COVID-19: Drug management following positive LFT / PCR test (Guidelines)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Audience

  • All NHS Highland
  • Secondary Care only
  • Adults only
If severe pneumonitis with poor response to therapy: discuss with Infectious Diseases or Microbiology

Pathway

On oxygen?
New O2
OR increased O2 need, secondary to COVID infection
Yes
1. Start dexamethasone
2. Assess suitability for tocilizumab
3. If unsuitable for tocilizumab, consider baricitinib
No
No
Yes
No
Yes
NOT eligible for antivirals
Treat
1. Paxlovid (Nirmatrelvir/ritonavir)
2. If Paxlovid unsuitable: consider remdesivir 
3. Consider molnupiravir (ONLY if within 5 days of symptom onset)
NOT eligible for antivirals.
Evidence does NOT support use of antivirals.
Consider remdesivir

NB benefit may be greatest during early phase of infection

Prescribing information

Drug interactions

  • MUST be checked before prescribing nirmatrelvir / ritonavir as these can be significant. See Drug interaction checker 

Renal disease and dialysis

Infectious Diseases & Renal Specialists in NHS Highland recommend using: 

Note: this advice is at variance with manufacturer’s recommendations and is therefore unlicensed.

Prescription form

For Hospital Pharmacy supply of oral COVID antiviral medication, use: Hospital prescription forms.

Essential handover communication

Tocilizumab can cause immunosuppression that renders patients at risk of bacterial and fungal infections.

  • Low clinical threshold for identification and management of infection must be used. 
  • CRP level may be a less reliable marker of active infection and procalcitonin may be negative.

All handovers of clinical care must explicitly mention that an IL-6 inhibitor has been given and the date of administration. This includes:

  • Between hospitals if patients are transferred
  • Between levels of care and clinical teams within hospitals
  • Between hospitals and primary care

Clinicians MUST ensure the GP is aware the patient has received an IL-6 inhibitor and provide information to the patient to such effect.

  • The following standard text should be added to the hospital discharge letter:

**** Your patient received tocilizumab on ../../.. Immune function will be suppressed for the next 3 months.  Clinical assessment is required to diagnose and manage infection as inflammatory markers will be unreliable ****

Editorial Information

Last reviewed: 22/07/2024

Next review date: 30/09/2025

Author(s): Acute Medicine, Antimicrobial Management Team.

Version: 1.1

Approved By: TAMSG of the ADTC

Reviewer name(s): Dr D Scott, Clinical Director, Acute, A MacDonald, Area Antimicrobial Pharmacist.

Document Id: COVID121