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Table 2a. Therapeutic Management of Nonhospitalized Adults With Mild to Moderate COVID-19 Who Do Not Require Supplemental Oxygen

Last Updated: April 20, 2023

Table 2a. Therapeutic Management of Nonhospitalized Adults With Mild to Moderate COVID-19 Who Do Not Require Supplemental Oxygen
Patient DispositionPanel’s Recommendations
All Patients
  • Symptom management should be initiated for all patients (AIII).
  • The Panel recommends against the use of dexamethasonea or other systemic corticosteroids in the absence of another indication (AIIb).
Patients Who Are at High Risk of Progressing to Severe COVID-19bPreferred therapies. Listed in order of preference:
  • Ritonavir-boosted nirmatrelvir (Paxlovid)c,d (AIIa)
  • Remdesivird,e (BIIa)
Alternative therapy. For use when the preferred therapies are not available, feasible to use, or clinically appropriate:
  • Molnupiravird,f,g (CIIa)
Each recommendation in the Guidelines receives a rating for the strength of the recommendation (A, B, or C) and a rating for the evidence that supports it (I, IIa, IIb, or III). 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 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 (e.g., >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 risk factors also 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 an IV infusion once daily for 3 days.

f Molnupiravir appears to have lower efficacy than the other options recommended by the Panel. Therefore, it should be considered when the other options are not available, feasible to use, or clinically appropriate.

g 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