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

eGFR: estimated glomerular filtration rate; UTD: UpToDate.

* The authorized time window for administration of various COVID-19-specific therapies varies by agent. We encourage treatment initiation as soon as possible after symptom onset to try to optimize efficacy.

¶ Drug interaction resources include:

• Lexicomp Interact tool
• The University of Liverpool interaction tool
• The US FDA PAXLOVID Patient Eligibility Screening Checklist Tool for Prescribers
• The US NIH COVID-19 Treatment Guidelines

Δ The antiviral agent molnupiravir (Lagevrio) has Emergency Use Authorization for mild to moderate symptomatic COVID-19 in patients at risk for progression, but we do not use it because the benefit is unproven and studies do not consistently demonstrate efficacy against hospitalization or death. Monoclonal antibodies (including bebtelovimab) are no longer recommended for treatment because prevalent Omicron subvariants (eg, BQ.1 and BQ1.1) escape neutralization and render this intervention ineffective.

◊ Although the manufacturer's labeling for remdesivir does not recommend administration at eGFR <30 mL/min, studies report safe use in patients with chronic kidney disease, including small numbers on dialysis.