Table 1.

Treatment guidelines for SARS-CoV-2 infection

SARS-CoV-2 Patient Population	Recommendations by Organization/Societya
Not hospitalized, mild-to-moderate	NIH: Bamlanivimab + etesevimabb or casirivimab + imdevimabb or sotrovimab; 3-day course of remdesivir in settings where omicron is the dominant variant; ritonavir-boosted nirmatrelvir, molnupiravir ERS: N/A WHO: Among patients at high risk of progression to severe disease casirivimab + imdevimab (conditional recommendation) IDSA: Among ambulatory patients with mild-to-moderate COVID-19 at high risk of progression to severe disease; bamlanivimab/etesevimab, casirivimab/imdevimab or sotrovimab, remdesivir, ritonavir-boosted nirmatrelvir, molnupiravir (conditional recommendation)
Hospitalized and not requiring supplemental oxygen	NIH: Remdesivir may be appropriate for some patients at high risk of progression ERS/WHO/IDSA: N/A
Hospitalized and requiring supplemental oxygen	NIH: Remdesivir; dexamethasone + remdesivir; dexamethasone (when combination with remdesivir is not possible) ERS: Corticosteroids + tocilizumab (conditional recommendation) WHO: Systemic corticosteroids + tocilizumab or sarilumab; casirivimab + imdevimab (conditional recommendation) IDSA: Dexamethasone or alternative corticosteroids; tocilizumabc + corticosteroids; sarilumab; remdesivir (5 days vs.10 days; conditional recommendation); baricitinib + remdesivird or baricitinib + remdesivir + corticosteroids (conditional recommendation); tofacitinib
Hospitalized and requiring oxygen delivery through high-flow device or noninvasive ventilation	NIH: Dexamethasone; dexamethasone + remdesivir; add baricitinib or tocilizumab for recently hospitalized with increasing oxygen needs and systemic inflammation. If neither are available or feasible to use, use tofacitinib instead of baricitinib or sarilumab instead of tocilizumab ERS: Corticosteroids + tocilizumab (conditional recommendation) WHO: Systemic corticosteroids + tocilizumab or sarilumab; casirivimab + imdevimab (conditional recommendation in seronegative patients) IDSA: Dexamethasone or alternative corticosteroids; tocilizumabc + corticosteroids; sarilumab; remdesivir (5 days vs.10 days; conditional recommendation); baricitinib + remdesivir or baricitinib + remdesivir + corticosteroids (conditional recommendation); tofacitinib
Hospitalized and requiring mechanical ventilation	NIH: Dexamethasone; add tocilizumab for patients who are within 24 hours of ICU admission or sarilumab if tocilizumab is not available or feasible to use ERS: Corticosteroids + tocilizumab WHO: Systemic corticosteroids + tocilizumab or sarilumab; casirivimab + imdevimab (conditional recommendation in seronegative patients) IDSA: Dexamethasone or alternative corticosteroids; tocilizumabc; sarilumab
Not recommended	NIH: Dexamethasone or other systemic glucocorticoids in non-hospitalized patients; continuation of remdesivir or baricitinib in patients discharged from hospital not requiring supplemental oxygen; chloroquine or hydroxychloroquine and/or azithromycin, lopinavir/ritonavir and other HIV protease inhibitors for outpatient treatment; antibacterial therapy in outpatients; dexamethasone in hospitalized patients not requiring supplemental oxygen; baricitinib + tocilizumab in combination; interferons; acalabrutinib, ibrutinib, zanubrutinib; ruxolitinib, tofacitinib; non-SARS-CoV-2-specific intravenous immunoglobulin; sarilumab in patients not requiring ICU care or admitted to ICU but not requiring ventilation or high-flow oxygen; siltuximab; colchicine in hospitalized patients; convalescent plasma (low titer; any titer in mechanically ventilated patients; high titer in hospitalized patients who are not mechanically ventilated) ERS: Hydroxychloroquine; azithromycin; hydroxychloroquine + azithromycin; lopinavir/ritonavir; interferon beta; remdesivir in patients who require invasive mechanical ventilation WHO: Chloroquine or hydroxychloroquine; lopinavir/ritonavir; remdesivir (conditional); ivermectin (research use only) IDSA: Corticosteroids (hospitalized patients not needing supplemental oxygen); remdesivir (hospitalized patients not needing supplemental oxygen; patients on invasive ventilation, with septic shock or on ECMO); hydroxychloroquine or chloroquine; hydroxychloroquine ± azithromycin; lopinavir/ritonavir; convalescent plasma (hospitalized patients); famotidine; ivermectin; bamlanivimab monotherapy
Insufficient data to support a recommendation, or no recommendation	NIH: Continued remdesivir or baricitinib after hospital discharge in patients requiring supplemental oxygen; ivermectin; convalescent plasma (high titer in hospitalized patients with impaired immunity or non-hospitalized patients); colchicine (for non-hospitalized patients); fluvoxamine; granulocyte-macrophage colony-stimulating factor inhibitors for hospitalized patients; inhaled budesonide; interleukin-1 inhibitors (e.g. anakinra); interferon beta for early mild-to-moderate disease; sarilumab (for patients within 24 hours of ICU admission who require ventilation or high-flow oxygen) ERS: Remdesivir in hospitalized patients not requiring invasive mechanical ventilation WHO: N/A IDSA: Convalescent plasma (ambulatory patients with mild-moderate disease – research use only); ivermectin (research use only)

^aNIH, National Institutes of Health [14]; ERS, European Respiratory Society [15]; WHO, World Health Organization [16]; Infectious Diseases Society of America (December 2021 update) [17].

^bRecommended prior to the occurrence of the dominant omicron variant.

^cPatients with elevated markers of systemic inflammation.

^dRecommended in combination with remdesivir for patients with a contraindication to corticosteroid therapy.

COVID-19: coronavirus disease 2019; ECMO: extracorporeal mechanical oxygenation; HIV: human immunodeficiency virus; ICU: intensive care unit; N/A: not available.