{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:02:41Z","timestamp":1760234561509,"version":"build-2065373602"},"reference-count":69,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T00:00:00Z","timestamp":1621987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>This paper aims to analyze the ethical challenges in experimental drug use during the early stage of the COVID-19 pandemic, using Germany as a case study. In Germany uniform ethical guidelines were available early on nationwide, which was considered as desirable by other states to reduce uncertainties and convey a message of unity. The purpose of this ethical analysis is to assist the preparation of future guidelines on the use of medicines during public health emergencies. The use of hydroxychloroquine, remdesivir and COVID-19 convalescent plasma in clinical settings was analyzed from the perspective of the ethical principles of beneficence, non-maleficence, justice and autonomy. We observed that drug safety and drug distribution during the pandemic affects all four ethical principles. We therefore recommend to establish ethical guidelines (i) to discuss experimental treatment options with patients from all population groups who are in urgent need, (ii) to facilitate the recording of patient reactions to drugs in off-label use, (iii) to expand inclusion criteria for clinical studies to avoid missing potentially negative effects on excluded groups, and (iv) to maintain sufficient access to repurposed drugs for patients with prior conditions.<\/jats:p>","DOI":"10.3390\/ijerph18115685","type":"journal-article","created":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T10:30:32Z","timestamp":1622025032000},"page":"5685","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Medication of Hydroxychloroquine, Remdesivir and Convalescent Plasma during the COVID-19 Pandemic in Germany\u2014An Ethical Analysis"],"prefix":"10.3390","volume":"18","author":[{"given":"Katja","family":"Voit","sequence":"first","affiliation":[{"name":"Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7935-2823","authenticated-orcid":false,"given":"Cristian","family":"Timmermann","sequence":"additional","affiliation":[{"name":"Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8108-1591","authenticated-orcid":false,"given":"Florian","family":"Steger","sequence":"additional","affiliation":[{"name":"Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Emanuel, E.J., Persad, G., Upshur, R., Thome, B., Parker, M., Glickman, A., Zhang, C., Boyle, C., Smith, M., and Phillips, J.P. (2020). Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N. Engl. J. Med.","DOI":"10.1056\/NEJMsb2005114"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1111\/bioe.12836","article-title":"Saving the most lives\u2014A comparison of European triage guidelines in the context of the COVID-19 pandemic","volume":"35","author":"Ehni","year":"2021","journal-title":"Bioethics"},{"key":"ref_3","unstructured":"Robert Koch-Institut, Ethikrat, D., and der Nationale, A.W.L. (2021). Wie Soll der Zugang zu Einem COVID-19-Impfstoff Geregelt Werden?, Deutscher Ethikrat."},{"key":"ref_4","unstructured":"Arbeitskreis Medizinischer Ethik-Kommissionen in der Bundesrepublik Deutschland (2021, April 15). Hinweise zu COVID-19. Available online: https:\/\/www.akek.de\/aktuelle-hinweise\/covid-19\/."},{"key":"ref_5","unstructured":"Munthe, C., Heilinger, J.-C., and Wild, V. (2021, April 15). Policy Brief: Ethical Aspects of Pandemic Public Policy-Making under Uncertainty. Available online: https:\/\/www.public-health-covid19.de\/images\/2021\/Ergebnisse\/PB_uncertainty_pandemic_olicy_6Jan2021.pdf."},{"key":"ref_6","unstructured":"Ranisch, R., and Nijsingh, N. (2021, April 15). Ethics of Digital Contact Tracing Apps for the Covid-19 Pandemic Response. Available online: https:\/\/www.public-health-covid19.de\/images\/2020\/Ergebnisse\/Ethics_of_digital_contact_tracing-v1.pdf."},{"key":"ref_7","unstructured":"Faust, A., Sierawska, A., Kr\u00fcger, K., Wisgalla, A., Hasford, J., and Strech, D. (2021). Herausforderungen Deutscher Ethikkommissionen mit Eingereichten Forschungsantr\u00e4gen W\u00e4hrend der COVID-19 Pandemie\u2014Ergebnisse einer Orientierenden Abfrage, BIH QUEST und Arbeitskreis Medizinischer Ethik-Kommissionen in der Bundesrepublik Deutschland e.V."