Guidelines
Inpatient Treatment Options

Inpatient Treatment Options

Inpatient Treatment Options

  • An FDA-approved agent for COVID-19
  • An antiviral with in vitro activity against SARS CoV-2, which works by inhibiting RNA polymerase, and has been previously studied for SARS, MERS, and Ebola

See Remdesivir Treatment Guideline (previous page) for dosing and criteria

  • A corticosteroid which may mitigate the systemic inflammatory response associated with COVID-19
  • Recommend in patients who require respiratory support
    • No benefit has been noted in patients not requiring respiratory support, with a trend towards harm in this subgroup within the RECOVERY trial
  • Known adverse effects of steroids include decreased viral clearance, risk of infection, and other adverse effects of steroids (hyperglycemia, neurologic side effects, adrenal suppression)

Dose

  • 6 mg IV/PO once daily for up to 10 days or until not requiring supplemental oxygen (whichever comes first)
    • Doses > 6 mg daily are not routinely recommended

  • An interleukin-6 (IL-6) receptor antagonist that may interrupt the excessive host inflammatory response that can occur in severely ill COVID-19 patients
  • When available, it is our preferred agent for patients who rapidly decompensate to high-flow nasal cannula or non-invasive ventilation
  • Confirm site availability; limited supply as of 8/31/21

See Tocilizumab Treatment Guideline (previous page) for dosing and criteria

  • A janus kinase (JAK) inhibitor which may reduce viral entry and inflammation associated with SARS CoV-2
  • The FDA has granted emergency use authorization (EUA) for treatment of hospitalized COVID-19 patients requiring supplemental oxygen or mechanical ventilation
  • Recommended by the National Institutes of Health (NIH) guidelines as an alternative to tocilizumab and preferred over tofacitinib
  • Limited supply available

See Baricitinib Treatment Guideline (previous page) for dosing and criteria

  • Another janus kinase (JAK) inhibitor studied in hospitalized COVID-19 patients and showed a lower risk of respiratory failure and death
  • It is not yet approved for emergency use via the FDA but is included in NIH guidelines as an alternative when neither tocilizumab nor baricitinib is available

See Tofacitinib Treatment Guideline (previous page) for dosing and criteria

  • A monoclonal antibody for COVID-19 authorized via EUA for patients not admitted for COVID-related reasons
    • Mild-moderate symptoms with a risk factor for progression to severe disease
    • Post-exposure prophylaxis in COVID-negative patients who are not fully vaccinated OR are immune suppressed with a confirmed or high-risk of exposure

More information:

Notes

Use of tocilizumab, baricitinib, or tofacitinib will be interchangeable based on each site’s supply of each agent

  • Azithromycin
  • Baloxavir
  • Bamlanivimab/etesevimab
  • Convalescent plasma
  • Hydroxychloroquine
  • Ivermectin
  • Lopinavir-ritonavir
  • Oseltamivir
  • Ribavirin

More Information