Page 28 - COVID-19-Mortality-review-in-Malaysia-and-updates-on-clinical-management-of-COVID-19

MOH guidelines

Patients in category 4 and 5 are those who require oxygen, we need to look out for
markers suggestive of cytokine release syndrome (CRS). If any of these criteria (below)

is present, then our recommendation is to give dexamethasone, methylprednisolone
or tocilizumab.
Clinical:
● Persistent or new onset fever
● Increasing oxygen requirement

PLUS

● Increasing CRP /Raised CRP
● Increasing Ferritin/Raised Ferritin
● Persistently low OR dropping ALC <1.0
● High Interleukin 6 levels (if available)

We are giving a shorter course of dexamethasone as compared to what is
recommended in the Recovery study. This is our own recommendation:

IV Dexamethasone 4mg bd or tds – 3- 5 days
OR
IV Methylprednisolone 1-2mg/kg daily – 3- 5 days
OR
IV Tocilizumab 4-8mg/kg single dose – preferred in late presentation

We are still continuing with this particular recommendation which means we are
not giving it to everybody that requires oxygen. We are looking for markers of high

cytokine release before giving it. That's regarding anti-inflammatory/
immunomodulatory agents