},{"key":"ref_8","unstructured":"Beauchamp, T.L., and Childress, J.F. (2019). Principles of Biomedical Ethics, Oxford University Press. [8th ed.]."},{"key":"ref_9","unstructured":"Statistisches Bundesamt (2021, May 15). Sonderauswertung der Sterbefallzahlen 2020. Available online: https:\/\/www.destatis.de\/DE\/Methoden\/WISTA-Wirtschaft-und-Statistik\/2020\/04\/sonderauswertung-sterbefallzahlen-042020.pdf?__blob=publicationFile."},{"key":"ref_10","unstructured":"Bundesinstitut f\u00fcr Arzneimittel und Medizinprodukte (2021, April 15). Leitfaden zur Anzeige eines Arzneimittel-H\u00e4rtefallprogramms nach Arzneimittel-H\u00e4rtefall-Verordnung (AMHV)\u2014Version 1.3 vom 20. Available online: https:\/\/www.bfarm.de\/SharedDocs\/Downloads\/DE\/Arzneimittel\/Zulassung\/klin-pr\/compUse\/BfArM-LeitfadenZuArzneimittel-Haertefallprogrammen.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s00048-020-00257-5","article-title":"Die \u201chistorische Studie\u201d SOLIDARITY als Antwort der Forschung auf die Sars-CoV-2 Pandemie","volume":"28","author":"Marloth","year":"2020","journal-title":"NTM"},{"key":"ref_13","unstructured":"U.S. Food and Drug Administration (2021, April 15). Coronavirus (COVID-19) Update: FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine, Available online: https:\/\/www.fda.gov\/news-events\/press-announcements\/coronavirus-covid-19-update-fda-revokes-emergency-use-authorization-chloroquine-and."},{"key":"ref_14","unstructured":"U.S. Food and Drug Administration (2021, April 15). FDA In Brief: FDA Updates Emergency Use Authorization for COVID-19 Convalescent Plasma to Reflect New Data, Available online: https:\/\/www.fda.gov\/news-events\/fda-brief\/fda-brief-fda-updates-emergency-use-authorization-covid-19-convalescent-plasma-reflect-new-data."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1080\/15265161.2020.1795538","article-title":"Allocating remdesivir under scarcity: Social justice or more systemic racism","volume":"20","author":"Weber","year":"2020","journal-title":"Am. J. Bioeth."},{"key":"ref_16","unstructured":"Bundesinstitut f\u00fcr Arzneimittel und Medizinprodukte (2021, April 30). Licensing Procedures. Available online: https:\/\/www.bfarm.de\/EN\/Drugs\/licensing\/zulassungsverfahren\/_node.html."},{"key":"ref_17","unstructured":"U.S. Food and Drug Administration (2021, April 30). Development & Approval Process\u2014Drugs, Available online: https:\/\/www.fda.gov\/drugs\/development-approval-process-drugs."},{"key":"ref_18","unstructured":"European Commission (2021, April 15). Questions and Answers: Conditional Marketing Authorization of COVID-19 Vaccines in the EU. Available online: https:\/\/ec.europa.eu\/commission\/presscorner\/detail\/de\/qanda_20_2390."},{"key":"ref_19","unstructured":"U.S. Food and Drug Administration (2021, April 30). Emergency Use Authorization, Available online: https:\/\/www.fda.gov\/emergency-preparedness-and-response\/mcm-legal-regulatory-and-policy-framework\/emergency-use-authorization."},{"key":"ref_20","unstructured":"Bundesinstitut f\u00fcr Arzneimittel und Medizinprodukte (2020). Coronavirus SARS-CoV-2, Bundesinstitut f\u00fcr Arzneimittel und Medizinprodukte."},{"key":"ref_21","unstructured":"U.S. Food and Drug Administration (2021, April 30). Expanded Access, Available online: https:\/\/www.fda.gov\/news-events\/public-health-focus\/expanded-access."},{"key":"ref_22","unstructured":"(2021, May 24). Strafgesetzbuch (StGB) in der Fassung der Bekanntmachung vom 13. November 1998 (BGBl. I S. 3322) zuletzt ge\u00e4ndert durch Art. 1 G zur Bek\u00e4mpfung des Rechtsextremismus und der Hasskriminalit\u00e4t vom 30.3.2021 (BGBl. I S. 441, ge\u00e4nd. durch G v. 30.3.2021, BGBl. I S. 448). Available online: https:\/\/www.gesetze-im-internet.de\/englisch_stgb\/englisch_stgb.html#p0191."