Guidance on use of antivirals in residential aged care homes (RACH)

​​​COVID-19 and influenza often co-circulate in the community. It is important to protect those at higher risk of severe disease, including residents of residential aged care homes (RACHs).

NSW Health is working with general practitioners (GPs) and aged care providers to make sure residents have a plan in place in case they develop symptoms of COVID-19 or influenza; including a plan for testing and a discussion about antiviral medicines.

A Pre-assessment action plan for respiratory infections in aged care home residents is available to facilitate timely access of antiviral medicines for residents if they test positive to COVID-19, or test positive or are exposed to influenza.

Antiviral medicines for COVID-19 and influenza

The administration of antiviral medicine soon after symptom onset for people with COVID-19 or influenza can reduce disease severity.

• COVID-19: Nirmatrelvir/ritonavir (Paxlovid^™) or Molnupiravir (Lagevrio®) can be used in people with confirmed COVID-19 who meet the eligibility criteria, including RACH residents. The drug should be commenced as early as possible but no later than day 5 after symptom onset. Nirmatrelvir/ritonavir (Paxlovid^™) is the preferred treatment, however is contradicted in many patients due to drug interactions and comorbidities. Molnupiravir (Lagevrio®) may be used in patients for whom nirmatrelvir/ritonavir is contraindicated.
  
• Influenza: Oseltamivir (Tamiflu®) can be used in residents with confirmed influenza or for prophylactic use in exposed residents during influenza outbreaks in RACFs. 
  

Nirmatrelvir/ritonavir and molnupiravir are available on the Pharmaceutical Benefits Scheme (PBS) for residents of RACHs through community pharmacies for treatment of COVID-19. Oseltamivir is available as outlined below or on private prescription.

Accessing influenza antiviral treatment 

Aged care homes can order Oseltamivir (Tamiflu®) directly from the State Vaccine Centre by completing the online RACH influenza antiviral treatment access form.

Once the form is complete, the request will go to the NSW vaccine distribution warehouse to be filled and distributed. Aged care homes can only order up to 250 doses of oseltamivir using this form. For orders over 250 doses, aged care homes will need to contact their local public health unit on 1300 066 055.

Resources

These resources have been developed to guide discussions between residents and their families with their GP regarding the use of antiviral medicines:

• COVID-19 and flu antiviral medicines – advice for people at high risk of severe illness
  A fact sheet for people at high risk of severe illness, including residents of RACHs, and their loved ones to help guide decisions about using antivirals for COVID-19 and influenza treatment and prevention.
• Pre-assessment action plan for respiratory infections in aged care home residents
  To be completed by a GP and supports the resident (or their guardian) to collaboratively form a plan with their doctor as to what antiviral medicines would be best for them. The pre-assessment form will not replace the requirement for a GP to prescribe the medication prior to administration but it will expedite access to the medication post exposure and for a confirmed case.
• Influenza and COVID-19 antiviral medicines - advice for clinicians
  A fact sheet for clinicians to provide guidance on the use of oseltamivir, molnupiravir and nirmatrelvir/ritonavir.

For additional information on holding antivirals at residential facilities, see the Requirements for residential care facilities (RCFs) under the NSW Poisons and Therapeutic Goods Legislation.