Mild to Moderate COVID-19 Outpatient Treatment Options
Several outpatient therapies for COVID-19 positive patients with mild to moderate symptoms, who are at high risk for progression to severe illness, are now available.
The chart below is intended to help you identify which treatment is best for your patients.
Available Therapies
| Therapies for High-Risk, Nonhospitalized Patients with Mild to Moderate COVID-19 Therapy |
| Therapy |
Ages |
Symptom Onset (Day of symptom onset = Day 0) |
Dose/Duration |
Criteria for Use |
Clinical Considerations |
| Nirmatrelvir/ritonavir (Paxlovid™) Available in Missouri and Illinois Click here for Paxlovid drug interaction management (updated 08/2023) |
≥ 12 years AND ≥ 40 kg |
≤ 5 days |
Dose Pack eGFR > 60 mL/min: 300 mg nirmatrelvir with 100 mg ritonavir PO twice daily eGFR 30 to 59 mL/min: 150 mg nirmatrelvir with 100 mg ritonavir PO twice daily |
• COVID-19 positive • Symptomatic • High risk* for progression to severe illness |
• Highly efficacious • Significant drug interactions • Caution should be taken in patients with uncontrolled HIV due to risk of developing HIV resistance to protease inhibitors. • Not recommended if eGFR < 30 mL/min or severe liver impairment • 1st line in pregnancy |
| Remdesivir Adults: Only available at BJH Cancer Care Clinic & MHB Infusion Center Click here for ordering information Click here for talking points to use with patients and families Pediatrics: Only available at SLCH 9S Infusion for pediatrics < 18 yrs, or 18-30 yrs who are followed by a SLCH subspecialist Click here for ordering information Click here for talking points to use with patients and families |
≥ 3 kg AND ≥ 28 days old |
≤ 7 days |
≥ 40 kg: 200 mg IV on day 1, then 100 mg IV daily x 2 days 3 to <40 kg: 5 mg/kg IV on day 1, then 2.5 mg/kg IV daily x 2 days |
• COVID-19 positive • Symptomatic • Unable to receive nirmatrelvir/ritonavir (Paxlovid) due to age/weight restrictions, severe drug-use interactions, etc. • Room air or baseline oxygen • *High risk for progression to severe illness Additional pediatric criteria for use • Moderately to severely immunocompromised**, regardless of vaccination status OR • Unvaccinated with one or more risk factors for severe disease* |
• Highly efficacious • Requires clinic visit 3 days in a row • Few/no drug interactions |
| Molnupiravir Available in Missouri and Illinois Click here for ordering information (updated 6/3/2022) |
≥ 18 years |
≤ 5 days |
800 mg PO twice daily x 5 days |
• Not pregnant • COVID-19 positive • Symptomatic • High risk* for progression to severe illness • Other preferred FDA-authorized therapies are not clinically appropriate or accessible |
• Contraception required for females of childbearing age during therapy and for 4 days following last dose • Contraception required for males with partners of childbearing age during therapy and for 90 days following last dose. |
* Diabetes, sickle cell disease, cardiovascular disease or hypertension, pregnancy, obese or overweight, older age, immunosuppressive disease or treatment, neurodevelopmental disorder or other condition that confers medical complexity, medical-related technological dependence, chronic kidney disease, chronic lung disease, part of a group with long-standing systemic health and social inequities including racial and ethnic minority groups and those with disabilities.
** See CDC website here for full list of moderately to severely immunocompromising conditions.