Bibliographic information
GuidelineWHO guidelines for the clinical management of filovirus disease
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
New
WHO suggests that patients with suspected or confirmed filovirus disease requiring a vasopressor be treated with norepinephrine rather than epinephrine.
Recommended in favor
Conditional
Certainty of evidence
Very low
Notes and Remarks
- This recommendation applies to children and adults, including pregnant women. • The choice of norepinephrine or epinephrine may depend on availability and local practices. • For some patients, for example, those with cardiac systolic dysfunction, epinephrine may may be preferable to norepinephrine alone. • Vasopressors should be used within a resuscitation strategy that includes appropriate fluid therapy, frequent monitoring, including early identification of arrythmia. • Individualize titration of the dose to desired effect (improved perfusion). • To minimize adverse effects, use the lowest dose possible for desired effect and discontinue vasopressors when no longer indicated. Practical info Given the higher lactate levels in patients treated with epinephrine compared with norepinephine, the use choice of agent should be considered when using lactate monitoring