COVID-19: Clinical Resources &
Patient Education

Updated January 13, 2022

Treatment Options

NIH COVID-19 Treatment Guidelines

These guidelines provide recommendations for treatment of patients in the hospital and outpatient setting and are updated as new evidence is available. Currently there is only one treatment (remdesivir) that is approved for treatment of COVID-19. All others are available for use under emergency use authorization (EUA).

Monoclonal Antibodies  

The FDA has issued an Emergency Use Authorization (EUA) for several monoclonal antibody treatments for COVID-19. View updates on treatments and the use of Sotrovimab and Omicron. (12/21/21) Please note that distribution and use of the monoclonal antibodies will vary by region in response to changes in circulating variants. These treatments are only available following a prescription and must be administered by a clinician via intravenous infusion or subcutaneous injections. 

Watch the AAFP's Monoclonal Antibody Treatments for COVID-19 web page for additional updates.

Oral COVID-19 Treatments

The FDA has given emergency use authorization to two new oral medications to treat COVID-19. These medications are NOT a substitute for vaccination and are NOT authorized for pre or post exposure prophylaxis. Clinicians should discuss the benefits and risks with patients before prescribing. 

Paxlovid 
On Dec. 22, the FDA gave emergency use authorization for paxlovid, an antiviral oral medication which may reduce hospitalization and death due to COVID-19. The EUA was based on limited data in slightly over 2,000 adults who received paxlovid twice daily for five days following positive PCR test (within 5 days of symptom onset). The number of individuals hospitalized for COVD-19 was significantly lower in the treatment group (n = 8) compared to placebo (n = 66). Please note that there are not specific data for the use of paxlovid in individuals who are pregnant or lactating or for children/adolescents younger than 18.

Paxlovid is not recommended in patients with severe kidney or severe liver impairment. In patients with moderate renal impairment, a reduced paxlovid dose is needed.

Side effects observed include impaired sense of taste, diarrhea, high blood pressure and muscle aches. There are potentially significant drug interactions—clinicians should review the full list of drug interactions.

Specifically, use in individuals with uncontrolled or undiagnosed HIV infection may lead to HIV drug resistance and there is a potential for liver damage so use in individuals with liver disease, liver inflammation, or liver enzyme abnormalities should be done with caution. Paxlovid can decrease hormonal contraception effectiveness, so patients will need to be counseled to use back up contraception. More information can be found in the EUA factsheet for clinicians.  

Molnupiravir
On Dec. 23, the FDA gave emergency use authorization for a second oral medication, molnupiravir, which may prevent hospitalization. The authorization is limited to individuals aged 18 and older for whom other COVID-19 treatments are not an option. 

It is not recommended for individuals who are pregnant based on results of animal studies and should only be prescribed following a discussion of the benefits and risks for the pregnant individual. Individuals of childbearing age should use contraception to prevent pregnancy and individuals who are lactating should discontinue or pump and discard during and for four days after completing treatment. 

Authorization of molnupiravir was based on limited data in approximately 1,400 adults who received molnupiravir twice daily for five days following positive PCR test (within 5 days of symptom onset). The number of individuals hospitalized for COVD-19 was slightly lower in the treatment group (n = 48) compared to placebo (n = 68). Please note that there are not specific data for individuals who are pregnant or lactating. More information can be found in the fact sheet. 

Therapy Warnings

• CDC Issues Ivermectin Health Alert: Taking ivermectin for COVID-19 can cause severe illness when taken outside of its intended use or when taking veterinary formulations. The CDC issued a health alert warning about the rise in prescriptions for ivermectin and the increased number of calls to poison centers. It is important to note that ivermectin can cause severe illness when taken outside of its intended use or when taking veterinary formulations.
  
  Ivermectin is not recommended for prevention or treatment of COVID-19. Current NIH Treatment Guidelines state that there is insufficient evidence to recommend either for or against the use of ivermectin for the treatment of COVID-19 outside of clinical trials.  The AAFP urges caution in prescribing therapeutics for treatment or prevention of COVID-19 that have not been approved or authorized by the U.S. Food and Drug Administration (FDA) based on substantial evidence for safety and efficacy.
  
  The FDA has issued the following statements: FDA has not approved or issued an Emergency Use Authorization for ivermectin for use in treating or preventing COVID-19 in humans. Ivermectin tablets are approved at very specific doses for some parasitic worms, and there are topical formulations for head lice and skin conditions. Ivermectin is not an anti-viral. For additional information see the FDA Information Page  and the FDA Ivermectin FAQ.
  
  
  • Taking large doses of this drug is dangerous and can cause serious harm.  
  • If you have a prescription for ivermectin for an FDA-approved use, get it from a legitimate source and take it exactly as prescribed.  
  • Never use medications intended for animals on yourself. Ivermectin preparations for animals are very different from those approved for humans.  

• AAFP Policy on COVID-19 Therapeutics: The AAFP cautions against prescribing therapeutics for treatment or prevention of COVID-19 that have not been approved or authorized by the FDA. (11/11/20)
  
• FDA Revokes EUA for Hydroxychloroquine for Treatment of COVID-19: It has not shown efficacy in its antiviral activity. Data do not support that the benefits outweigh the harms of the drug. (6/15/20)
  
• Evidence lacking to support use of ivermectin for COVID-19: There are insufficient data to recommend either for or against the use of ivermectin for the treatment of COVID-19. (1/14/21) 

Interim Guidance for Clinical Management

• Evaluating and Caring for Patients with Post-COVID Conditions: Interim Guidance: How to manage a wide range of physical and mental health consequences experienced by some patients four or more weeks after SARS-CoV-2 infection. (6/14/21)
• Updated NIH COVID-19 Treatment Guidelines: Each recommendation is assigned a rating for strength of recommendation statement and quality of the evidence that supports the recommendation. (2/11/21)
• Management of COVID-19 at Home: View a webcast on current recommendations for advising patients on managing mild to moderate COVID-19 at home and when to escalate care. (1/22/21)
• Outpatient Management of COVID-19: Rapid Evidence Review: AFP addresses the lack of evidence-based treatments for outpatient settings; management is supportive and should include education about isolation. 
• Updated Interim Guidance for Clinical Management of Patients with COVID-19 (12/8/20)
• Reinfection with COVID-19 Reports: There have been some reports of reinfection, but these are rare. The CDC is monitoring these cases and develop criteria and guidance for potential cases of reinfection. (10/27/20)