Active COVID-19, Clinical Pathway — All Settings

Therapies We DO NOT Recommend

The therapies listed below have been demonstrated to be ineffective or harmful. They should not be used at CHOP for the treatment of COVID-19.

Therapy	Rationale for recommendation
Convalescent plasma	Multiple studies have demonstrated that convalescent plasma is not effective in the treatment of COVID-19. Use of convalescent plasma is therefore not recommended, and further, convalescent plasma is no longer being supplied as of 9/1/2021.
CytoSorb	There are no published studies that support use of CytoSorb in COVID-19. Further, a small single-center randomized trial of adults on VV-ECMO demonstrated higher mortality in those treated with CytoSorb compared to those not treated with CytoSorb therapy. Given no evidence of benefit and possible signal for harm, use is not recommended.
Hydroxychloroquine	Multiple published observational studies and large randomized clinical trials have shown that hydroxychloroquine is not effective for treatment of COVID-19. There is also a FDA safety warning related to potential arrhythmias.
Azithromycin + Hydroxychloroquine	Multiple studies have demonstrated that this combination is not effective and QTc prolongation occurs in up to 30%, given additive side effects of azithromycin and hydroxychloroquine.
Ribavirin	Ribavirin has not been shown to have in vitro activity against SARS-CoV-2 at clinically relevant concentrations. Further, there is little biologic basis for efficacy based on mechanism. Finally, there are significant adverse drug reactions (e.g., hemolytic anemia) that may be particularly deleterious in severely/critically ill patients.
Ivermectin	Multiple studies have demonstrated that ivermectin is ineffective in the treatment of COVID-19. While it may inhibit viral replication in vitro, the concentrations needed to inhibit viral replication are not achievable in humans.
Lopinavir-ritonavir	Large randomized clinical trials have demonstrated no difference in clinical outcomes for patients treated with lopinavir-ritonavir as compared to standard therapy.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.