Indications for and selection of COVID-19-specific therapy for adult outpatients

COVID-19: coronavirus disease 2019; eGFR: estimated glomerular filtration rate; IV: intravenous.

* Common comorbidities that increase the risk of severe COVID-19 infection include chronic lung conditions (eg, asthma or chronic obstructive pulmonary disease), chronic liver disease, diabetes mellitus, and cancer. Refer to related UpToDate content for a comprehensive list of conditions. Importantly, we evaluate all comorbidities on a spectrum, as patients with advanced disease states are more likely to benefit from COVID-19 therapy than those with milder disease states.

¶ Although we generally only treat patients with COVID-specific therapy within 5 days of symptom onset, remdesivir is an option for patients within 7 days of symptom onset. However, it is challenging to coordinate administration and we reserve it for those at the highest risk (eg, severe immunocompromise).

Δ Drug interaction resources include:

• Drug interaction program
• University of Liverpool interaction tool
• US Food and Drug Administration PAXLOVID Patient Eligibility Screening Checklist Tool for Prescribers

◊ On hemodialysis days, medication should be administered after hemodialysis.

§ Approaches to selecting alternative options vary. This algorithm reflects the approach of the contributors to the UpToDate content on management of COVID-19 in adult outpatients.

¥ Females who may become pregnant should use reliable contraception correctly and consistently during therapy and for 4 days after the last dose. Males sexually active with females who may become pregnant should also use effective contraception during therapy and for at least 3 months after the last dose.