Treatment
Explore COVID-19 treatment options with these AAAAI resources. Both patients and practicing allergist/immunologists can stay up to date on available treatment paths and make informed decisions for better patient outcomes.
JAMA just published a clinical guideline update from the Infectious Disease Society of America on treatment of adults with COVID-19. For those with mild-moderate disease (no O2) at high risk of progression, recommendations include either Paxlovid or IV remdesivir, with molnupiravir if others are not available. For those with mild-to-moderate disease with risk, but not high risk for progression: Paxlovid or IV remdesivir but not molnupiravir. For those at no risk for progression, treatment is not recommended. Antiviral Therapies for Adults With Mild to Moderate COVID-19 Infection | Guidelines | JAMA | JAMA Network - June 30, 2026
A small study in Pediatrics Journal on the pharmacokinetics and safety of Paxlovid in children found that the appropriate dose for children 6 years of age and older:
Weight greater or equalto 40 kg: 300/100 BID was safe and appropriate
Weight between 20 and 40 kg: 150/100 was safe and appropriate. - June 25 2026
FDA approves oral antiviral agent to help prevent COVID-19 after exposure
MedPage Today (6/1, Rudd) reports, The FDA approved the oral antiviral agent ensitrelvir (Xocova) to help prevent COVID-19 in people ages 12 years or older who were exposed to the SARS-CoV-2 virus, drugmaker Shionogi announced. The agent is a SARS-CoV-2 main protease inhibitor also approved in Japan as COVID-19 postexposure prophylaxis and as a treatment for mild to moderate COVID. The FDA’s decision was based on the phase III SCORPIO-PEP trial, which showed the risk of getting sick from a household contact with COVID-19 dropped by more than half among those who took ensitrelvir compared with placebo. - June 2, 2026
This article from Japan demonstrated that early antiviral treatment for recent SARS-CoV2 strains were associated with a small, but significant reduction in post COVID condition. The antivirals which demonstrated an effect include molnupiravir, but not nirmatrelvir. The other antiviral that showed an effect is not available in the US. Early-Phase Oral Antiviral Use and Post–COVID-19 Condition in Outpatients | Infectious Diseases | JAMA Network Open | JAMA Network - May 15, 2026
Combined results from two open-label platform trials in the UK and Canada showed that Paxlovid administered to higher-risk adults with COVID-19 had no effect on hospitalization or death. This contrasts with the results earlier in the pandemic and indicates that this drug has limited effectiveness in an era where most patients have either been vaccinated or previously infected. Oral Nirmatrelvir–Ritonavir for Covid-19 in Higher-Risk Outpatients | New England Journal of Medicine. There is an accompanying editorial by Drs. Lane and Fauci. Same Pill, Different Impact — Reassessing the Efficacy of Nirmatrelvir–Ritonavir | New England Journal of Medicine - April 22, 2026
Since early in the COVID-19 pandemic, the Annals of Internal Medicine has published reviews and recommendations on the treatment of outpatients with COVID-19 infection. These most recent papers present the latest reviews on the effectiveness of anti-virals in COVID-19 infection, and practical recommendations for treatment. Outpatient Treatment of Confirmed COVID-19 in Symptomatic Adults: Living, Rapid Practice Points From the American College of Physicians (Version 3) | Annals of Internal Medicine. Outpatient Treatment of Confirmed COVID-19: A Living, Rapid Review for the American College of Physicians (Version 3) | Annals of Internal Medicine - February 10, 2026
Azelastine nasal spray reduces COVID-19 infections: A phase 2 randomized clinical trial involving 450 participants found that the regular use of azelastine nasal spray 0.1% 1 spray in each nostril three times daily for a mean duration of 56 days reduced COVID-19 infections by two-thirds (2.2% vs. 6.7%). It should be noted that the participants increased the nasal spray to five times daily for three days with a known or suspected exposure. Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections: A Phase 2 Randomized Clinical Trial | Infectious Diseases | JAMA Internal Medicine | JAMA Network -September 2, 2025
Champions for Vaccine Education, Equity + Progress (CVEEP) has created a document to educate people on the safety and effectiveness of antiviral treatments. The Underutilization of COVID-19 and Flu Antivirals highlights the benefits of antivirals for high-risk populations and explores various barriers contributing to under-prescription and uptake. - March 24, 2025
Non-pharmacologic interventions to prevent infection: This cohort study in the Mass General Brigham hospital system looked at the effects of masking during the respiratory season on the relative incidence of hospital onset of COVID-19, influenza, and RSV during the testing and universal masking phases during pre-Omicron and Omicron, and Omicron after restarting masking for health care workers alone. Stopping universal masking and SARS-CoV-2 testing was associated with a significant increase in hospital-onset respiratory viral infections relative to community infections. Restarting the masking of health care workers was associated with a significant decrease. - November 27, 2024
COVID-19 and Asthma: What Patients Need to Know
Caring for Pregnant Patients With Asthma During the COVID-19 Pandemic
7/9/2026