Atlanta—COVID-19 rebound after treatment with the antiviral Paxlovid tends to be mild, but patients should isolate themselves per guidelines, according to a Health Alert Network Health Advisory issued by the CDC.

"COVID-19 rebound has been reported to occur between 2 and 8 days after initial recovery and is characterized by a recurrence of COVID-19 symptoms or a new positive viral test after having tested negative," according to the alert. President Joe Biden was among the Paxlovid recipients who had a rebound.

Paxlovid still is recommended for early-stage treatment of mild-to-moderate COVID-19 among people at high risk for progression to severe disease, according to the CDC, which emphasized that treatment with the drug helps prevent hospitalization and death due to COVID-19.

In recommendations for healthcare providers, public health officials report there is currently no evidence that additional treatment is needed for COVID-19 rebound. "Based on data available at this time, patient monitoring continues to be the most appropriate management for patients with recurrence of symptoms after completion of a treatment course of Paxlovid," according to the alert.

Pharmacists and other healthcare professionals are urged to advise COVID-19 rebound patients to follow the CDC's guidance on isolation and take precautions to prevent further transmission. Based on the CDC guidance, patients experiencing COVID-19 rebound should isolate for at least 5 days but can end their isolation if fever has resolved for 24 hours without the use of fever-reducing medication and if their symptoms are improving. Patients should isolate for 10 days after rebound symptoms started, according to the guidance.

If COVID-19 rebounds include symptoms that persist or worsen, a clinical evaluation should be performed, the CDC stated.

None of this information changes recommendations on how patients just diagnosed with COVID-19 should be treated, however.

Public health officials urge healthcare providers to counsel patients on available COVID-19 treatment options, especially if they have risk factors for developing severe COVID-19. "Paxlovid should be considered for any patient who meets the eligibility criteria" based on the FDA's Fact Sheet for Healthcare Providers, according to the CDC.

In fact, the alert stated, "Due to the potential for severe drug-drug interactions with the ritonavir component of Paxlovid, it is strongly suggested that healthcare providers not experienced in prescribing this drug refer to the Fact Sheet for Healthcare Providers, the Paxlovid Patient Eligibility Screening Checklist Tool for Prescribers, and the NIH [National Institution of Health] Statement on Paxlovid Drug-Drug Interactions/COVID-19 Treatment Guidelines. Healthcare providers can also contact a local clinical pharmacist or infectious disease specialist for advice."

Exactly why rebound occurs remains a mystery. "A brief return of symptoms may be part of the natural history of SARS-CoV-2 (the virus that causes COVID-19) infection in some persons, independent of treatment with Paxlovid and regardless of vaccination status," the CDC pointed out. "Limited information currently available from case reports suggests that persons treated with Paxlovid who experience COVID-19 rebound have had mild illness; there are no reports of severe disease. There is currently no evidence that additional treatment is needed with Paxlovid or other anti-SARS-CoV-2 therapies in cases where COVID-19 rebound is suspected. Regardless of whether the patient has been treated with an antiviral agent, risk of transmission during COVID-19 rebound can be managed by following CDC's guidance on isolation, including taking other precautions such as masking."

Paxlovid (nirmatrelvir tablets; ritonavir tablets, available under Emergency Use Authorization by the FDA for adults and pediatric patients aged 12 years and older weighing at least 40 kilograms or 88 pounds), must be administered speedily. The FDA stated that treatment should be initiated as soon as possible and within 5 days of symptom onset among those testing positive for SARS-CoV-2 infection and who have mild-to-moderate illness. Patients prescribed the drug also should:

• Have one or more risk factors for progression to severe disease.
• Not require hospitalization due to severe or critical COVID-19 at the time of treatment initiation.
• Have no evidence of severe renal or hepatic impairment.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.