at back up rate of
12 per minute, IPAP of
6-10 cm H2O to keep
tidal volume >6 ml/kg,
EPAP of 4-6 cm H2O,
and supplemental
oxygen titrated to
optimal oxygenation
1) Consider non-invasive See previous paragraph
ventilation (CPAP or
for recommendations for
BIPAP) following
NIV setting.
infection control
guidelines on the use of
NIV.
2) Observe for need for
invasive ventilation
3) Use of pulse steroids
and choice of regimen is
at the discretion of the
clinician based on the
principle of
evidence-based
medicine.
Suggested regimen for
pulse steroid therapy:
methylprednisolone
(MP) at 0.5 g per day IV
for 3 days followed by
tapering course starting
at 3 mg/kg/d. The
cumulative dose of MP
should preferably not
exceed 2 g.
2
* 1) Dosage of ribavirin: 2.4 g oral loading followed by 1.2 g q12h orally for a total of
10 days
2) Dosage of Kaletra: 3 tabs bd orally (each tablet containing 400 mg of Lopinavir
and 100 mg of Ritonavir) for a total of 10 days
** Choice of anti-viral therapy and additional therapy such as TCM should be at the
discretion of the clinician-in-charge
*** Patients who request traditional Chinese medicine (TCM) will be referred to the
experts on Chinese medicine from Guangzhou Hospital, who are stationed in the
TCM Clinic in YCH.
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