A patient with COVID-19 pneumonia requiring supplemental oxygen (SpO2 88-92% on room air) but NOT on mechanical ventilation is admitted. Per WHO/NIH COVID-19 Treatment Guidelines, which therapy improves 28-day mortality in this patient?
- A Remdesivir 200 mg IV loading then 100 mg daily for 5 days
- B Dexamethasone 6 mg once daily for 10 days ✓
- C Tocilizumab alone without steroids
- D High-dose methylprednisolone 1 g IV pulse for 3 days
Correct answer: B. Dexamethasone 6 mg once daily for 10 days
Explanation
The RECOVERY trial (NEJM 2021) demonstrated that dexamethasone 6 mg daily for 10 days significantly reduced 28-day mortality in COVID-19 patients on oxygen (21% relative risk reduction) and on mechanical ventilation (36% reduction). It is NOT beneficial in patients not requiring oxygen. Remdesivir reduces time to clinical improvement but showed no significant mortality benefit (SOLIDARITY trial). Tocilizumab reduces mortality when added to dexamethasone (RECOVERY sub-trial) but not as sole therapy. High-dose pulse methylprednisolone is not the recommended regimen.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.