A 58-year-old man hospitalised with COVID-19 pneumonia on day 9 requires 6 L/min of supplemental oxygen to maintain SpO2 of 93%. C-reactive protein has risen from 40 to 180 mg/L, ferritin is markedly elevated, and he is on prophylactic anticoagulation. Which additional therapy is most appropriate?

• A Tocilizumab, an interleukin-6 receptor antagonist ✓
• B High-dose systemic corticosteroids beyond the dexamethasone dose
• C Convalescent plasma transfusion
• D Empirical broad-spectrum antibacterial cover with meropenem

Explanation

Tocilizumab improves outcomes in hospitalised patients with severe COVID-19 who require oxygen or ventilatory support and have evidence of systemic inflammation, classically a rapidly rising CRP. Dexamethasone remains the corticosteroid of choice and escalation to high-dose steroids increases secondary infection risk without benefit. Convalescent plasma showed no mortality benefit in randomised trials, and meropenem is unjustified without bacterial culture evidence or strong suspicion of bacterial superinfection.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.