Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
Remdesivir is recommended as an option for treating COVID-19 in hospitals in:
adults, only if they have a high risk of serious illness (as defined in section 5 of TA878)
babies, children and young people, only if they:
are aged 4 weeks to 17 years and weigh at least 3 kg, and:
have pneumonia, and
need supplemental oxygen, or
weigh at least 40 kg, and have a high risk of serious illness (as defined in section 5 of TA878).
For full details, see NICE's technology appraisal guidance on remdesivir (TA971, 2024).
Molnupiravir is recommended as an option for treating mild to moderate COVID‑19 in adults who have a positive SARS‑CoV‑2 test, only if:
they have 1 or more risk factors for progression to severe COVID‑19 (as defined in section 5 of TA878) and
nirmatrelvir plus ritonavir is contraindicated or unsuitable.
For full details, see NICE's technology appraisal guidance on molnupiravir (TA1056, 2026).
Offer dexamethasone, or either hydrocortisone or prednisolone when dexamethasone cannot be used or is unavailable, to people with COVID‑19 who:
need supplemental oxygen to meet their prescribed oxygen saturation levels or
have a level of hypoxia that needs supplemental oxygen but who are unable to have or tolerate it.
Continue corticosteroids for up to 10 days unless there is a clear indication to stop early, which includes discharge from hospital or a hospital-supervised virtual COVID ward. [8 April 2021]
See box 1 on dosage information.
Dosage in adults
Dexamethasone
6 mg orally once a day for 10 days (three 2 mg tablets or 15 ml of 2 mg/5 ml oral solution) or
6 mg intravenously once a day for 10 days (1.8 ml of 3.3 mg/ml ampoules [5.94 mg]).
For people able to swallow and in whom there are no significant concerns about enteral absorption, prescribe tablets. Only use intravenous administration when tablets or oral solutions are inappropriate or unavailable.
Suitable alternatives
Prednisolone: 40 mg orally once a day for 10 days.
Hydrocortisone: 50 mg intravenously every 8 hours for 10 days (0.5 ml of 100 mg/ml solution; powder for solution for injection or infusion is also available); this may be continued for up to 28 days for people with septic shock.
Dosage in pregnancy
Follow Royal College of Obstetrics and Gynaecology guidance.
Dosage for children with a greater than 44-week corrected gestational age
Dexamethasone: 150 micrograms/kg (as a base) orally, nasogastrically or intravenously once a day for 10 days (max 6 mg).
Prednisolone: 1 mg/kg orally, nasogastrically or intravenously once a day for 10 days (maximum 40 mg; doses can be rounded as per routine clinical practice).
Dosage for preterm babies with a corrected gestational age of less than 44 weeks
Seek specialist advice.
For more information on the management of children, follow the Royal College of Paediatrics and Child Health National guidance for the management of children in hospital with viral respiratory tract infections (2023).
For people able to swallow and in whom there are no significant concerns about enteral absorption, prescribe tablets. Only use intravenous administration when tablets or oral solutions are inappropriate or unavailable.
Do not use corticosteroids to treat COVID-19 in people who do not need supplemental oxygen. (People who need corticosteroids for another medical reason should still have them.) [8 April 2021, amended 20 April 2022]
For a short explanation of why the panel made these recommendations, see the rationale section on corticosteroids.
Full details of the evidence and the panel's discussion are in evidence review A: corticosteroids.
Tocilizumab is recommended as an option for treating COVID‑19 in adults who are having systemic corticosteroids and need supplemental oxygen or mechanical ventilation. For full details, see NICE's technology appraisal guidance on tocilizumab (TA878, 2026).
Consider baricitinib for people 2 years and over in hospital with COVID-19 who:
need supplemental oxygen for COVID-19 and
are having or have completed a course of corticosteroids such as dexamethasone, unless they cannot have corticosteroids and
have no evidence of infection (other than SARS-CoV-2) that might be worsened by baricitinib.
In March 2023, this was an off-label use of baricitinib. See NICE's information on prescribing medicines.
Baricitinib may be considered in people who meet the above criteria, and who cannot have tocilizumab. When there is clinical deterioration despite treatment with tocilizumab, it may be appropriate to add baricitinib.
Baricitinib is contraindicated in pregnancy and breastfeeding. The Royal College of Obstetricians and Gynaecologists has produced guidance on managing coronavirus infection in pregnancy. [6 May 2022, amended 29 March 2023]
For a short explanation of why the panel made this recommendation, see the rationale section on baricitinib.
Full details of the evidence and the panel's discussion are in evidence review L: baricitinib.
Do not use antibiotics for preventing or treating COVID-19 unless there is clinical suspicion of additional bacterial co-infection. See the section on suspected or confirmed co-infection. See also the recommendations on azithromycin and doxycycline. [21 March 2021, amended 3 June 2021]
Do not use azithromycin to treat COVID-19. [3 June 2021]
For a short explanation of why the panel made this recommendation, see the rationale section on azithromycin.
Full details of the evidence and the panel's discussion are in evidence review B: azithromycin.
Only use budesonide to treat COVID-19 as part of a clinical trial. (People already on budesonide for conditions other than COVID-19 should continue treatment if they test positive for COVID-19.) [3 November 2021]
For a short explanation of why the panel made this recommendation, see the rationale section on budesonide.
Full details of the evidence and the panel's discussion are in evidence review E inhaled budesonide.
Do not use colchicine to treat COVID-19. [27 May 2021, amended 1 December 2021]
For a short explanation of why the panel made this recommendation, see the rationale section on colchicine.
Full details of the evidence and the panel's discussion are in evidence review F: colchicine.
Do not use doxycycline to treat COVID-19 in the community. [2 September 2021]
For a short explanation of why the panel made this recommendation, see the rationale section on doxycycline.
Full details of the evidence and the panel's discussion are in evidence review C: doxycycline.
Do not use ivermectin to treat COVID-19 except as part of an ongoing clinical trial. [22 November 2021, amended 15 June 2022]
For a short explanation of why the panel made this recommendation, see the rationale section on ivermectin.
Full details of the evidence and the panel's discussion are in evidence review M: ivermectin.
Tixagevimab plus cilgavimab is not recommended for treating COVID-19 in adults who do not need supplemental oxygen and who have an increased risk of progression to severe COVID-19. For full details, see NICE's technology appraisal guidance on tixagevimab plus cilgavimab for treating COVID-19 (TA971, 2024).
Do not use vitamin D to treat COVID-19 except as part of a clinical trial.
For existing UK guidance on taking vitamin D to maintain muscle and bone health, see NHS advice on vitamin D. [14 July 2022]
For a short explanation of why the panel made this recommendation, see the rationale section on vitamin D.
Full details of the evidence and the panel's discussion are in evidence review N: vitamin D.