From the Guidelines
Corticosteroids and Paxlovid (nirmatrelvir/ritonavir) are typically prescribed alone, without antibiotics, for COVID-19 positive patients, unless there is a clear indication of a bacterial infection.
Key Points
- Antibiotics should not be prescribed routinely for COVID-19 patients, as the vast majority of patients do not have or develop a bacterial co-infection 1.
- Clinical justification is required for the prescription of antibiotics, such as disease manifestations, disease severity, radiographic imaging, and laboratory data 1.
- Paxlovid (nirmatrelvir/ritonavir) and corticosteroids can be prescribed alone for COVID-19 treatment, without the need for antibiotics, unless a bacterial infection is suspected or confirmed 1.
- Procalcitonin levels can be used to guide antibiotic therapy, but the evidence base for this strategy is limited, and clinical judgment should be used in conjunction with laboratory results 1.
- Empirical antibiotic therapy may be considered in patients with a high suspicion of bacterial co-infection, severe immunocompromisation, or critically ill patients admitted to the ICU 1.
Antibiotic Use
- Restrictive use of antibacterial drugs is recommended in patients with community-acquired respiratory infection and proven or high likelihood of COVID-19 1.
- Local and/or national guidelines should be followed for the antibacterial treatment of community-acquired pneumonia (CAP) in patients with COVID-19 1.
- Sputum and blood cultures should be obtained before starting empirical therapy to support or refute the diagnosis of bacterial infection 1.
From the FDA Drug Label
PAXLOVID is indicated for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults who are at high risk for progression to severe COVID-19, including hospitalization or death.
Prior to prescribing PAXLOVID: 1) Review all medications taken by the patient to assess potential drug-drug interactions with a strong CYP3A inhibitor like PAXLOVID and 2) Determine if concomitant medications require a dose adjustment, interruption, and/or additional monitoring
The FDA drug label does not provide information on whether corticosteroids and Paxlovid (nirmatrelvir/ritonavir) are prescribed alone or with antibiotics for a COVID-19 positive patient. 2
From the Research
Treatment of COVID-19 with Corticosteroids and Paxlovid (Nirmatrelvir/Ritonavir)
- Corticosteroids are used in the treatment of COVID-19, particularly for hospitalized patients with severe or critical disease 3.
- Paxlovid (nirmatrelvir/ritonavir) is approved for the treatment of mild-to-moderate COVID-19 and has been shown to reduce the risk of hospitalization and death in high-risk patients 4, 5.
- The use of corticosteroids and Paxlovid (nirmatrelvir/ritonavir) may be prescribed alone or in combination with other treatments, depending on the patient's condition and disease severity.
Use of Antibiotics in COVID-19 Treatment
- There is no evidence to suggest that antibiotics are prescribed in combination with corticosteroids and Paxlovid (nirmatrelvir/ritonavir) for the treatment of COVID-19, unless there is a secondary bacterial infection present.
- The treatment of COVID-19 focuses on antiviral medications, such as Paxlovid (nirmatrelvir/ritonavir), and supportive care, including corticosteroids for severe cases 3, 4, 5.
Drug-Drug Interactions and Dosage Adjustments
- The use of Paxlovid (nirmatrelvir/ritonavir) can lead to significant drug-drug interactions, particularly with medications that are highly dependent on CYP3A4 for clearance 6.
- Dosage adjustments may be necessary when coadministering Paxlovid (nirmatrelvir/ritonavir) with other medications, including immunosuppressive drugs and corticosteroids 6.