COVID-19 mild illness: treatments and referrals
This information is designed to support medical practitioners, including General Practitioners, to prescribe COVID-19 treatments and to refer patients for consideration of medicines supply from the National Medical Stockpile for the early intervention of COVID-19.
There are currently five therapies, available from the National Medical Stockpile, provisionally registered by the Therapeutics Goods Administration (TGA) for the treatment of mild COVID-19:
- nirmatrelvir plus ritonavir (Paxlovid®)
- molnupiravir (Lagevrio®)
- remdesivir (Veklury®)
- sotrovimab (Xevudy®)
- casirivimab plus imdevimab (Ronapreve®)
Supplies from the National Medical Stockpile can vary according to outbreaks and demand. In the setting of limited supply certain risk factors or patients with greater than one risk factor may be prioritised for treatment.
The Commonwealth Government has provided a supply of National Medical Stockpile medicines directly to Residential Aged Care Facilities.
COVID-19 Pre-Exposure Prophylaxis (PrEP): tixagevimab-cilgavimab (Evusheld®)
On 24 February 2022, the Therapeutic Goods Administration provisionally approved tixagevimab-cilgavimab (Evusheld®) for the pre-exposure prophylaxis of COVID-19 for severely immunocompromised adults and adolescents aged 12 years and older weighing at least 40 kg.
Tixagevimab-Cilgavimab (Evusheld®) is not a substitute for vaccination but may be an option for those with proven allergies to COVID-19 vaccinations.
Referrals can be made by Specialists via their Local Health Network referral pathways.
- COVID-19: Pre-Exposure Prophylaxis (PrEP) with Tixagevimab plus Cilgavimab Clinical Guideline (PDF 400KB)
- tixagevimab plus cilgavimab (Evusheld®) Eligibility Declaration Form (PDF 224KB)
- tixagevimab plus cilgavimab (Evusheld®) Patient Information (PDF 228KB)
Nirmatrelvir plus ritonavir (Paxlovid®) and molnupiravir (Lagevrio®)
Nirmatrelvir plus ritonavir (Paxlovid®) and molnupiravir (Lagevrio ®) are oral antiviral medications which reduce SARS-CoV-2 replication. When commenced within five days of symptom onset, in patients at high risk of progressing to severe illness, nirmatrelvir plus ritonavir and molnupiravir have been shown to reduce hospitalisations and death from COVID-19 by approximately 88% and 30% respectively.
Paxlovid® and Lagevrio® are both listed on the Pharmaceutical Benefits Scheme (PBS) for the following groups of patients with COVID-19 not requiring supplemental oxygen:
- People 50 years of age or older, with two additional risk factors for developing severe disease;
- People 30 years of age or older, identifying as Aboriginal or Torres Strait Islander, with two additional risk factors for developing severe disease; and
- People 18 years of age or older, with moderate to severe immunocompromise;
where treatment is commenced within 5 days of the onset of signs/symptoms.
- People 70 years of age or older, where treatment is commenced within 5 days of the onset of symptoms, or where asymptomatic, treatment is initiated as soon as possible after diagnosis is confirmed.
Further PBS information
Remdesivir is an intravenous antiviral which inhibits SARS-CoV-2 replication. When given within seven days of symptom onset remdesivir decreased hospitalisation in outpatients with mild COVID-19 by 72%. Three intravenous doses of remdesivir on consecutive days is recommended.
Guidelines for outpatient COVID-19 treatment
The following COVID-19 Mild Illness treatment guidelines have been developed by the Central Adelaide Local Health Network Antimicrobial Stewardship Committee and initially endorsed for SA Health use by the South Australia Medicines Advisory Committee on 19 January 2022, the guidelines have been updated to reflect changes in clinical evidence, national and international guidelines and patient access pathways such as updates to the Pharmaceutical Benefits Scheme (PBS).
