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Clinical Management Guidelines Lacking for Monkeypox

Treatment guidance mainly limited to antiviral advice, vaccination recommended as postexposure prophylaxis

By Physician’s Briefing Staff | April 19, 2022

There is a lack of evidence-based clinical management guidelines for monkeypox (MPX), according to a review published online Aug. 16 in BMJ Global Health .

Eika Webb, M.B.B.S., from Liverpool School of Tropical Medicine in the United Kingdom, and colleagues conducted a systematic review and identified MPX guidelines providing treatment and supportive care recommendations. A total of 14 guidelines were included, from 2,026 records screened.

The researchers found that most guidelines were of low quality (median score, 2 out of 7), lacked detail, and covered only a narrow range of topics. Most of the guidelines focused on adults; five, three, and three provided some advice for children, pregnant women, and people living with HIV, respectively. Treatment guidance was mainly limited to antiviral advice; cidofovir was advised in seven guidelines (four for severe MPX only), while four and one guidelines advised tecovirimat and brincidofovir, respectively. Recommendations on supportive care and treatment of complications were provided in only one guideline. Vaccination was recommended as postexposure prophylaxis (PEP) in all guidelines. Vaccinia immune globulin was advised as PEP for severe cases in people with immunosuppression in three guidelines.

"Urgent investments into research to identify optimal treatment and prophylaxis strategies are needed for the whole population, in any setting, to benefit patient care and outcomes," the authors write.

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