WHO guidelines for the clinical management of filovirus disease: Executive summary

Key recommendations

• Systematic patient monitoring should be established for patients with suspected or confirmed filovirus disease, using structured and documented clinical assessment at regular intervals, with frequency adapted to patient condition (Good practice statement).
• WHO recommends that for patients with suspected or confirmed filovirus disease, systematic laboratory monitoring be performed based on clinical assessment, rather than on routine testing (Strong recommendation for, low certainty of evidence).
• WHO recommends patients with suspected or confirmed filovirus disease with ongoing gastrointestinal fluid losses and some dehydration, be treated with a protocolized oral rehydration regimen (e.g. WHO Plan B) (Strong recommendation for, moderate certainty evidence).
• WHO suggests patients with suspected or confirmed filovirus disease with ongoing gastrointestinal fluid losses and severe dehydration be treated with a protocolized intravenous fluid regimen compared with no protocolized intravenous fluid regimen (Conditional recommendation for, low certainty evidence).
• WHO recommends balanced crystalloids (such as Ringer’s lactate) rather than 0.9% sodium chloride for acute intravenous fluid resuscitation in patients with suspected or confirmed filovirus disease (Strong recommendationfor, moderate certainty of evidence).
  Executive summary 3
• WHO suggests for patients with suspected or confirmed filovirus disease and clinical signs of shock or circulatory impairment, the serial measurement of lactate as part of the assessment of perfusion to guide further intravenous fluid management (Conditional recommendation for, low certainty of evidence).
• WHO suggests for patients with suspected or confirmed filovirus disease and clinical signs of shock or circulatory impairment, capillary refill time should be used as part of the assessment of perfusion to guide intravenous fluid management (Conditional recommendation for, low certainty of evidence).
• WHO suggests that patients with suspected or confirmed filovirus disease with shock who are being resuscitated with intravenous fluids, vasopressor treatment be initiated early rather than later (Conditional recommendation for, low certainty of evidence).
• WHO recommends that patients with suspected or confirmed filovirus disease requiring a vasopressor be treated with norepinephrine rather than dopamine (Strong recommendation for, moderate certainty evidence).
• WHO suggests that patients with suspected or confirmed filovirus disease requiring a vasopressor be treated with norepinephrine rather than epinephrine (Conditional recommendation for, very low certainty of evidence).
• WHO suggests that for patients with filovirus disease requiring initiation of vasopressors, peripheral intravenous catheters be used rather than central venous catheters (Conditional recommendation for, very low certainty of evidence)
• WHO recommends that for patients with suspected or confirmed filovirus requiring central venous access, ultrasound guided placement be used rather than non-ultrasound guided placement (Strong recommendation for, moderate certainty of evidence).
• WHO suggests for the use of presumptive broad-spectrum antibiotics in patients with confirmed filovirus disease in the presence of suspected sepsis or bacterial co-infection (Conditional recommendation for, low certainty of evidence).
• WHO suggests against the use of tranexamic acid in patients with confirmed filovirus disease and haemorrhage (Conditional recommendation against, very low certainty of evidence).
• WHO suggests for the use of tranexamic acid in patients with confirmed filovirus disease and postpartum haemorrhage (Conditional recommendation for, low certainty evidence).
• WHO recommends that persons who have survived/recovered from filovirus disease be offered structured followup after discharge (Strong recommendation for, moderate certainty of evidence).