Spoon Feed – IDSA Guidelines for Pharmacologic Treatment of COVID-19

October 17, 2022

Written by Seth Walsh-Blackmore

Spoon Feed
The most recent IDSA guidelines recommend steroids in most patients who need oxygen. Consider nirmatrelvir or remdesivir in high-risk outpatients, and reserve most other therapies for particular circumstances, if at all.

Why does this matter?
COVID-19 remains prevalent, and research continues into novel therapies. If it’s been a minute since you thought about COVID-19 meds, freshen up with this summary guide. Importantly, these guidelines are ever changing as new research is published. See the latest at: https://idsociety.org/COVID19guidelines.

Beyond The Bleach

For those hospitalized or to be admitted:

• Dexamethasone 6 mg (or equivalent) x 10 days is recommended for patients on a vent or ECMO and is recommended in those with any new O2 requirement if no relative contraindication.
• Baricitinib (JAK inhibitor) or remdesivir (lower certainty) in those stable on non-invasive O2.
• In those with a contraindication to steroids, consider baricitinib plus remdesivir.
• In addition to steroids, consider with a low certainty of benefit: IL-6 inhibitor (tocilizumab) if CRP > 75 in those on the vent or heading that way.

For ambulatory patients at high risk* for progression to a new oxygen requirement, you may consider with a low certainty of benefit: 

• Nirmatrelvir/ritonavir (Paxlovid) may be used if > 12 years old within 5 days of symptoms onset and if no significant medication interactions or contraindications. It is not recommended outside these criteria. 
• Neutralizing antibodies may be used if within 7 days of symptoms and are known to be active against the predominant strain in your area.
• Remdesivir may be used if within 7 days of symptom onset, but 3 sequential days of an IV treatment can be a logistical challenge.

*High risk patients: Age > 65, obesity, pregnancy, CKD, diabetes, immune compromise, CVD including HTN, any chronic lung disease, sickle cell, severe congenital disorders (ex. cerebral palsy, cystic fibrosis) trach/vent dependent at baseline

Rarely indicated:
Molnupiravir, convalescent plasma, prophylactic antibodies, tofacitinib 

Never indicated:
Hydroxychloroquine, lopinavir/ritonavir, famotidine, ivermectin, colchicine, fluvoxamine

Source
Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Clin Infect Dis. 2022 Sep 5;ciac724. doi: 10.1093/cid/ciac724. Online ahead of print.