Recently, an emergency use authorization was granted by the FDA for two new oral antivirals against COVID-19, i.e. molnupiravir by Merck and Ridgeback Biotherapeutics and Pfizer’s nirmatrelvir/ritonavir. Both target specific enzymes and functions other than the spike protein and play a complementary role to vaccines. 

Nevertheless, the urgent need for effective outpatient treatment may increase the risk of irrational use of these antivirals. Moreover, their potential to induce resistance in case of inappropriate use remains still unclear. 

When cost is considered, each treatment course costs hundreds of dollars. Thus to optimize their use, antiviral stewardship initiatives are necessary. From a healthcare system perspective, administration monitoring via electronic prescription can be employed for antiviral usage control. 

Limited drug availability and high treatment cost suggest that currently, the use of these antivirals should be limited to only high-risk outpatients. Additionally, post-prescription review and feedback can further help improve outcomes.

The above-mentioned tools will aid in the optimization of organizational, surveillance and prescribing preparedness. However, to ensure a minimum competency skillset for all prescribers, prompt, accessible and effective educational resources are required, which are even more critical during the early phase of disposal of these antiviral medications.

Further, it is also important to continue emphasizing the significant differences between prevention of disease through vaccination and treatment of disease with medications.

 The evolution of diagnostics is necessary for effective stewardship. Thus, countries investing in these medications must enhance their diagnostic yield, by supporting their testing capacity to meet the expected needs of prompt diagnosis. 

New oral antivirals represent an important addition to combat against COVID-19. Early implementation of antiviral stewardship interventions is needed to ensure their appropriate use and to observe their real-world effectiveness.

SOURCE- Infection Control & Hospital Epidemiology, 2022; 1–7. http://doi.org/10.1017/ice.2022.25