Current Supportive Prescription Regimen for COVID-19
For patients with COVID-19, the current supportive prescription regimen should include remdesivir for hospitalized patients requiring oxygen, dexamethasone for those with moderate to severe disease, and baricitinib in combination with remdesivir for selected patients, based on the most recent evidence-based guidelines. 1
Treatment Approach Based on Disease Severity
Non-Hospitalized Patients (Mild COVID-19)
- Remdesivir: 3-day course for non-hospitalized patients at high risk for progression to severe disease, initiated within 7 days of symptom onset 2
- Monoclonal antibodies: Consider for patients at high risk for progressing to severe COVID-19 1
- Avoid: Hydroxychloroquine, chloroquine, and ivermectin are not recommended for prevention or treatment 1
Hospitalized Patients Not Requiring Mechanical Ventilation
- Remdesivir: 5-day course (200 mg IV on day 1, followed by 100 mg IV daily) 2
- For pediatric patients: Weight-based dosing per FDA guidelines 2
- Dexamethasone: For patients requiring supplemental oxygen (6 mg daily for up to 10 days) 1
- Baricitinib: In combination with remdesivir for selected patients 1
- Anticoagulation: Prophylactic dose for all hospitalized patients without contraindications 1
Hospitalized Patients Requiring Mechanical Ventilation/ECMO
- Remdesivir: Extended 10-day course 2
- Dexamethasone: 6 mg daily for up to 10 days 1
- Baricitinib: In combination with remdesivir 1
- Anticoagulation: Prophylactic dose (therapeutic dosing has not shown benefit in critically ill patients) 1
Important Monitoring Parameters
- Hepatic function: Perform laboratory testing before starting remdesivir and monitor during treatment 2
- Coagulation: Determine prothrombin time before starting remdesivir and monitor as clinically appropriate 2
- Inflammatory markers: Monitor C-reactive protein, procalcitonin, and other inflammatory markers to guide therapy 1
- Oxygen saturation: Regular monitoring to determine need for escalation of respiratory support
Special Considerations
Bacterial Co-infections
- Antibiotics: Should not be prescribed routinely for COVID-19 patients 1
- Only prescribe antibiotics when there is clinical evidence of bacterial infection based on:
- Laboratory findings (elevated WBC, CRP, PCT >0.5 ng/mL)
- Radiographic evidence of bacterial pneumonia
- Clinical deterioration not explained by COVID-19 alone 1
Nutritional Support
- Screen hospitalized patients using NRS2002 score 1
- For patients with score ≥3, provide early nutritional support with protein supplements (≥18g protein/time, 2-3 times/day) 1
- Consider enteral nutrition tube placement when oral intake is inadequate 1
Gastrointestinal Protection
- Use H2 receptor antagonists or proton pump inhibitors in patients with risk factors for gastrointestinal bleeding 1
Common Pitfalls to Avoid
Inappropriate antibiotic use: Avoid prescribing antibiotics without clear evidence of bacterial co-infection 1
Unproven therapies: Hydroxychloroquine, chloroquine, and ivermectin have shown no benefit and may cause harm 1
Delayed initiation of effective therapies: Remdesivir should be started as soon as possible after diagnosis in eligible patients 2
Inadequate thromboprophylaxis: All hospitalized COVID-19 patients should receive prophylactic anticoagulation unless contraindicated 1
Failure to adjust treatment based on disease progression: Treatment should be escalated appropriately as patients deteriorate, including timely addition of dexamethasone when oxygen requirements increase 1
The management of COVID-19 continues to evolve as new evidence emerges. This regimen represents the current evidence-based approach to supportive prescription therapy for COVID-19 patients across the spectrum of disease severity.