COVID-19 Mild illness: Treatments and Referrals
This information is designed to support medical practitioners including General Practitioners with information about COVID-19 treatments and the referral of patients for the treatment of mild COVID-19 illness, early in the disease course, to reduce the risk COVID-19 illness progressing.
There are currently 5 therapies provisionally registered by the Therapeutics Goods Administration (TGA) for the treatment of mild COVID-19: nirmatrelvir plus ritonavir, molnupiravir, remdesivir, sotrovimab and casirivimab plus imdevimab.
Please note currently certain medications for the treatment of mild COVID-19 are via the National Medical Stockpile (NMS) and supplies can vary according to outbreaks and demand.
In the setting of limited supply certain risk factors or patients with greater than 1 risk factor may be prioritised for treatment.
Nirmatrelvir plus ritonavir (Paxlovid®) and molnupiravir (Lagevrio®) are oral antiviral medications which reduce SARS-CoV-2 replication. When commenced within 5 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.
Molnupiravir (Lagevrio®) is listed on the PBS Section 85 program for certain vulnerable patient groups, it is also available through COVID Care Centres and major regional hospitals.
Nirmatrelvir plus ritonavir (Paxlovid®) is currently available through COVID Care Centres and major regional hospitals. The PBS announced that from 1st May 2022 nirmatrelvir plus ritonavir (Paxlovid®) will be listed on the PBS as a General Schedule, Authority Required (STREAMLINED) benefit for patients with mild-moderate COVID 19 who have a high risk for developing severe disease. Further information can be found in the PBS factsheet.
The Commonwealth government has also provided supply of both of these medicines to Residential Aged Care Facilities.
For patients unable to collect the oral medications in person, alternative ways of supplying the medications may be available.
Remdesivir is an intravenous antiviral which inhibits SARS-CoV-2 replication. When given within 7 days of symptom onset remdesivir decreased hospitalisation in outpatients with mild COVID-1 by 72%. Three intravenous doses of remdesivir on consecutive days are recommended.
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.
- Access to Evusheld® for COVID-19 Pre-Exposure Prophylaxis (PrEP) Fact Sheet (PDF 176KB)
- COVID-19: Pre-Exposure Prophylaxis (PrEP) with Tixagevimab plus Cilgavimab Clinical Guideline (PDF 478)
- Tixagevimab plus Cilagavimab (Evusheld®) Referral Form (PDF 307KB)
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
Outpatients guidelines for COVID-19
The following COVID-19 Mild Illness treatment guidelines have been developed by the Central Adelaide Local Health Network Antimicrobial Stewardship Committee and endorsed for SA Health use by the South Australia Medicines Advisory Committee on 19 January 2022, updated on 7 June 2022.
- Medication management of mild illness in the outpatient setting guideline (PDF 122KB)
- Risk factors for severe COVID-19 and classification of immunosuppressed patients (PDF 569KB)
- Classification of disease severity
Prescriber information sheets:
- Molnupiravir (Lagevrio®) - prescribers (PDF 293KB)
- Nirmatrelvir-Ritonavir (Paxlovid®) - prescribers (PDF 256KB)
Patient eligibility criteria
The Medication management of mild illness in the outpatient setting guideline (PDF 641KB) provides guidance on on patient eligibility criteria and treatment options.
Refer to ATAGI clinical guidance for COVID-19 vaccine providers for 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 your patient for an infusion of a monoclonal antibody (sotrovimab) or oral antiviral medication. This process will require information about you as the referrer and will require the patient to be on hand when entering information.
Please review the patient education information below and speak to your patient regarding the treatment chosen as part of the referral process.
Patient education information
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.
- Example consent forms
- Molnupiravir (Lagevrio) Patient Information (259KB)
- NPS Medicinewise: Lagevrio for people with mild COVID-19
- Nirmatrelvir plus Ritonavir (Paxlovid) Patient Information (328KB)
- NPS Medicinewise: Paxlovid for people with mild COVID-19
- Sotrovimab (Xevudy®) Patient Information (284KB)
- NPS Medicinewise: Xevudy for people with mild COVID-19
- For people who are breastfeeding (PDF 288KB)
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.
- English - Patient information for Sotrovimab (PDF 357KB)
- Arabic - Patient information for Sotrovimab (PDF 373KB)
- Vietnamese - Patient information for Sotrovimab (PDF 315KB)
- Hindi - Patient information for Sotrovimab (PDF 347KB)
- Assyrian - Patient information for Sotrovimab (PDF 278KB)
- Chinese simplified - Patient information for Sotrovimab (PDF 395KB)
- Chinese traditional - Patient information for Sotrovimab (PDF 411KB)
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.
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.