What are the primary treatment options for COVID-19?

Primary Treatment Options for COVID-19

For COVID-19 treatment, corticosteroids (specifically dexamethasone) are strongly recommended for severe cases, remdesivir is recommended for hospitalized patients requiring oxygen, and nirmatrelvir-ritonavir is suggested for high-risk non-hospitalized patients. 1

Treatment Based on Disease Severity

Non-Hospitalized Patients with Mild-to-Moderate COVID-19

• For high-risk patients:

  • Nirmatrelvir-ritonavir: 300 mg nirmatrelvir with 100 mg ritonavir twice daily for 5 days (adjust to 150 mg nirmatrelvir with 100 mg ritonavir twice daily for eGFR 30-59 mL/min) 1
  • Remdesivir: 200 mg IV on Day 1, followed by 100 mg IV daily for 2 days (total 3-day course) 2
  • Molnupiravir: Consider only if other options are unavailable 1

• For symptomatic relief:

  • Paracetamol for fever
  • Honey for cough (for patients >1 year old)
  • Maintain adequate hydration 1

Hospitalized Patients

Moderate Disease

• Remdesivir: 200 mg IV on Day 1, followed by 100 mg IV daily from Day 2 for 5 days 2
• Supportive care: Oxygen therapy as needed to maintain SpO2 ≥94% 1

Severe Disease

• Corticosteroids: Dexamethasone (strong recommendation) 3, 1
• Remdesivir: 200 mg IV on Day 1, followed by 100 mg IV daily for up to 10 days 2
• Tocilizumab: Consider for patients with high inflammatory markers 3
• Respiratory support: Oxygen therapy, high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), or invasive mechanical ventilation (IMV) as needed 3, 1
• Awake prone positioning: For patients on HFNC or NIV 3
• Intravenous immunoglobulin (IVIg): Consider for patients who fail to respond to initial therapy 3

Monitoring and Supportive Care

• Laboratory monitoring:

  • Hepatic function tests before and during treatment 2
  • Prothrombin time before and during treatment 2
  • Inflammatory markers (CRP, IL-6) 3, 1

• Thromboprophylaxis:

  • Standard prophylaxis for all hospitalized patients
  • Consider intensified prophylaxis for patients with additional risk factors (obesity, known thrombophilia, ICU treatment, elevated D-dimers) 4

• Close monitoring:

  • Vital signs, especially respiratory rate and oxygen saturation
  • Signs of clinical deterioration
  • Secondary infections 3, 1

Special Considerations

Traditional Chinese Medicine (TCM) Approaches

For patients with access to TCM, consider as adjunctive therapy:

• Jinhua Qinggan granules, Lianhua Qingwen capsules/granules, or Xuebijing injection for mild-moderate disease
• Qingfei Paidu decoction, Huashi Baidu decoction, or Xuanfei Baidu decoction for severe disease 3

Pediatric Patients

• For patients weighing ≥40 kg: Same dosing as adults
• For patients 1.5 kg to <40 kg: Weight-based dosing of remdesivir 2
  • ≥28 days old and 3 kg to <40 kg: 5 mg/kg loading dose, then 2.5 mg/kg daily
  • <28 days old and ≥1.5 kg: 2.5 mg/kg loading dose, then 1.25 mg/kg daily

Important Caveats

• Antibiotic use: Not routinely recommended unless bacterial co-infection is suspected 1
• Antifungal use: Not recommended for prophylaxis; consider only for confirmed fungal infections 1
• Hydroxychloroquine: Not recommended due to lack of efficacy and potential adverse effects 3, 1
• Treatment initiation: Start antiviral therapy as soon as possible after diagnosis for optimal outcomes 1, 2
• Drug interactions: Carefully review potential interactions, especially with nirmatrelvir-ritonavir 1

Treatment Escalation

• Implement treatment escalation plans early as patients may deteriorate rapidly 1
• For patients with worsening hypoxemia despite oxygen therapy, consider transfer to ICU 3, 4
• Progression from HFNC/NIV to IMV should be considered if no improvement within 1-2 hours 3

The evidence strongly supports a stepwise approach to COVID-19 treatment based on disease severity, with early intervention for high-risk patients to reduce progression to severe disease and mortality.