COVID-19: Non-hospitalised patients with symptomatic COVID-19 infection (Guidelines)

What's new / Latest updates

11/03/2026 V6.1: Sotrovimab has been withdrawn. To note there is no change to local guidance.

26/02/2026 V6:

PDF patient information leaflet for molnupiravir changed to online link.
Guidance revised with updated NICE recommendations and links to prescribing information for licensed treatments provided.

11/04/2023:

Although intravenous remdesivir is included in the guidance, this drug is NOT available for delivery in the community setting in NHS Highland.
An update on the use of remdesivir within current NICE Guidance is awaited, pending an appeal by the manufacturer

20/07/2022:

Due to concerns over the efficacy of sotrovimab against the current circulating Omicron variants of SARS-CoV-2 (BA.2 and others), sotrovimab is NOT currently being offered routinely.
Please discuss any individual patient requirements with one of the Infectious Diseases consultants.

Audience

All NHS Highland
Primary Care only
Adults and Children

Please direct patient enquiries about COVID treatments to:

NHS Inform
OR NHS Highland single point of contact: 0800 085 1558.

Please note:

Information for this guideline is taken from NICE NG191 COVID-19 rapid guideline: managing COVID-19

Treatment

Patients in the cohort identified as being at highest risk of progression to severe disease ARE likely to benefit from treatment with antivirals.

See: COVID-19: Risk factors for progression to severe infection

Evidence does NOT support the use of antivirals OUTWITH this cohort.

Nirmatrelvir / ritonavir (Paxlovid^®) and molnupiravir are now licensed for treatment of COVID-19 infection.

Follow the manufacturer’s information on dosage and prescribing.
Molnupiravir should ONLY be used if nirmatrelvir/ritonavir is unsuitable.

Drug interaction note:

Nirmatrelvir plus ritonavir has a number of significant drug interactions and ALL current medication being taken by the patient (hospital or GP prescribed, purchased over the counter or online, herbal or illicit products) MUST be checked using the following website: https://www.covid19-druginteractions.org/checker

Swallowing difficulties:

Administering COVID-19 oral antiviral therapy for patients with swallowing difficulties, see: www.covid19-druginteractions.org/prescribing_resources/guidance-swallowing

Highest risk group in paediatrics

For NHS Highland patients, please refer paediatric patients to the local paediatric team in Inverness or Glasgow, according to the established specialist input for the patient.

Each case will be considered by a national paediatric MDT and the paediatric consultant will liaise with the national team to determine if treatment is required.

Patient assessment, supply information and stock holding

This is managed through the Single Point of Contact and the Flow Navigation Team, with information shared with the patient's GP.

Patients who test PCR or lateral flow device (LFD) positive will be directed to the NHS Highland Single Point of Contact phone number as detailed on NHS Inform.

An initial review will take place to check eligibility for treatment, patient location and need for immediate medical assistance.
If the eligibility criteria are met, details will be phoned and emailed to the Flow Navigation Team who will phone the patient to discuss and agree the most appropriate therapy using Clinical triage and consent form (NHS Highland intranet access required).
Prescriptions for an oral antiviral (nirmatrelvir plus ritonavir [Paxlovid^®] or molnupiravir) will be completed electronically and emailed to the most appropriate stock holding location.
- This will be a hospital prescription form for Raigmore or Lorn and Islands plus a screen shot of the ADASTRA episode of care.
- Hospital prescription form for Paxlovid^® (NHS Highland intranet access required)
- Hospital prescription form for molnupiravir (NHS Highland intranet access required)
A phone call to alert that area will be required, including arrangements for delivery of the oral antiviral to the patient.
Contact information for locations in Argyll and Bute has been shared with the Flow Navigation Team.
For future reference, the completed ADASTRA episode of care will automatically be uploaded to SCi Store and a copy sent to the patient’s GP practice once the episode is concluded

Patient information

NHS Inform:

Covid-19 treatments

For information on pregnancy and breastfeeding

UK Health Security Agency: Patient information for molnupiravir

For information on what tablets to take for reduced dosing in renal impairment

See NHS Highland: Patient information leaflet for Paxlovid® reduced dose in renal impairment

Last reviewed: 26/02/2026

Next review date: 28/02/2029

Author(s): Infectious Diseases.

Version: 6.1

Co-Author(s): Flow Navigation Team.

Approved By: TAM subgroup of the ADTC

Reviewer name(s): A MacDonald, Area Antimicrobial Pharmacist, Dr W Beadles, Consultant, Infectious Diseases.

Document Id: COVID111