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Table 2a. Therapeutic Management of Nonhospitalized Adults With COVID-19
Last Updated: September 26, 2022
Patient DispositionPanel’s RecommendationsDoes Not Require Hospitalization or Supplemental OxygenFor All Patients
All patients should be offered symptom management (AIII).
The Panel recommends against the use of dexamethasonea or other systemic corticosteroids in the absence of another indication (AIIb). Look at the risk factors below
For Patients Who Are at High Risk of Progressing to Severe COVID-19b Preferred therapies. Listed in order of preference:
Ritonavir-boosted nirmatrelvir (Paxlovid)c,d (AIIa)
Alternative therapies. For use ONLY when neither of the preferred therapies are available, feasible to use, or clinically appropriate. Listed in alphabetical order:
Bebtelovimabf (CIII) (NOTE: Bebetovimab's Emergency authorization has just been cancelled by the FDA.)
Discharged From Hospital Inpatient Setting in Stable Condition, Even if Receiving Supplemental OxygenThe Panel recommends against continuing the use of remdesivir (AIIa), dexamethasonea (AIIa), or baricitinib (AIIa) after hospital discharge.Each recommendation in the Guidelines receives 2 ratings that reflect the strength of the recommendation and the quality of the evidence that supports it. See Guidelines Development for more information.a There is currently a lack of safety and efficacy data on the use of dexamethasone in outpatients with COVID-19. Using systemic glucocorticoids in outpatients with COVID-19 may cause harm.
b For a list of risk factors, see the CDC webpage Underlying Medical Conditions Associated With Higher Risk for Severe COVID-19. When deciding whether to prescribe antiviral treatment (including an anti-SARS-CoV-2 mAb) to a patient who has been vaccinated, clinicians should be aware of the conditions associated with a high risk of disease progression. These conditions include older age, a prolonged amount of time since the most recent vaccine dose (i.e., >4–6 months), and a decreased likelihood of an adequate immune response to vaccination due to a moderate to severe immunocompromising condition or the receipt of immunosuppressive medications. The number and severity of the risk factors affects the level of risk.
c Ritonavir-boosted nirmatrelvir has significant drug-drug interactions. Clinicians should carefully review a patient’s concomitant medications and evaluate potential drug-drug interactions. See Drug-Drug Interactions Between Ritonavir-Boosted Nirmatrelvir (Paxlovid) and Concomitant Medications for more information.
d If a patient requires hospitalization after starting treatment, the full treatment course can be completed at the health care provider’s discretion.
e Administration of remdesivir requires 3 consecutive days of IV infusion.
f Bebtelovimab is active in vitro against all circulating Omicron subvariants, but there are no clinical efficacy data from placebo-controlled trials that evaluated the use of bebtelovimab in patients who are at high risk of progressing to severe COVID-19. Therefore, bebtelovimab should be used only when the preferred treatment options are not available, feasible to use, or clinically appropriate.
g Molnupiravir appears to have lower efficacy than the preferred treatment options. Therefore, it should be used only when the preferred options are not available, feasible to use, or clinically appropriate.
h The Panel recommends against the use of molnupiravir for the treatment of COVID-19 in pregnant patients unless there are no other options and therapy is clearly indicated (AIII).
Key: CDC = Centers for Disease Control and Prevention; IV = intravenous; the Panel = the COVID-19 Treatment Guidelines Panel