What medicines are available to treat an acutely unwell person with COVID-19 in the primary care setting to reduce the risk of hospitalisation?
What the research says:
No evidence-based primary care-based treatment currently exists to prevent progression of COVID-19 severity. The majority of treatments evaluated so far have been for the management of patients hospitalised with COVID-19. A range of medicines are under evaluation for use in the primary care with a view to i) symptom relief/control, ii) reducing the likelihood of hospitalization and iii) reducing the need for ICU care and of death.
Last updated: 15 February 2021
|Care Setting||Evaluated:Evidence of efficacy confirmed||Evaluated: No evidence of efficacy||Under Evaluation|
|Primary Care Setting||
|Antibacterials with anti-inflammatory properties (azithromycin, doxycycline)b||
Inhaled ciclesonideOral dexamethasoned
|Secondary Care Setting||
Oral steroids (dexamethasone [preferred], prednisolone, methylprednisolone or hydrocortisone as alternatives)
Antivirals (lopinavir, ritonavir, remdesivir)Hydroxychloroquine
Monoclonal antibody combinationsAntivirals: e.g baloxavir marboxil, favipiravir, darunavir/cobicistat
aCOLCORONA trial: https://www.medrxiv.org/content/10.1101/2021.01.26.21250494v1 (Note: the results of this trial are currently under peer review); bPRINCIPLE study in community patients: https://www.principletrial.org/; cSTOIC study: https://stoic.ndm.ox.ac.uk/; dhttps://clinicaltrials.gov/ct2/show/NCT04746430; eRecommendation from the International Society on Thrombosis and Haemostatsis and the American Society of Hematology
Although no specific studies have been conducted on the efficacy and safety of paracetamol it remains widely used as part of a SOC for symptoms of COVID-19, with no reports of safety concerns identified. Similarly, for ibuprofen, despite initial concerns, no data indicating safety concerns exist in the context of COVID-19 infection.
What this means for your clinical practice:
Medicinal treatment of acute COVID-19 should currently focus on symptomatic relief. Standard antipyretics, paracetamol or ibuprofen, can be used for the management of fever and pain, there is no evidence to suggest they halt progression to more severe disease. Diarrhoea and nausea should be managed according to local SOC. Antibiotic stewardship remains important during the COVID-19 pandemic. Antibiotic prophylaxis is not advised and antibiotics should not be prescribed unless there is a clinical suspicion of a bacterial infection. At the present time there is no evidence to support the use of antiviral agents or oral steroids for the treatment of patients with COVID-19 in the community setting. Patients with underlying health conditions should continue to take their medications as prescribed, including patients receiving inhaled corticosteroids (ICS) for the management of respiratory conditions. While a phase 2 study in 146 patients has shown inhaled budesonide used within 7 days of COVID-19 symptom onset reduce the need for hospitalisation, larger studies are ongoing to determine whether this agent is appropriate for routine use in the primary care setting.