COVID-19 Treatment Guidelines

Introduction to COVID-19 Treatment

The American College of Cardiology recommends supportive care with disease severity-based targeted therapies, including remdesivir for hospitalized patients and high-risk outpatients, dexamethasone for those requiring oxygen, and antiviral agents or monoclonal antibodies for high-risk patients with mild-to-moderate disease 1

For non-hospitalized patients with mild-to-moderate disease at high risk for progression, nirmatrelvir/ritonavir can be considered as an alternative oral option 1, 2
Anti-SARS-CoV-2 monoclonal antibodies are recommended, especially for unvaccinated individuals or those with impaired immune response 1
Molnupiravir may be considered when other options are unavailable 1
High-titer convalescent plasma within 72 hours of symptom onset if monoclonal antibodies are unavailable 1

Oxygen supplementation to maintain SpO2 >90-96% is essential for all hospitalized patients 1
Prophylactic anticoagulation to prevent venous thromboembolism is recommended 1, 4
Careful fluid management is necessary for all hospitalized patients 1
Monitor and treat co-infections or superinfections 1

Pre-exposure prophylaxis with long-acting monoclonal antibodies is recommended for unimmunized immunocompromised patients 1
Post-exposure prophylaxis with monoclonal antibodies is recommended for high-risk immunocompromised patients (unvaccinated, vaccine non-responders) 1
Consider longer treatment duration with antivirals for immunocompromised patients 1

Patients may be discharged when they have two consecutive negative RT-PCR tests from respiratory tract samples, temperature returned to normal for >3 days, respiratory symptoms significantly improved, and significant absorption of pulmonary lesions on CT imaging 2, 3

Combinations of three or more antiviral drugs should not be used simultaneously 2, 3
Lopinavir-ritonavir and hydroxychloroquine/chloroquine combinations with azithromycin are not recommended 2, 3