| Patients with fever | Antipyretics can be used in patients with COVID-19 symptoms including fever, arthralgia, myalgia and headache. Specific dosages of each medication are as follows: paracetamol (500 mg, 2–3 times a day), ibuprofen (400 mg, 2–3 times a day) and diclofenac suppository (one at a time, every 6–8 hours). Paedoksan as Koryo medicine (traditional North Korean medicine) can also be used (4 g, three times a day). Antibiotics can be considered in cases involving accompanying symptoms of bacterial infection, while injection of antibiotics (eg, penicillin, ceftriaxone, levofloxacin) should be managed under the instruction of a doctor. Antibiotic allergy testing is required prior to administration of antibiotics. Antibiotics (eg, amoxicillin, erythromycin) can also be administered orally.
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| Patients with diabetes | Blood sugar level should be strictly managed as elevation of blood sugar levels is frequently observed within 7–10 days after fever. Some antidiabetic drugs such as metformin are not recommended during the period of COVID-19 infection, considering the risk of metabolic acidosis and increased plasma drug concentration, while insulin or sulfonylureas are relatively safe to use. Steroid medications such as prednisolone should not be used without the direction of a doctor.
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| Patients with gastrointestinal disorders | Repeated use of antipyretics, painkillers and antibiotics should be avoided as they can cause gastrointestinal symptoms including abdominal pain, epigastric discomfort, diarrhoea, nausea, vomiting or even gastric bleeding. Foods that do not irritate the mucous membrane, such as porridge or soup, are recommended. Proton-pump inhibitors (eg, omeprazole, pantoprazole, lansoprazole) or H2 receptor antagonists (eg, ranitidine, cimetidine) can be used in cases involving severe symptoms.
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| Pregnant women | The antipyretic effects of medication in pregnant women are relatively low; most antipyretics can pose a risk depending on the period of pregnancy. While paracetamol is relatively safe for pregnant women, those with underlying diseases such as gestational diabetes or impaired liver function should use antipyretics only under the instruction of a doctor. Fluoroquinolones (eg, ciprofloxacin, levofloxacin) should not be used in pregnant women. Some Koryo medicine (traditional North Korean medicine) such as Paedoksan can be safely used in pregnant women with symptoms of COVID-19, regardless of the period of pregnancy.
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| Children | The majority of COVID-19 symptoms are not severe in the child population; early diagnosis and a proper approach to treatment may result in a good prognosis. Antipyretics can be used in children with a fever of 38°C or more, specific dosages of each medication are as follows: paracetamol (10–15 mg/kg), diclofenac (1 mg/kg), ibuprofen (10–15 mg/kg). Diphenhydramine (1–2 mg/kg, one or two times a day) and chlorpheniramine (0.35 mg/kg, one or two times a day) can also be used in cases where fever is accompanied by rhinorrhea and cough. Chlorpromazine, diphenhydramine and diazepam can be used for the management of febrile seizures, while phenobarbital is preferred in neonatal seizures. Antibiotics (eg, penicillin, ceftriaxone, ciprofloxacin, levofloxacin) or corticosteroids (eg, prednisolone, dexamethasone) may be required in patients diagnosed with pneumonia. An oxygen supply or intravenous fluids can be administered in critically ill patients.
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