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e041437","DOI":"10.1136\/bmjopen-2020-041437","article-title":"Protocol for the DisCoVeRy trial: Multicentre, adaptive, randomised trial of the safety and efficacy of treatments for COVID-19 in hospitalised adults","volume":"10","author":"Ader","year":"2020","journal-title":"BMJ Open"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1136\/medethics-2020-106306","article-title":"Hydroxychloroquine and COVID-19: Critiquing the impact of disease public profile on policy and clinical decision-making","volume":"46","author":"Aquino","year":"2020","journal-title":"J. Med Ethics"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3416","DOI":"10.1128\/AAC.01509-08","article-title":"Antiviral activity of chloroquine against human coronavirus OC43 infection in newborn mice","volume":"53","author":"Keyaerts","year":"2009","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.4269\/ajtmh.20-0290","article-title":"Chloroquine and hydroxychloroquine for the prevention or treatment of COVID-19 in Africa: Caution for inappropriate off-label use in healthcare settings","volume":"102","author":"Abena","year":"2020","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1126\/science.abc1731","article-title":"Against pandemic research exceptionalism","volume":"368","author":"London","year":"2020","journal-title":"Science"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1056\/NEJMoa2007764","article-title":"Remdesivir for the Treatment of Covid-19\u2014Final Report","volume":"383","author":"Beigel","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1038\/nature17180","article-title":"Therapeutic efficacy of the small molecule GS-5734 against Ebola virus in rhesus monkeys","volume":"531","author":"Warren","year":"2016","journal-title":"Nature"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"117","DOI":"10.4103\/ijp.IJP_310_20","article-title":"COVID-19 pandemic: A review based on current evidence","volume":"52","author":"Mahalmani","year":"2020","journal-title":"Indian J. Pharmacol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/S1473-3099(20)30141-9","article-title":"Convalescent plasma as a potential therapy for COVID-19","volume":"20","author":"Chen","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1111\/bcp.14480","article-title":"The impact of the global COVID-19 pandemic on the conduct of clinical trials: Return to normalcy by considering the practical impact of a structured ethical analysis","volume":"87","author":"Vissers","year":"2021","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1007\/s40199-020-00351-y","article-title":"COVID-19 and off label use of drugs: An ethical viewpoint","volume":"28","author":"Shojaei","year":"2020","journal-title":"Daru J. Pharm. Sci."},{"key":"ref_34","unstructured":"World Medical Association (2013). WMA Declaration of Helsinki\u2014Ethical Principles for Medical Research Involving Human Subjects, WMA."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3413","DOI":"10.1590\/1413-81232020259.16792020","article-title":"Off label, compassionate and irrational use of medicines in Covid-19 pandemic, health consequences and ethical issues","volume":"25","author":"Paumgartten","year":"2020","journal-title":"Cienc. Saude Coletiva"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1126\/science.368.6496.1166","article-title":"Big studies dim hopes for hydroxychloroquine","volume":"368","author":"Kupferschmidt","year":"2020","journal-title":"Science"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1001\/jama.2020.11464","article-title":"A proposed lottery system to allocate scarce COVID-19 medications: Promoting fairness and generating knowledge","volume":"324","author":"White","year":"2020","journal-title":"JAMA"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1946","DOI":"10.1016\/j.mayocp.2020.06.016","article-title":"Developing an ethics framework for allocating remdesivir in the COVID-19 pandemic","volume":"95","author":"Lim","year":"2020","journal-title":"Mayo Clin. Proc."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Doshi, P., Jefferson, T., and Del Mar, C. (2012). The imperative to share clinical study reports: Recommendations from the Tamiflu experience. PLoS Med., 9.","DOI":"10.1371\/journal.pmed.1001201"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1472-6939-7-12","article-title":"Pandemic influenza preparedness: An ethical framework to guide decision-making","volume":"7","author":"Thompson","year":"2006","journal-title":"BMC Med. Ethics"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.gendis.2020.07.001","article-title":"Pandemic COVID-19: Current status and challenges of antiviral