What is the common treatment regimen for Coronavirus disease (COVID-19)?

From the Guidelines

The common treatment regimen for COVID-19 depends on symptom severity, with corticosteroids such as dexamethasone and immunomodulators like tocilizumab being considered for moderate to severe cases requiring hospitalization, as they have been shown to reduce disease progression and mortality 1.

Treatment Overview

For mild cases, rest, hydration, and over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil) at standard doses can help manage fever and pain.

• Acetaminophen: 325-650mg every 4-6 hours, not exceeding 3000mg daily
• Ibuprofen: 200-400mg every 4-6 hours with food Antiviral medications such as nirmatrelvir/ritonavir (Paxlovid) may be prescribed for high-risk patients within 5 days of symptom onset, typically as 300mg nirmatrelvir with 100mg ritonavir taken twice daily for 5 days.

Hospitalized Patients

For moderate to severe cases requiring hospitalization, treatments may include:

• Remdesivir: typically 200mg IV on day 1, followed by 100mg daily for 4-9 days
• Dexamethasone: 6mg daily for up to 10 days
• Other corticosteroids
• Supplemental oxygen
• Immunomodulators like tocilizumab or baricitinib These medications work by either directly inhibiting viral replication or modulating the immune response to prevent excessive inflammation, as supported by recent studies 1.

Prevention of Transmission

Isolation for at least 5 days from symptom onset (or positive test if asymptomatic) is recommended to prevent transmission, with mask-wearing for an additional 5 days when around others. The use of corticosteroids and immunomodulators in hospitalized patients with COVID-19 has been associated with improved outcomes, including reduced mortality and disease progression 1.

From the FDA Drug Label

The recommended dosage for adults and pediatric patients weighing at least 40 kg is a single loading dose of VEKLURY 200 mg on Day 1 via intravenous infusion followed by once-daily maintenance doses of VEKLURY 100 mg from Day 2 via intravenous infusion. The treatment course of VEKLURY should be initiated as soon as possible after diagnosis of symptomatic COVID-19 has been made. The recommended total treatment duration for hospitalized patients requiring invasive mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO) is 10 days The recommended treatment duration for hospitalized patients not requiring invasive mechanical ventilation and/or ECMO is 5 days. The recommended total treatment duration for non-hospitalized patients diagnosed with mild-to-moderate COVID-19 who are at high risk for progression to severe COVID-19, including hospitalization or death, is 3 days.

The common treatment regimen for Covid-19 using remdesivir (IV) is as follows:

• Hospitalized patients:
  • Requiring invasive mechanical ventilation and/or ECMO: 10 days
  • Not requiring invasive mechanical ventilation and/or ECMO: 5 days
• Non-hospitalized patients: 3 days for those with mild-to-moderate COVID-19 who are at high risk for progression to severe COVID-19. The dosage is a single loading dose of 200 mg on Day 1, followed by once-daily maintenance doses of 100 mg from Day 2 via intravenous infusion 2.

From the Research

Common Treatment Regimens for Covid

• The treatment for COVID-19 depends on the disease severity, with different medications used for different levels of severity 3.
• Remdesivir is an antiviral used to treat COVID-19, which has been shown to improve clinical outcomes, and is currently the only recommended antiviral for use in hospitalized patients with COVID-19 4, 5.
• Dexamethasone has been shown to be effective in reducing mortality, and the combination of remdesivir and dexamethasone has been associated with significant reduction in mortality, length of hospitalization, and faster SARS-CoV-2 clearance 4, 6.
• Other medications used to treat COVID-19 include antiviral agents, inflammation inhibitors/antirheumatic drugs, low molecular weight heparins, plasma, and hyperimmune immunoglobulins 7.
• The use of remdesivir and dexamethasone has been shown to be effective in reducing mortality risk in patients hospitalized for COVID-19, across all levels of baseline respiratory support 6.

Medications Used to Treat Covid

• Remdesivir: an antiviral used to treat COVID-19, which has been shown to improve clinical outcomes 4, 5.
• Dexamethasone: a medication used to reduce inflammation, which has been shown to be effective in reducing mortality 4, 6.
• Antiviral agents: used to treat COVID-19, particularly in patients with moderate to severe disease 7.
• Inflammation inhibitors/antirheumatic drugs: used to reduce inflammation and treat COVID-19 7.
• Low molecular weight heparins: used to prevent blood clots in patients with COVID-19 7.
• Plasma and hyperimmune immunoglobulins: used to treat COVID-19, particularly in patients with severe disease 7.

Treatment Outcomes

• Remdesivir and dexamethasone combination therapy has been associated with significant reduction in mortality, length of hospitalization, and faster SARS-CoV-2 clearance 4, 6.
• Remdesivir has been shown to improve survival and disease progression in a variety of patient populations with COVID-19 5.
• Dexamethasone has been shown to be effective in reducing mortality in patients with COVID-19 4, 6.
• The use of remdesivir and dexamethasone has been shown to be effective in reducing mortality risk in patients hospitalized for COVID-19, across all levels of baseline respiratory support 6.