What are the recommended treatments for Covid-19?

Recommended Treatments for COVID-19

The recommended treatment for COVID-19 includes dexamethasone for hospitalized patients requiring oxygen, remdesivir for moderate to severe disease, and oral antivirals such as nirmatrelvir/ritonavir for high-risk outpatients with mild-to-moderate disease. 1

Pharmacological Interventions

Hospitalized Patients

1. Corticosteroids

   • Dexamethasone 6 mg/day is recommended for patients requiring oxygen therapy
   • Reduces mortality from 26.2% to 23.3% in patients on simple oxygen therapy, and from 41.4% to 29.3% in mechanically ventilated patients 1

2. Antiviral Therapy

   • Remdesivir is indicated for hospitalized patients with COVID-19 2
     • Dosing for adults and pediatric patients ≥40 kg: 200 mg IV loading dose on day 1, followed by 100 mg IV daily
     • Treatment duration: 5 days for non-mechanically ventilated patients; can be extended to 10 days for those requiring mechanical ventilation 2
     • Monitor hepatic laboratory tests and prothrombin time before and during treatment 1, 2

3. Immunomodulatory Agents

   • Tocilizumab (anti-IL-6) is recommended in combination with dexamethasone for patients with worsening disease and systemic inflammation 1
   • JAK inhibitors (baricitinib/tofacitinib) may be considered for patients with evidence of systemic inflammation 1

4. Anticoagulation

   • All hospitalized COVID-19 patients should receive thromboprophylaxis with low molecular weight heparin (LMWH) 1
   • Higher doses may be considered for patients with additional risk factors 1

Non-Hospitalized Patients

1. Oral Antivirals

   • Nirmatrelvir/ritonavir is recommended for patients with mild-to-moderate COVID-19 who are at high risk for progression to severe disease 1
   • Should be initiated as soon as possible after diagnosis 2

2. Monoclonal Antibodies

   • Recommended for high-risk patients, especially those who are unvaccinated or vaccine non-responders 1
   • Can be used for pre-exposure prophylaxis in non-immunized immunocompromised patients 1

Non-Pharmacological Interventions

1. Respiratory Support

   • High-flow nasal oxygen therapy or non-invasive CPAP is recommended for patients with acute hypoxemic respiratory failure without immediate indication for invasive mechanical ventilation 1, 3
   • Timely tracheal intubation and appropriate mechanical ventilation support are critical for severe cases 4

2. Supportive Care

   • Acetaminophen for fever management 5
   • Albuterol for bronchospasm (particularly effective in patients with underlying respiratory conditions) 5
   • NSAIDs for myalgia, arthralgia, or headache 5

Special Populations

1. Immunocompromised Patients

   • Monoclonal anti-SARS-CoV-2 antibodies are recommended for pre-exposure prophylaxis in non-immunized patients 1
   • Post-exposure prophylaxis with anti-SARS-CoV-2 monoclonal antibodies for high-risk patients 1

2. Patients with Inflammatory Bowel Disease

   • Admission decisions should consider both COVID-19 and IBD severity 1
   • Thromboprophylaxis should be adapted to each situation 1

Treatments to Avoid

The following treatments are strongly discouraged based on lack of efficacy and potential harm 1:

• Hydroxychloroquine
• Azithromycin (unless bacterial co-infection is suspected)
• Lopinavir-ritonavir
• Interferon-β (for hospitalized patients)
• Colchicine (for hospitalized patients)

Monitoring and Discharge Criteria

• Perform hepatic laboratory testing before starting and during treatment with remdesivir 1, 2
• Monitor prothrombin time before and during remdesivir treatment 1, 2
• Discharge criteria include resolution of fever for >3 days, improvement of respiratory symptoms, and significant absorption of pulmonary lesions on imaging 1

Clinical Pearls

• Early initiation of treatment is crucial for optimal outcomes 2, 3
• Severe COVID-19 is associated with heightened inflammatory responses and a procoagulant state, suggesting that treatment strategies must extend beyond antiviral agents 6
• The most challenging symptoms to manage are lower respiratory symptoms and anxiety 5
• Treatment should be initiated as soon as possible after diagnosis of symptomatic COVID-19 2

Remember that COVID-19 treatment approaches continue to evolve as new evidence emerges, and clinicians should stay updated with the latest guidelines.