Antiviral Agents, Including Antibody Products
Last Updated: February 29, 2024
Remdesivir and ritonavir-boosted nirmatrelvir (Paxlovid) are approved by the Food and Drug Administration for the treatment of COVID-19.
Molnupiravir and high-titer COVID-19 convalescent plasma (CCP) are available only under Food and Drug Administration Emergency Use Authorizations for the treatment of COVID-19.
Summary Recommendations
Recommendations for Treating Nonhospitalized Adults
- The COVID-19 Treatment Guidelines Panel (the Panel) recommends the following anti-SARS-CoV-2 therapies as preferred treatments for COVID-19. These drugs are listed in order of preference:
- Ritonavir-boosted nirmatrelvir (Paxlovid) (AIIa)
- Remdesivir (BIIa)
- The Panel recommends molnupiravir as an alternative therapy when neither of the preferred therapies are available, feasible to use, or clinically appropriate (CIIa).
- For more information on using these agents in nonhospitalized adults, see Therapeutic Management of Nonhospitalized Adults With COVID-19.
Recommendations for Treating Nonhospitalized Children
- For recommendations on using antiviral therapy in nonhospitalized children, see Therapeutic Management of Nonhospitalized Children With COVID-19.
Recommendations for Treating Hospitalized Adults or Children
- See Therapeutic Management of Hospitalized Adults With COVID-19 and Therapeutic Management of Hospitalized Children With COVID-19 for recommendations on using remdesivir with or without immunomodulators in certain hospitalized patients.
Antiviral Treatments With Insufficient Evidence
- There is insufficient evidence for the Panel to recommend either for or against the use of high-titer CCP for the treatment of COVID-19 in hospitalized or nonhospitalized patients who are immunocompromised.
- Some people who are immunocompromised have prolonged, symptomatic COVID-19 with evidence of ongoing SARS-CoV-2 replication. For the Panel’s recommendations for managing these patients, see Special Considerations in People Who Are Immunocompromised.
- There is insufficient evidence for the Panel to recommend either for or against the use of high-titer CCP for the treatment of COVID-19 in nonhospitalized patients who are immunocompetent.
Antiviral Treatments That the Panel Recommends Against
- The Panel recommends against the use of the following drugs for the treatment of COVID-19, except in a clinical trial:
- Interferon alfa or beta in nonhospitalized patients (AIIa)
- Systemic interferon alfa in hospitalized patients (AIIa)
- Nitazoxanide (BIIa)
- The Panel recommends against the use of the following drugs for the treatment of COVID-19:
- Anti-SARS-CoV-2 monoclonal antibodies (AIII)
- Chloroquine or hydroxychloroquine and/or azithromycin in hospitalized patients (AI) and nonhospitalized patients (AIIa)
- CCP in hospitalized patients who are immunocompetent (BIIa)
- Lopinavir/ritonavir and other HIV protease inhibitors in hospitalized patients (AI) and nonhospitalized patients (AIII)
- Interferon beta in hospitalized patients (AI)
Each recommendation in the Guidelines receives a rating for the strength of the recommendation (A, B, or C) and a rating for the evidence that supports it (I, IIa, IIb, or III). See Guidelines Development for more information.