Should Paxlovid be prescribed for patients with severe COVID‐19 in the late course of infection? A case report

The infection of the coronavirus disease 2019 (COVID‐19) is often accompanied by pneumonia with both high incidence and mortality. Paxlovid is commonly prescribed in patients with mild and normal pneumonia within 5 days from the symptom onset. Herein, we report a practically effective use of Paxlovid compensatively in patients with COVID‐19 and severe pneumonia after 5 days of infection in a typical case in China. In this case, a 75‐year‐old man was diagnosed with severe COVID‐19 complicated with a pulmonary bacterial infection. After treatment with oxygen inhalation, Cefoperazone‐sulbactam and ambroxol, fever and upper respiratory symptoms were alleviated, except for the Oxygenation index (OI) remaining worse, Coronavirus was detected as positive, and levels of interleukin‐6 remained high. Paxlovid was prescribed for 5 days subsequently though it was 14 days since symptom onset. Thereafter, the nucleic acid of the patient turned negative in 7 days and the symptoms resolved. This case showed that Paxlovid can be considered in patients with COVID‐19 and severe pneumonia even in the later course of infection in clinical practice in China. Paxlovid is one of the main therapeutic drugs for COVID‐19, which is currently widely used in patients with mild to moderate COVID‐19. However, there is no current clinical evidence on Paxlovid for patients with severe COVID‐19. This case report indicates that a prescription of Paxlovid might be appropriate for patients with severe COVID‐19.