Skill Checkup: A 68-Year-Old Woman With Low-Grade Fever, Headache, Body Aches, Fatigue, Nasal Congestion, and Sore Throat

Enrico Brunetti, MD


November 07, 2022

Based on the patient's presentation (within 5 days of symptom onset) and risk status, the preferred treatment option is antiviral therapy. For those at high risk of progressing to severe COVID-19 and hospital admission, such as the one in this case, WHO guidance indicates that ritonavir-boosted nirmatrelvir (paxlovid) has the strongest recommendation, followed by a weaker recommendation for remdesivir or molnupiravir. The monoclonal antibodies, sotrovimab and casirivimab-imdevimab, are no longer recommended by the WHO in this patient setting.

In the present case, the dominant strain in the community at the time was Omicron BA.5. Rapid viral genotyping is available and confirms infection with this strain of SARS-CoV-2. Because there is a significant drug interaction between the glucocorticoid and ritonavir, the glucocorticoid would have to be suspended during the 5-day course of nirmatrelvir/ritonavir. Given this obstacle, the patient expresses a preference for a different antiviral therapy that doesn't require travel to a healthcare facility for treatment.


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