Treatment of COVID-19: Practical Questions and Insights for NPs and PAs

Treatment of COVID-19: Practical Questions and Insights for NPs and PAs Posted By:
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Is it reasonable to prescribe a 5-day supply of an oral antiviral to people traveling abroad with risk factors for severe COVID-19 in the event they become infected with SARS-CoV-2?

Yes, in general, it is reasonable to prescribe a 5-day course of a COVID-19 oral antiviral for this purpose. Although more countries have approved antiviral therapies for use, access to the drugs can be delayed or difficult to receive in time. Any unused medication should be returned to the pharmacy or properly disposed of after the patients have returned from their travels. 

Does a patient require hospitalization to receive IV remdesivir for an acute COVID-19 infection?

No, remdesivir can be administered in an infusion center or a clinic that is set up to administer IV medications. It can also be administered by a home healthcare nurse if the patient has access to that type of service. Remdesivir is indicated in ambulatory patients with mild to moderate COVID-19 who are at high risk for disease progression and hospitalized patients with COVID-19.  

Is there a role for anticoagulation in nonhospitalized patients with mild to moderate COVID-19?

The National Institutes of Health (NIH) COVID-19 treatment guidelines recommend against the use of anticoagulation or antiplatelet therapy in nonhospitalized patients with COVID-19 unless they are enrolled in a clinical trial. Patients who are receiving anticoagulation or antiplatelet therapy for an underlying condition and then become infected with COVID-19 should continue these medications under the supervision of their healthcare professional.

Is there a role for treatment with vitamin C, vitamin D, zinc, or corticosteroids in nonhospitalized patients with mild to moderate COVID-19?

According to the NIH COVID-19 treatment guideline panel, there is insufficient evidence to recommend for or against the use of vitamin C, vitamin D, or zinc for the treatment of nonhospitalized patients with COVID-19. Because patients who are not critically ill with COVID-19 are less likely to experience oxidative stress or severe inflammation, the benefit of vitamin C in nonhospitalized patients is unknown. It is hypothesized that vitamin D may have immunomodulatory effects that could be beneficial in the prevention or treatment of COVID-19, but clinical trials have not confirmed any beneficial effects. Studies are evaluating the role of zinc in the treatment of COVID-19, but no data have yet confirmed any beneficial effects. Some studies have found that corticosteroid use in patients with mild to moderate COVID-19 may increase the risk of hospitalization and severe illness, and the NIH COVID-19 guideline panel specifically advises healthcare professionals to avoid the use of corticosteroids in these patients.


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Filed under: Infectious Diseases , Public Health , NPs & PAs

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