From the Guidelines
For inpatient COVID-19 treatment, the primary medications include remdesivir (typically 200mg IV on day 1, followed by 100mg IV daily for 4 days), dexamethasone (6mg daily for up to 10 days) for patients requiring oxygen, and baricitinib or tocilizumab for those with severe inflammation. The treatment approach is based on the most recent and highest quality study available, which emphasizes the importance of antiviral, immunosuppressive, and immunomodulatory treatments in managing COVID-19 symptoms 1. Key considerations in inpatient COVID-19 treatment include:
- Supplemental oxygen therapy provided based on oxygen saturation levels, with progression from nasal cannula to high-flow oxygen, non-invasive ventilation, or mechanical ventilation as needed
- Prone positioning to improve oxygenation in severe cases
- Anticoagulation with prophylactic-dose heparin or enoxaparin to prevent blood clots
- Supportive care, including IV fluids for hydration, acetaminophen for fever (650mg every 4-6 hours as needed), and close monitoring of vital signs and laboratory values These interventions are tailored to disease severity, with mild cases requiring less intervention than critical cases, and work by reducing viral replication, managing inflammatory responses, and supporting organ function while the body fights the infection 1. It's also important to consider the potential for secondary bacterial infections and the use of oral antibiotics, such as amoxicillin, azithromycin, or fluoroquinolones, in patients with suspected bacterial superinfection 1. Overall, the goal of inpatient COVID-19 treatment is to reduce morbidity, mortality, and improve quality of life by providing evidence-based care that addresses the complex needs of patients with COVID-19.
From the FDA Drug Label
1.7 Coronavirus Disease 2019 (COVID-19) ACTEMRA® (tocilizumab) is indicated for the treatment of coronavirus disease 2019 (COVID-19) in hospitalized adult patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).
The treatment course of VEKLURY should be initiated as soon as possible after diagnosis of symptomatic COVID-19 has been made. For hospitalized patients requiring invasive mechanical ventilation and/or ECMO, the recommended total treatment duration is 10 days. For hospitalized patients not requiring invasive mechanical ventilation and/or ECMO, the recommended treatment duration is 5 days.
Prescribed treatments for inpatient Covid symptoms:
- Tocilizumab (IV): for hospitalized adult patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) 2
- Remdesivir (IV): for hospitalized patients, with a recommended treatment duration of 5 to 10 days depending on the severity of the disease and the need for invasive mechanical ventilation and/or ECMO 3
From the Research
Inpatient Covid-19 Treatment
The treatment for inpatient Covid-19 symptoms typically involves a combination of medications and supportive care. Some of the commonly prescribed treatments include:
- Remdesivir, an antiviral agent that has been shown to reduce recovery time and improve clinical outcomes 4, 5, 6
- Corticosteroids, such as dexamethasone, which have been found to decrease mortality in patients with severe or critical Covid-19 4, 7, 6
- Tocilizumab, an interleukin-6 receptor antagonist that has been used in combination with corticosteroids to treat hospitalized patients with Covid-19 4
- Baricitinib, a Janus kinase inhibitor that has been used in combination with remdesivir and dexamethasone to treat severe Covid-19 5
Treatment Guidelines
The treatment guidelines for inpatient Covid-19 symptoms vary depending on the severity of the disease and the presence of underlying medical conditions. Some of the key considerations include:
- Determining the indication for hospital admission, which should involve consideration of age, comorbidities, respiratory rate, and oxygen saturation 7
- Providing supportive care, such as oxygen therapy and mechanical ventilation, as needed 7, 5
- Using pharmacological treatments, such as antiviral agents and corticosteroids, to manage the disease and prevent complications 4, 7, 5, 6
- Monitoring patients for potential adverse events, such as liver dysfunction, thrombosis, and renal dysfunction 5
Combination Therapy
Combination therapy with multiple medications has been shown to be effective in treating severe Covid-19. For example, a study found that combination therapy with remdesivir, dexamethasone, and baricitinib was associated with a low 28-day mortality rate and a reduced need for invasive mechanical ventilation 5. Another study found that combination therapy with remdesivir and dexamethasone was associated with a significant reduction in mortality, length of hospitalization, and faster SARS-CoV-2 clearance compared to dexamethasone alone 6.