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Guidelines
Treatment, Non-Hospitalized

Treatment, Non-Hospitalized

Severely Limited Supply

Most of these agents are being distributed via allocation from the state departments of health and are not widely available at this time

Treatment Criteria

For treatment of patients with mild to moderate COVID-19 who are at high risk of progression to severe or critical COVID-19, the following therapeutics are recommended based on efficacy and side effect profile

  • Clinical efficacy
  • Regional prevalence of the Omicron variant
  • Availability of therapeutic agent and staff
  • Feasibility
  • Potential for significant drug-drug interactions

Treatment Options (in order of preference)

1. Nirmatrelvir with ritonavir (Paxlovid)
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  • Time from Symptom Onset: ≤5 days
  • Duration: 5 days (10 doses total)
  • ORAL
  • Variant Activity:
    • Delta: Yes
    • Omicron: Yes
    • Omicron Subvariants (e.g., BQ.1, BQ.1.1): Yes

2. Remdesivir (where operationally feasible)
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  • Time from Symptom Onset: ≤7 days
  • Duration: 3 days (3 doses total)
  • IV only
  • Variant Activity:
    • Delta: Yes
    • Omicron: Yes
    • Omicron Subvariants (e.g., BQ.1, BQ.1.1): Yes

3. Molnupiravir
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  • Time from Symptom Onset: ≤5 days
  • Duration: 5 days (10 doses total)
  • ORAL
  • Variant Activity:
    • Delta: Yes
    • Omicron and Subvariants (e.g., BQ.1, BQ.1.1): Likely

For use ONLY when neither of the preferred therapies are available, feasible to use, or clinically appropriate

Note

As of 11/30/2022, bebtelovimab is no longer authorized for use in the U.S.

As of 04/05/2022, sotrovimab is no longer authorized for use in the U.S.