Outpatient COVID-19 Treatments – Guidelines Knowledge Check

Andrea Eberly, MD, MS, FAAEMBedside Diagnostic Challenge, Emergency Medicine, Family Medicine, Guideline Knowledge Check, Internal Medicine, Nurse Practitioner, Pediatric Emergency Medicine, Pediatric Medicine, Physician Assistant, Urgent Care

New Outpatient COVID-19 Treatments - Guideline Knowledge Check

New Outpatient COVID-19 Treatments - Guideline Knowledge Check

Andrea Eberly, MD, MS, FAAEM examines newly updated COVID-19 recommendations from the NIH and IDSA addressing the omicron variant and two newly authorized oral antiviral treatments for ambulatory patients with COVID-19.

In January / February 2022, both the National Institutes of Health (NIH) and Infectious Diseases Society of America (IDSA) updated their COVID-19 recommendations to address the omicron variant and include two newly authorized oral antiviral treatments for ambulatory patients with COVID-19.

What do these guidelines state about the indications / contraindications of these two new oral drugs (molnupiravir and ritonavir/nirmatrelvir [plaxovid]) and the two previously authorized intravenous drugs (remdesivir and sotrovimab) that are now recommended for ambulatory patients with COVID-19 that is likely due to omicron?

Try this case and test your knowledge of the new guidelines for these outpatient COVID-19 treatments.

In a busy emergency department several patients are presenting with fever and mild to moderate COVID-19 symptoms (fatigue and various degrees of respiratory symptoms).

Four of these patients are testing positive for SARS-CoV-2 during a time when omicron is the dominant variant.

They all have various risk factors for severe COVID-19 disease and meet indications for COVID-19 treatment as an outpatient. 

Question:

Which patient is correctly matched to an outpatient COVID-19 treatment option?

Answer Options:

Give the intravenous antiviral remdesivir to a 32-year-old diabetic patient who is pregnant in her second trimester and developed COVID-19 about 8 days ago.

Give the oral antiviral ritonavir/nirmatrelvir (plaxovid) to a 21-year-old single mother on birth control pills, who developed COVID-19 about 8 days ago.

Give the monoclonal antibody sotrovimab to a 13-year-old boy with sickle cell disease and estimated glomerular filtration rate (eGFR) < 30 ml/min who developed COVID-19 about 8 days ago.

Give the oral antiviral molnupiravir to a 17-year-old overweight male (BMI 39%) who developed COVID-19 roughly 8 days ago. Upon questioning, he reveals that he recently married and now abstains from alcohol and instead drinks St. John's Wort tea in the evening to relax.

See the Answer:

Dr. Andrea Eberly is one of the seasoned medical experts that contribute to Med-Challenger Medical Education products for medical board certification exam preparation, maintenance of medical certification, and continuing medical education requirements. 

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