Antiviral Agents, Including Antibody Products

Recommendations for Treating Nonhospitalized Adults

• The COVID-19 Treatment Guidelines Panel (the Panel) recommends the following anti-SARS-CoV-2 therapies as preferred treatments for COVID-19. These drugs are listed in order of preference:
• Ritonavir-boosted nirmatrelvir (Paxlovid) (AIIa)
• Remdesivir (BIIa)
• The Panel recommends molnupiravir as an alternative therapy when neither of the preferred therapies are available, feasible to use, or clinically appropriate (CIIa). 

Recommendations for Treating Nonhospitalized Children

• For recommendations on using antiviral therapy in nonhospitalized children, see Therapeutic Management of Nonhospitalized Children With COVID-19. 

Recommendations for Treating Hospitalized Adults or Children

• See Therapeutic Management of Hospitalized Adults With COVID-19 and Therapeutic Management of Hospitalized Children With COVID-19 for recommendations on using remdesivir with or without immunomodulators in certain hospitalized patients.

Antiviral Treatments With Insufficient Evidence

• There is insufficient evidence for the Panel to recommend either for or against the use of high-titer CCP for the treatment of COVID-19 in hospitalized or nonhospitalized patients who are immunocompromised. 
  • Some Panel members would use CCP to treat a patient who is immunocompromised and who has significant symptoms that are attributable to COVID-19, shows signs of active SARS-CoV-2 replication, and responds inadequately to the available therapies. In these cases, clinicians should attempt to obtain high-titer CCP from a vaccinated donor who recently recovered from COVID-19 likely caused by a SARS-CoV-2 variant similar to the variant causing the patient’s illness.
• There is insufficient evidence for the Panel to recommend either for or against the use of high-titer CCP for the treatment of COVID-19 in nonhospitalized patients who are immunocompetent. 

Antiviral Treatments That the Panel Recommends Against

• The Panel recommends against the use of the following drugs for the treatment of COVID-19, except in a clinical trial:
  • Interferons in nonhospitalized patients (AIIa)
  • Interferon alfa or lambda in hospitalized patients (AIIa)
  • Nitazoxanide (BIIa)
• The Panel recommends against the use of the following drugs for the treatment of COVID-19:
  • Bamlanivimab plus etesevimab, bebtelovimab, casirivimab plus imdevimab, or sotrovimab (AIII)
  • Chloroquine or hydroxychloroquine and/or azithromycin in hospitalized (AI) and nonhospitalized patients (AIIa)
  • CCP in hospitalized patients who are immunocompetent (AI)
  • Lopinavir/ritonavir and other HIV protease inhibitors in hospitalized (AI) and nonhospitalized patients (AIII)
  • Systemic interferon beta in hospitalized patients (AI)

COVID-19 Pre-Exposure Prophylaxis

• The prevalence of SARS-CoV-2 Omicron subvariants that are not susceptible to the anti-SARS-CoV-2 monoclonal antibody combination tixagevimab plus cilgavimab (Evusheld) has exceeded 90% in all regions of the United States. Therefore, the Panel recommends against the use of tixagevimab plus cilgavimab as pre-exposure prophylaxis (PrEP) of COVID-19 (AIII).

The sections on Chloroquine or Hydroxychloroquine and/or Azithromycin, Lopinavir/Ritonavir and Other HIV Protease Inhibitors, and Nitazoxanide have been archived. The Panel will no longer be updating the information on these therapies.