Favipiravir and the Need for Early Ambulatory Treatment of SARS-CoV-2 Infection (COVID-19)

Antimicrob Agents Chemother. 2020 Nov 17;64(12):e02017-20. doi: 10.1128/AAC.02017-20. Print 2020 Nov 17.


It is becoming increasingly clear that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), like most human viral infections, will require multiple drugs in combination to treat COVID-19 illness. In this issue of the Journal, Doi and colleagues describe successful treatment of patients with early COVID-19 with favipiravir, an oral polymerase inhibitor, to rapidly and substantially clear SARS-CoV-2 from nasal secretions irrespective if it was started relatively early or later within the first week of infection. These data support the concept that favipiravir could be paired with at least one more off-target antiviral agent (doxycycline, azithromycin, or ivermectin) followed by corticosteroids and antithrombotics to prevent COVID-19 hospitalization and death in those over age 50 and/or those with one or more comorbidities. Clinical trials and advanced practice should immediately pivot to combination/sequential drug therapy for ambulatory COVID-19 illness.

Keywords: COVID-19; SARS-CoV-2; ambulatory treatment; antiviral agents; favipiravir.

Publication types

  • Comment

MeSH terms

  • Amides
  • Antiviral Agents* / therapeutic use
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections* / drug therapy
  • Humans
  • Pandemics*
  • Pneumonia, Viral* / drug therapy
  • Prospective Studies
  • Pyrazines
  • SARS-CoV-2
  • Severe Acute Respiratory Syndrome* / drug therapy


  • Amides
  • Antiviral Agents
  • Pyrazines
  • favipiravir