NIH Publishes New Version of COVID-19 Treatment Guidelines

September 26, 2022

The COVID-19 Treatment Guidelines Panel (the Panel) has published a new version of the Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. This version of the Guidelines includes the following key updates:

• In Clinical Spectrum of SARS-CoV-2 Infection, the Panel discusses some important limitations of using pulse oximetry to detect hypoxemia.
• In Therapeutic Management of Nonhospitalized Adults With COVID-19, the Panel provided modified treatment recommendations for patients with COVID-19 who, because of limited hospital resources, are discharged from the emergency department despite having new or increasing supplemental oxygen requirements. Because these situations are currently quite rare, the Panel removed this case scenario from this section. The Panel also combined the recommendations for patients discharged from the hospital in stable condition, with or without supplemental oxygen, into a single recommendation.
• In Ritonavir-Boosted Nirmatrelvir (Paxlovid), the Panel discusses SARS-CoV-2 viral rebound and the recurrence of COVID-19 symptoms and notes that concerns about viral rebound and symptom recurrence should not be a reason to avoid the use of ritonavir-boosted nirmatrelvir.
• The Panel has added drugs to its presentation of Drug-Drug Interactions Between Ritonavir-Boosted Nirmatrelvir (Paxlovid) and Concomitant Medications.
• In Molnupiravir, the Panel notes that there is a lack of definitive data regarding the benefit of molnupiravir in patients who are vaccinated and at high risk of progressing to severe COVID-19. Due to the fetal toxicities that have been reported in animal studies of molnupiravir, the Panel recommends against the use of molnupiravir for the treatment of COVID-19 in pregnant patients unless there are no other options and therapy is clearly indicated.
• The text and clinical data table in Antithrombotic Therapy in Patients With COVID-19 were updated with data from 2 randomized controlled trials that assessed the use of prophylactic doses of low-molecular-weight heparin in outpatients with COVID-19.
• Special Considerations in Pregnancy has been revised with updated data regarding the epidemiology of COVID-19 in pregnancy, including obstetric and perinatal outcomes and rates of vertical transmission of SARS-CoV-2. The Panel also discusses the safety and efficacy of administering COVID-19 vaccines to pregnant people.

For more information, please see What's New in the Guidelines on the COVID-19 Treatment Guidelines website.