Federal health officials are urging clinicians to consider readily available recommended therapies such as Paxlovid as first-line COVID-19 treatments. They also issued a reminder to avoid using steroids and antibiotics to treat outpatients with the disease.
In an advisory released Monday, the Centers for Disease Control and Prevention noted that they had seen evidence of increasing use of systemic corticosteroids and antibiotics in these patients.
“These drugs may cause harm and provide no demonstrated benefit in patients with COVID-19 without additional oxygen requirements or bacterial co-infection,” the agency said. “Short courses of systemic corticosteroids have been associated with adverse events such as hyperglycemia, gastrointestinal bleeding, psychosis, infections, and longer-term effects.”
Antibacterial drugs, meanwhile, have no benefit in treating viral infections, the CDC added.
Previously rare, now plentiful
But before that, rare recommended therapies are now available for COVID-19 patients that don’t require hospitalization or supplemental oxygen, the CDC added. He referred to the guidelines update April 8 by the National Institutes of Health, which recommends treating these patients with the following drugs in order of preference: the oral antiviral Paxlovid and the infused antiviral remdesivir.
In situations where Paxlovid or remdesivir are not clinically appropriate, usable, or available, the following drugs may also be used: the monoclonal antibody bebtelovimab and the oral antiviral molnupiravir, NIH added.
Oral Antiviral Distinctions
The CDC meanwhile reminded clinicians that the oral antivirals Paxlovid and molunupiravir are quite distinct in terms of efficacy, risk profiles and restrictions on use. “Health care providers should be familiar with these distinctions to make clinical decisions and inform patients,” the CDC wrote. “Additionally, initiation of treatment with these oral antivirals must begin within five days of the onset of symptoms to maintain product efficacy. The NIH advises against the use of dexamethasone and other systemic corticosteroids in these outpatients unless indicated for other underlying conditions.
During this time, clinicians should continue to encourage patients to stay until Deat with the COVID-19 vaccine. People who are immunocompromised or severely allergic to COVID-19 vaccines may be prescribed the long-acting monoclonal antibody tixagevimab with cilgavimab (Evusheld), for pre-exposure prophylaxis.