therapies","volume":"7","author":"Chan","year":"2020","journal-title":"Genes Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1126\/science.abe2803","article-title":"An ethical framework for global vaccine allocation","volume":"369","author":"Emanuel","year":"2020","journal-title":"Science"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1016\/j.mayocp.2020.08.018","article-title":"Exclusion of Older Adults in COVID-19 Clinical Trials","volume":"95","author":"Kouzy","year":"2020","journal-title":"Mayo Clin. Proc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e20201081","DOI":"10.1542\/peds.2020-1081","article-title":"A call for pediatric COVID-19 clinical trials","volume":"146","author":"Campbell","year":"2020","journal-title":"Pediatrics"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1055\/s-0040-1712103","article-title":"Exclusion of pregnant women from clinical trials during the coronavirus disease 2019 pandemic: A review of international registries","volume":"37","author":"Smith","year":"2020","journal-title":"Am. J. Perinatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1097\/AOG.0000000000003924","article-title":"Protection by exclusion: Another missed opportunity to include pregnant women in research during the coronavirus disease 2019 (COVID-19) pandemic","volume":"136","author":"Costantine","year":"2020","journal-title":"Obstet. Gynecol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1001\/jama.2020.4742","article-title":"Treating COVID-19\u2014off-label drug use, compassionate use, and randomized clinical trials during pandemics","volume":"323","author":"Kalil","year":"2020","journal-title":"JAMA"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"100547","DOI":"10.1016\/j.jemep.2020.100547","article-title":"Ethical issues related to the hydroxychloroquine treatment prescription for Covid-19","volume":"14","author":"Adarmouch","year":"2020","journal-title":"Ethics Med. Public Health"},{"key":"ref_49","first-page":"4","article-title":"Clinical trials and the COVID-19 pandemic","volume":"23","author":"Retsas","year":"2020","journal-title":"Hell. J. Nucl. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1136\/annrheumdis-2020-217480","article-title":"Festina lente: Hydroxychloroquine, COVID-19 and the role of the rheumatologist","volume":"79","author":"Graef","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Husayn, S.S., Brown, J.D., Presley, C.L., Boghean, K., and Waller, J.D. (2020). Hydroxychloroquine alternatives for chronic disease: Response to a growing shortage amid the Global COVID-19 Pandemic. J. Pharm. Pract.","DOI":"10.1177\/0897190020942658"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1002\/eahr.500061","article-title":"Advantages of Using Lotteries to Select Participants for High-Demand Covid-19 Treatment Trials","volume":"42","author":"Iyer","year":"2020","journal-title":"Ethics Hum. Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1093\/phe\/phr005","article-title":"Is there a duty to share? Ethics of sharing research data in the context of public health emergencies","volume":"4","author":"Langat","year":"2011","journal-title":"Public Health Ethics"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1001\/jama.2020.4984","article-title":"Optimizing the trade-off between learning and doing in a pandemic","volume":"323","author":"Angus","year":"2020","journal-title":"JAMA"},{"key":"ref_55","unstructured":"IPBES (2020). IPBES Workshop on Biodiversity and Pandemics: Excecutive Summary, Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES)."},{"key":"ref_56","unstructured":"Paul-Ehrlich-Institut (2021, April 15). Empfehlung des Paul-Ehrlich-Instituts zur Gewinnung und Herstellung von COVID-19-Rekonvaleszentenplasma. Available online: https:\/\/www.pei.de\/DE\/newsroom\/hp-meldungen\/2020\/200407-empfehlung-pei-covid-19-rekonvaleszentenplasma-rkp.html?nn=13577266."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12910-020-00478-2","article-title":"COVID-19: Where is the national ethical guidance?","volume":"21","author":"Huxtable","year":"2020","journal-title":"BMC Med. Ethics"},{"key":"ref_58","unstructured":"Deutsche Apothekerzeitung (2021, May 15). Gilead gibt Preis f\u00fcr Remdesivir Bekannt. Available online: https:\/\/www.deutsche-apotheker-zeitung.de\/news\/artikel\/2020\/06\/30\/gilead-legt-preis-fuer-remdesivir-fest."