COVID-19 acute respiratory infection (Adults)

• This guideline is for those diagnosed with COVID-19 infection
• COVID-19 is a viral infection.
• COVID-19 antivirals may be considered for selected seriously immunocompromised COVID-19 patients. (Updated HSE guidance, July 2025)
• Secondary bacterial infection appears uncommon in COVID-19 patients.
• Differentiating viral COVID-19 infection versus a secondary bacterial COVID-19 pneumonia:
  
  • Viral COVID-19 infection more likely if;
    • history of typical COVID-19 symptoms for about a week
    • severe muscle pain (myalgia),
    • loss of sense of smell (anosmia), taste (dysgeusia)
    • breathless but has no pleuritic pain
    • history of exposure to known or suspected COVID-19, such as a household or workplace contact.
  • Secondary bacterial COVID-19 more likely if;
    • became rapidly unwell after only a few days of symptoms.
    • does not have a history of typical COVID-19 symptoms.
    • purulent sputum.
    • pleuritic pain.
    • underlying chronic lung disease with history of secondary bacterial infection in winters e.g. in acute infective exacerbation of COPD.

• Doxycycline is preferred because it has a broader spectrum of cover than amoxicillin, particularly against Mycoplasma pneumoniae and Staphylococcus aureus, which are more likely to be secondary bacterial causes of pneumonia during the COVID-19 pandemic.
• Check pulse oximetry.
• Use the following symptoms and signs to help identify patients with more severe illness to help make decisions about hospital admission:
  • severe shortness of breath at rest or difficulty breathing.
  • reduced oxygen saturation levels measured by pulse oximetry.
  • Severe comorbidity.
  • Signs of overt sepsis.
• At convalescence, ensure COVID-19, influenza and pneumococcal vaccinations up to date.

Treatment

* Alternative doxycycline dose: 100mg every 12 hours.  

 In non-severe infection, 200mg stat then 100mg every 24 hours can be considered.

Symptom relief

• Honey may help to relieve symptoms of cough.
• Consider analgesia: paracetamol (or ibuprofen where appropriate).
• Ensure adequate hydration by drinking plenty of fluid.
• Advise to consult pharmacist for symptom relief.

Patient Information

HSE website: Coronavirus information

Safe Prescribing (visit the safe prescribing page)

• Doses are oral and for adults unless otherwise stated
• Penicillin allergy – tips on prescribing in penicillin allergy
• Renal impairment dosing table
• Safety in Pregnancy and Lactation
• Drug interactions table. Extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
• Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed January 2025, minor update November 2025