COVID-19 treatment
GPs play a crucial role in managing COVID-19 in the community, including engaging with at-risk patients.
The main Pharmaceutical Benefits Scheme (PBS) medications GPs currently prescribe are Paxlovid® (nirmatrelvir + ritonavir) and Lagevrio® (molnupiravir) – both oral antivirals.
These treatments can significantly reduce the risk of hospitalisation and death in patients with COVID-19. However, they are not suitable for everyone, and prescribing GPs need to work with individual patients to determine appropriate decisions.
Paxlovid vs Lagevrio
Paxlovid reduces risk of severe disease by 90 per cent and it should be the treatment of choice if it is suitable for the patient. Use the RACGP’s eGFR table – also available as a .pdf – to determine whether Paxlovid is recommended for your patient.
Lagevrio reduces risk of severe disease by 30 per cent. It is a good alternative for lower risk patients if Paxlovid is not suitable.
To receive Paxlovid or Lagevrio, patients must be COVID-positive, symptomatic, not in hospital and within 5 days of infection. These medications are not to be prescribed for patients prophylactically, or as a delayed “back pocket” prescription. Confirmation of infection can be by conversation between a patient and their GP.
To view the latest eligibility criteria, visit the Australian Department of Health website, HealthPathways Melbourne or visit the Pharmaceutical Benefits Scheme (PBS) website:
Contraindications are listed on HealthPathways Melbourne and on the product information for Paxlovid (.pdf) and Lagevrio (.pdf). The Liverpool tool for interactions is useful for working out drug interactions and medication changes.
Long COVID
Ongoing symptomatic COVID-19 is defined as signs and symptoms of COVID-19 extending from 4 to 12 weeks since initial symptom onset.
Post-COVID-19 syndrome is defined as symptoms extending beyond 12 weeks from initial symptom onset.
The term ‘long COVID’ usually refers to both stages, but there are currently no agreed diagnostic criteria. Research indicates that around one in five Australians who contract COVID-19 experience symptoms consistent with long COVID three months after infection.
There is evidence to show that vaccinated people who have breakthrough infection may develop long COVID-19. Children and adolescents are also susceptible.
General practice is well placed to manage patients with long COVID. GPs should keep in touch with patients who they know had the disease. Management may involve coordination of care with a multidisciplinary team of allied health and/or specialist services to address different symptoms.
HealthPathways Melbourne
The Long COVID management and referral pathways on HealthPathways Melbourne are regularly updated. They offer localised clinical guidance for managing patients experiencing physical and mental health issues resulting from COVID-19.
Quality improvement activity for general practice
We encourage practices to use our long COVID quality improvement activity template. It is easy to follow and will step you through the process for identifying and managing these patients in your practice.
