Current Symptomatic Prescription Treatment Recommendations for COVID-19
For patients with COVID-19, treatment should be tailored to disease severity, with dexamethasone plus tocilizumab recommended for those requiring oxygen support, while oral antivirals like nirmatrelvir-ritonavir are recommended for high-risk outpatients within 5 days of symptom onset. 1, 2, 3
Treatment Based on Disease Severity
Non-Hospitalized Patients (Mild-to-Moderate COVID-19)
- For high-risk patients within 5 days of symptom onset:
- First-line: Nirmatrelvir-ritonavir (Paxlovid) 300 mg/100 mg twice daily for 5 days 3
- Contraindicated with certain medications due to CYP3A interactions
- Dose adjustment required for moderate-to-severe renal impairment
- Alternatives (if nirmatrelvir-ritonavir not appropriate):
- First-line: Nirmatrelvir-ritonavir (Paxlovid) 300 mg/100 mg twice daily for 5 days 3
Hospitalized Patients Not Requiring Oxygen
- Prophylactic anticoagulation (LMWH preferred) 2
- No corticosteroids or IL-6 inhibitors recommended 1, 2
Hospitalized Patients Requiring Oxygen (Non-Invasive)
- Dexamethasone 6 mg daily for up to 10 days 1, 2
- Remdesivir 200 mg IV on day 1, then 100 mg IV daily for 4-9 more days 2, 4
- Consider adding tocilizumab (IL-6 inhibitor) for patients with worsening respiratory status and elevated inflammatory markers 1, 2
- Anticoagulation (prophylactic dose, consider therapeutic dose with deteriorating pulmonary status) 2
Hospitalized Patients Requiring Mechanical Ventilation
- Dexamethasone 6 mg daily for up to 10 days 1, 2
- Consider tocilizumab in combination with dexamethasone 1, 2
- Anticoagulation (consider therapeutic dose) 2
- Not recommended: Remdesivir (no proven benefit in this population) 1, 2
Symptomatic Management
Respiratory Symptoms
- For hypoxemic respiratory failure: High-flow nasal cannula (HFNC) or non-invasive continuous positive airway pressure (CPAP) 2
- For fatigue, chest distress, shortness of breath: Consider TCM treatments like HXZQ capsule/dropping pill combined with LHQW capsule/granule 1
Fever Management
- For fever >38.5°C: Acetaminophen (paracetamol) preferred over NSAIDs 2
- Maintain adequate hydration (no more than 2 liters per day) 2
Gastrointestinal Symptoms
- For digestive system complications (anorexia, diarrhea, constipation): Consider symptomatic treatment 1
- For patients with gastrointestinal bleeding risk factors: H2 receptor antagonists or proton pump inhibitors 2
Treatments NOT Recommended (Strong Evidence Against)
- Hydroxychloroquine (any stage of infection) 1, 2
- Lopinavir-ritonavir 1, 2
- Azithromycin (unless bacterial infection is present) 1, 2
- Hydroxychloroquine + azithromycin combination 1, 2
- Colchicine 1, 2
- Convalescent plasma (for patients without hypogammaglobulinemia and with symptom onset >5 days) 1
Monitoring Recommendations
- Vital signs: Heart rate, pulse oxygen saturation, respiratory rate, and blood pressure 2
- Laboratory monitoring: Complete blood count, CRP, liver enzymes, renal function, and coagulation parameters 2
- Before starting remdesivir: Perform hepatic laboratory testing and determine prothrombin time 4
- Active monitoring for signs or symptoms of thromboembolism (stroke, deep vein thrombosis, pulmonary embolism, acute coronary syndrome) 1
Important Considerations and Pitfalls
- Drug interactions: Carefully review all medications before prescribing nirmatrelvir-ritonavir due to significant CYP3A interactions 3
- Timing is critical: Antiviral treatments are most effective when started early (within 5-7 days of symptom onset) 4, 3
- Renal function: Adjust dosing of nirmatrelvir-ritonavir in patients with renal impairment 3
- Hepatic function: Monitor liver enzymes with remdesivir; avoid in severe hepatic impairment 4
- Avoid unnecessary antibiotics: Use only when bacterial infection is suspected or confirmed 2
By following these evidence-based recommendations, clinicians can optimize outcomes for patients with COVID-19 while minimizing potential harms from inappropriate treatments.