COVID-19 acute respiratory infection (Adults)

  • covid smallThis guideline is for those diagnosed with COVID-19 infection
  • COVID-19 is a viral infection.
  • Antivirals or agents with antiviral properties for COVID-19 should not be prescribed for treatment or prophylaxis in the community, unless as part of a clinical trial.
  • 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.
  • Useful guidance for requirements for isolation available:
  •  Further information on COVID-19 Clinical Advice and Guidelines including medicines management is available at the HSE COVID-19 repository


covid19 table oct 2021

* 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 short-term use of codeine linctus in people 18 years and over to suppress coughing if it is distressing.
  • 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)

Reviewed December 2021