Vaccination remains the strongest defense against COVID-19. Even as numbers in our community drop, it's important to remain vigilant. For more information about where you can schedule a vaccine, be tested for COVID-19 or learn more about the virus, visit https://www.bjc.org/coronavirus

COVID-19 Information
Select the search type
  • Site
  • Web
Go

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 and algorithm below are intended to help you identify which treatment is best for your patients.

Please be aware that some therapies are in short supply.

  • For those treatments, our goal is to prioritize the highest-risk patients.
  • Many of the treatments have eligibility requirements: please refer to the column “current criteria for use” below for the most up-to-date guidance.

Algorithm for Decision Making

Download the decision algorithm

View the decision algorithm.


Available Therapies

Therapies for High-Risk, Nonhospitalized Patients with Mild to Moderate COVID-19 Therapy (listed in order of preference)
Therapy (listed in order of preference) 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 and prescribing information (updated 6/3/2022) ≥ 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
• 2nd line in pregnancy
Bebtelovimab Available in Missouri and Illinois Click here for ordering information ≥ 12 years AND ≥ 40 kg ≤ 7 days 175 mg IV x 1 • COVID-19 positive
• Symptomatic
• High risk* for progression to severe illness
• Other FDA-authorized therapies are not clinically appropriate or accessible
• Few/no drug interactions
• 1st line in pregnancy

Remdesivir Available only at SLCH Infusion Clinics Click here for ordering information

Click here for talking points to use with patients and families

< 12 years OR 3 to < 40 kg ≤ 7 days < 12 years, ≥ 40 kg: 200 mg IV on day 1, then 100 mg IV daily x2 days.

3 - < 40 kg: 5 mg/kg IV on day 1, then 2.5 mg/kg IV daily x2 days.
• COVID-19 positive
• Symptomatic
• 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
• Prothrombin time, AST/ALT, and creatinine must be determined prior to first infusion
• Ordering provider will be contacted for any AST/ALT ≥ 3x ULN or CrCl < 30 ml/min to consider risk vs. benefit
• 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.
Fluvoxamine Available at any retail pharmacy ≥ 18 years < 10 days 100 mg PO twice daily x 10 days • COVID-19 positive
• Symptomatic
• High risk* for progression to severe illness
• Other preferred therapies are not clinically appropriate or accessible
• Drug interactions
• Limit caffeine

* 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.


Treatment Option Discussion Video

Watch this 12 minute video with BJC HealthCare and Washington University School of Medicine experts discussing treatment options.

4901 Forest Park Avenue
St. Louis, Missouri 63108
314.286.2000
Copyright © 1997- 2022 BJC HealthCare. All Rights Reserved.