Opportunities to “test and treat” for flu, COVID-19, and other conditions will continue to grow...and expand your role in patient care.
The PREP Act extension now allows pharmacists to order and administer COVID-19 tests through 2029. And more states are permitting pharmacists to screen and prescribe meds for influenza, strep throat, etc.
Learn more about your state’s requirements with Bula’s Test and Treat FAQ...and dig into our CE, Rapid Point-of-Care Testing in the Outpatient Setting, for tips on getting reimbursed, finding time, etc.
Continue to ensure all patients get appropriate therapy...even if you don’t offer test and treat services.
Influenza. For otherwise healthy patients with flu, suggest fluids, rest, antipyretics, etc. Antivirals only reduce symptoms by about a day.
On the other hand, recommend oseltamivir ASAP for patients with confirmed or suspected flu who are at high risk for complications, such as those who are pregnant or immunocompromised...or with severe illness.
Consider 5 days of oseltamivir OR 1 dose of baloxavir for nonsevere flu in other outpatients with risks (diabetes, heart disease, etc).
Recommend starting ASAP...ideally within 48 hours of symptom onset.
COVID-19. Advise treatment for patients at high risk of severe COVID-19 (diabetes, obesity, age 50+, etc)...even if symptoms are mild.
Recommend nirmatrelvir/ritonavir for these high-risk outpatients age 12 and up...within 5 days of symptom onset.
Verify the patient’s med list...and use an interaction checker, such as COVID19-DrugInteractions.org, to manage interactions. For example, avoid nirmatrelvir/ritonavir with salmeterol, rivaroxaban, or phenytoin.
Group A strep. Recommend treating confirmed strep with 10 days of oral penicillin or amoxicillin. Suggest 10 days of cephalexin instead if patients have a nonsevere penicillin allergy (non-itchy rash)...or 5 days of azithromycin if the allergy is more severe (hives, anaphylaxis, etc).
Use this table as a cheat sheet for usual meds...and click on the conditions above for in-depth guidance on benefits and risks.
- CDC. COVID-19 Treatment Clinical Care in Outpatients. December 20, 2024. https://www.cdc.gov/covid/hcp/clinical-care/outpatient-treatment.html (Accessed January 3, 2025).
- CDC. Influenza Antiviral Medications: Summary for Clinicians. December 8, 2023. https://www.cdc.gov/flu/hcp/antivirals/summary-clinicians.html (Accessed January 3, 2025).
- The Sanford Guide to Antimicrobial Therapy. (1995). Dallas, TX :Antimicrobial Therapy, Inc. Available at https://webedition.sanfordguide.com/en/sanford-guide-online/disease-clinical-condition/streptococcus-pyogenes-streptococcus-beta-hemolytic (Accessed January 3, 2025).
- Medication pricing by Elsevier, accessed January 2025.
- Chart: Antivirals for Influenza
- Algorithm: Outpatient COVID-19 Treatment Options