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1126\/science.abc1076","article-title":"Ethics of controlled human infection to address COVID-19","volume":"368","author":"Shah","year":"2020","journal-title":"Science"},{"key":"ref_60","unstructured":"European Commission (2021, April 15). Guidance on the Management of Clinical Trials during the COVID-19 (Coronavirus) Pandemic. Available online: https:\/\/ec.europa.eu\/health\/sites\/health\/files\/files\/eudralex\/vol-10\/guidanceclinicaltrials_covid19_en.pdf."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1007\/s00393-020-00833-z","article-title":"Auswirkungen von COVID-19 auf die rheumatologische Versorgung","volume":"79","author":"Freudenberg","year":"2020","journal-title":"Z. F\u00fcr Rheumatol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/s00063-020-00674-3","article-title":"Empfehlungen zur intensivmedizinischen Therapie von Patienten mit COVID-19","volume":"115","author":"Kluge","year":"2020","journal-title":"Med. Klin. Intensivmed. Und Notf."},{"key":"ref_63","unstructured":"Bundesministerium der Justiz und f\u00fcr Verbraucherschutz (2021, April 15). Bundesministerium f\u00fcr Gesundheit\u2014Verordnung zur Sicherstellung der Versorgung der Bev\u00f6lkerung mit Produkten des medizinischen Bedarfs bei der durch das Coronavirus SARS-CoV-2 verursachten Epidemie (Medizinischer Bedarf Versorgungssicherstellungsverordnung\u2014MedBVSV). Available online: https:\/\/www.bundesgesundheitsministerium.de\/fileadmin\/Dateien\/3_Downloads\/Gesetze_und_Verordnungen\/GuV\/M\/MedBVSV.pdf."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1080\/14740338.2020.1828861","article-title":"Impact of the COVID-19 pandemic on clinical trials with drugs","volume":"19","author":"Hasford","year":"2020","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_65","unstructured":"Bundesinstitut f\u00fcr Arzneimittel und Medizinprodukte (2021, April 15). Erlass \u00fcber die Einrichtung von Expertengruppen zur Anwendung von Arzneimitteln Au\u00dferhalb des Zugelassenen Indikationsbereichs (Expertengruppen Off-Label) nach \u00a7 35c Absatz 1 Sozialgesetzbuch V (SGB V) vom 21.10.2009, ge\u00e4ndert 17.10.2013. Available online: https:\/\/www.bfarm.de\/DE\/Arzneimittel\/Arzneimittelzulassung\/Zugelassene_Arzneimittel\/Expertengruppen_OffLabel\/AllgemeineInformationen\/Erlass_26-05-2020.html."},{"key":"ref_66","unstructured":"Bundesinstitut f\u00fcr Arzneimittel und Medizinprodukte (2021, April 15). Ergebnisprotokoll der 18. Sitzung der Task Force zur Sicherstellung der medikament\u00f6sen Versorgung in der Intensivmedizin\u2014Telekonferenz vom 10.11.2020. Available online: https:\/\/www.bfarm.de\/DE\/Arzneimittel\/Arzneimittelzulassung\/Arzneimittelinformationen\/Lieferengpaesse\/jourfixe\/protokolle\/ICU_Taskforce_Protokoll_18.pdf?__blob=publicationFile&v=1."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1055\/a-1334-1925","article-title":"S2k-Leitlinie\u2013Empfehlungen zur station\u00e4ren Therapie von Patienten mit COVID-19","volume":"75","author":"Kluge","year":"2021","journal-title":"Pneumologie"},{"key":"ref_68","unstructured":"Paul-Ehrlich-Institut (2021, April 15). Coronavirus und COVID-19. Biomedizinische Arzneimittel. Available online: https:\/\/www.pei.de\/DE\/newsroom\/dossier\/coronavirus\/coronavirus-inhalt.html;jsessionid=E05FB55974E5298140E6913E125132BB.intranet222?nn=169730&cms_pos=4."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Ramakrishnan, S., Nicolau, D.V., Langford, B., Mahdi, M., Jeffers, H., Mwasuku, C., Krassowska, K., Fox, R., Binnian, I., and Glover, V. (2021). Inhaled budesonide in the treatment of early COVID-19 (STOIC): A phase 2, open-label, randomised controlled trial. Lancet Respir. Med.","DOI":"10.1101\/2021.02.04.21251134"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/11\/5685\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:08:00Z","timestamp":1760162880000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/11\/5685"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,26]]},"references-count":69,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["ijerph18115685"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18115685","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2021,5,26]]}}}