Health care providers can find information on the use of select drug therapies for the management of adult patients with confirmed COVID-19 across all disease severities (mild, moderate, severe and critically ill).
Mild to Moderate COVID-19
Clinical Guidance
The following documents provide guidance on the appropriate prescribing of antiviral therapy (nirmatrelvir/ritonavir [Paxlovid] and remdesivir) for adults with mild to moderate COVID-19.
This guidance was updated to consider more recent circulating strains of SARS-CoV-2 as well as pre-existing immunity from prior infection and/or vaccination in Ontario. Highlights include updates to the COVID-19 severity classification and risk factors associated with more severe COVID-19 outcomes, along with an overview of the real-world evidence for antiviral therapies.
- Recommendations for Antiviral Therapy for Adults with Mild to Moderate COVID-19 (April 2, 2024)
- Frequently Asked Questions on Antiviral Therapy for Adults with Mild to Moderate COVID-19 (September 3, 2024)
Antiviral therapy for COVID-19 such as nirmatrelvir/ritonavir and remdesivir can prevent serious illness in certain high-risk individuals if taken within the first few days after symptoms start. Individuals should have mild or moderate symptoms and a positive test for SARS-CoV-2 before receiving antiviral therapy.
Antiviral therapy is recommended for individuals who are:
- 65 years of age or older (regardless of vaccine status and any other risk factors)
- 18 years of age or older and immunocompromised (regardless of vaccine status or prior COVID-19 infections)
A health care provider may also consider prescribing antiviral therapy to adults who are at an increased risk of severe COVID-19 outcomes because they have risk factors such as certain medical conditions or are unvaccinated.
A patient’s risk of progressing to severe COVID-19 exists on a continuum and is influenced by many factors such as age, vaccination status, and immunocompromised status, together with the number, type, and degree of control of medical conditions. The list of risk factors included in the guidance document is intended to assist prescribers in making individualized treatment decisions based on their assessment of patient risk.
Resources
- Nirmatrelvir/ritonavir (Paxlovid) use in patients with advanced chronic kidney disease and patients on dialysis with COVID-19 (April 13, 2022)
- Paxlovid Prescribing and Drug Interaction Information (University Health Network)
- Memo to Primary Care Providers: Paxlovid Prescribing in Primary Care: Testing and Tools (August 30, 2022)
- Access to Antiviral Therapy for COVID-19 in the Community (October 18, 2024)
Severe to Critical COVID-19
Clinical Guidance
The following document provides guidance on the appropriate prescribing of drug therapy (dexamethasone, remdesivir, baricitinib and/or tocilizumab) for adults with severe to critical COVID-19. This guidance is informed by Canadian and international guidelines and incorporates the latest available evidence from randomized controlled trials and real-world studies that reflect recently circulating strains of SARS-CoV-2 as well as pre-existing immunity from prior infection and/or vaccination. Highlights include recommendations for drug therapy in patients with severe or critical COVID-19 (including people who progress from severe to critical COVID-19), a treatment algorithm, and a comparison of the available evidence for baricitinib and tocilizumab in patients with critical COVID 19.
Recommendations for Drug Therapy for Adults with Severe to Critical COVID-19