Remdesivir is the only antiviral drug that is approved by the Food and Drug Administration (FDA) for the treatment of COVID-19. Ritonavir-boosted nirmatrelvir (Paxlovid), molnupiravir, and high-titer COVID-19 convalescent plasma (CCP) have received Emergency Use Authorizations from the FDA for the treatment of COVID-19.
Summary Recommendations Summary Recommendations |
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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 ChildrenRecommendations for Treating Hospitalized Adults or ChildrenAntiviral 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. |
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. |