# COVID-19 treatment of hospital patients worldwide at the onset of the pandemic in 2020: a systematic review

## TL;DR

This paper reviews how hospital patients with COVID-19 were treated globally in early 2020, highlighting drug use and regional differences.

## Contribution

The study provides the first comprehensive overview of early 2020 global in-patient COVID-19 treatment practices across multiple continents.

## Key findings

- Hydroxychloroquine was the most prescribed drug in Africa, Europe, and North America.
- Corticosteroids were used consistently across Asia, Europe, and North America.
- Asia showed unique treatment patterns, including higher oseltamivir use and exclusive use of umifenovir.

## Abstract

In early 2020, no drug had proven efficacy to treat COVID-19 in-patients. This work aimed to describe COVID-19 treatment for in-patients worldwide until June, 2020. A PubMed search was performed with the terms “retrospective observational study”, “hospital”, “treatment” and “COVID” to identify English-written studies describing treatments given to adult in-patients before June 30, 2020. The identified reports were analyzed, with data extracted regarding patient characteristics and treatments across continents and countries. Overall, 178 studies involving 181,510 patients in 28 countries were analyzed, including 484 patients from Africa, 36,840 from Asia, 69,088 from Europa and 68,524 from North America. The most prescribed drugs were hydroxychloroquine (64.3%, i.e. 41.9% of all patients), corticosteroids (31.0%, i.e. 21.0%) and lopinavir/ritonavir (30.8%, i.e. 12.0%). Corticosteroids was used worldwide with similar rates in Asia, Europe and North America. Hydroxychloroquine dominated prescriptions in Africa, Europe and North America. Asia exhibited unique features: less frequent hydroxychloroquine use, higher oseltamivir use and exclusive use of umifenovir. In Europe, repurposed drugs prescription was the highest in Spain and Italy. Our study is not an exhaustive review of the literature on COVID-19 treatment of in-patients early in 2020 but is the first one to provide a comprehensive overview of COVID-19 treatment modalities in such a broad range of countries worldwide. Our work reveals high prescription rates but also heterogeneity across continents and countries in the treatment of COVID-19 in-patients worldwide. These findings emphasize the critical role of international collaboration in generating and disseminating reliable information for managing emerging diseases.

The online version contains supplementary material available at 10.1186/s12879-025-12368-2.