Remarks

• See Section 6.1 for help to identify patients at highest risk for hospitalization.
• Several therapeutic options are available: see decision support tool that displays benefits and harms of nirmatrelvir-ritonavir, molnupiravir and remdesivir.
• The GDG concluded that nirmatrelvir-ritonavir represents a superior choice because it may have greater efficacy in preventing hospitalization than the alternatives, has fewer concerns with respect to harms than does molnupiravir; and is easier to administer than a 3 day course of intravenous remdesivir.
• Remdesivir should be administered as soon as possible after onset of symptoms, ideally within 7 days.

Practical Info Route, dosage and duration: Additional considerations are available in three summaries of practical issues (remdesivir for COVID-19, administration of remdesivir for COVID-19, safety and monitoring in patients receiving remdesivir for COVID-19). Here follows a brief summary of the key points:

• The recommended dose for remdesivir is one dose daily for 3 consecutive days as intravenous infusion, as per the regimen evaluated in large trials informing the recommendation. Remdesivir is given as 200 mg intravenously on day 1, followed by 100 mg intravenously on days 2 and 3.
• Administration should be as early as possible in the time course of the disease. In the included studies, remdesivir was administered within 7 days of disease onset.
• It may be reasonable to monitor patients for a brief period following infusion. Any health care workers administering the infusions should follow recommended infection prevention and control recommendations in the outpatient setting.
• One should use caution when administering remdesivir to patients with significant liver or kidney disease.
• The GDG noted that there is insufficient evidence to make a recommendation around the use of remdesivir in children and further studies are needed.
• Additionally, the trials did not enrol pregnant or breastfeeding women. The decision regarding use of this therapeutic should be made between the pregnant person and their health care provider while discussing whether the potential benefit justifies the potential risk to the mother and fetus (see Research evidence and WHO information sheet).