- COVID-19 Medication Management of Mild Illness in the Outpatient Setting Clinical Guideline
- Risk factors for severe COVID-19 and classification of immunosuppressed patients
- Classification of disease severity
Prescriber information sheets
- Nirmatrelvir plus ritonavir (Paxlovid®)
- Drug interaction checker
- Molnupiravir (Lagevrio®)
- Remdesivir (Veklury®)
- Sotrovimab (Xevudy®)
- Sotrovimab For people who are breastfeeding
Australian guidelines and recommendations
Medication recommendations for COVID-19 can change rapidly due to demand and supply constraints, ongoing research and as novel agents are discovered. For the most up to date Australian guidelines and recommendations refer to:
- National COVID-19 Clinical Evidence Taskforce (The Australian Living Guidelines)
- COVID-19 Resources: NSW Therapeutic Advisory Group
- Clinical Excellence Commission: Medication Safety Updates
Patient eligibility criteria
The COVID-19 Medication Management of Mild Illness in the Outpatient Setting Clinical Guideline provides guidance on patient eligibility criteria and treatment options.
Refer to ATAGI clinical guidance for COVID-19 vaccine providers for the latest updates from ATAGI, including clinical recommendations for COVID-19 vaccines, and information on vaccination status.
Refer your patient
Complete this online form to refer COVID-19 positive adult patients to SA Health for consideration of treatment with available medicines from the Commonwealth’s National Medical Stockpile for the early intervention of COVID-19.
This process will require information about you as the referrer and will require the patient to be on hand when entering information.
Note: Patients eligible for PBS access to oral antiviral therapy who are clinically appropriate for treatment with oral medication should NOT be referred via this pathway, except where needing specific consideration of NMS treatments not available via PBS (e.g. remdesivir or monoclonal antibody infusions).
Please review the patient education information below and speak to your patient regarding the treatment chosen as part of the referral process.
The following patients should NOT be referred for treatment using this form:
- Patients who are eligible for PBS supply of oral antiviral treatment AND who are clinically appropriate for treatment with oral medication, except where needing specific consideration of NMS treatments not available via PBS (e.g. remdesivir or monoclonal antibody infusions)
- Patients under 18 years of age (for children who may require COVID-19 treatment, please discuss with the COVIDKids service at the Women’s and Children’s Hospital), or
- Patients with a new or increased oxygen requirement. (Note: patients who are ordinarily on oxygen and do not have an increased need ARE eligible for referral).
What happens after the referral is made?
Step 1: Application submitted by referring clinician.
Step 2: Review of application by clinical team (and follow up with referrer, if required).
Step 3: If referral meets the criteria, patients who decide to proceed will be contacted by SA Health staff to discuss treatment options and arrange access to treatment.
Step 4: You will be advised by the relevant treating facility to inform you of the progress of the referral.
The patient information for the oral antiviral medications (molnupiravir and nirmatrelvir plus ritonavir) includes links to documents the Clinical Excellence Commission has developed. These documents have been approved for use in South Australia by SA Health with the advice of Infectious Diseases Consultants and pharmacy.
- Molnupiravir (Lagevrio) Patient Information
- NPS MedicineWise: Lagevrio for people with mild COVID-19
nirmatrelvir plus ritonavir (Paxlovid®)
- Nirmatrelvir plus Ritonavir (Paxlovid) Patient Information
- NPS MedicineWise: Paxlovid for people with mild COVID-19
- Sotrovimab (Xevudy®) Patient Information
- NPS MedicineWise: Xevudy for people with mild COVID-19
- English - Patient information for Sotrovimab
- translated information
The patient information for sotrovimab includes links to documents the NSW Therapeutic Advisory Group has developed. These documents have been approved for use in South Australia by SA Health with advice of Infectious Disease Consultants.
The NPS MedicineWise Antiviral treatments for COVID-19 Hub contains information on recently approved antivirals and monoclonal antibody medicines used for the treatment of COVID-19. The Hub provides new clinical information, resources and links to help keep health professionals and consumers up to date with the latest approvals, evidence and guidance.