30 Determining a potential alternative empirical antibiotic regimen for the treatment of neonatal sepsis in low- and middle-income settings using pre-clinical in vitro techniques

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Introduction: Nirmatrelvir/ritonavir (Paxlovid), is the first-line treatment in non-hospitalised patients with COVID-19 deemed clinically extremely vulnerable (CEV).Drug-drug interactions (DDIs) restrict its use, and there is limited real world tolerability data.We describe our experiences of using Paxlovid at our North Central London (NCL) CMDU.Methods: SARS-CoV-2 positive CEV patients were triaged between 10/ 02/22 and 21/03/22.Those meeting national eligibility criteria were considered for Paxlovid.We standardised management of some DDIs by modifying the Interim Clinical Commissioning Policy; directed by HIV physicians and pharmacists, this recommended which medications could be safely paused (statins, PDE5 inhibitors), or co-administered (inhaled corticosteroids) with Paxlovid.Additionally, an HIV consultant was available to discuss complex DDI cases.Patients prescribed Paxlovid between 10/02/22 and 10/03/22 were contacted after at least seven days to assess tolerability and adherence.Data were manually extracted from patient records and analysed in Microsoft Excel.Results: Paxlovid was considered in 298 patients and contraindicated in 37% (109/298) (Table 1).Additionally, many patients were prescribed Paxlovid using the modified interaction guidance.189 patients were prescribed Paxlovid, with 95 followed up.89% (85/95) completed the course.53% (50/95) reported side effects (Table 2) which resulted in discontinuation of Paxlovid in 6% (6/95).Discussion: Paxlovid is reasonably well tolerated.While half of patients experienced side effects, they are mild and transient, resulting rarely in discontinuation.A pragmatic approach to managing DDIs improves access to Paxlovid.However, numerous DDIs still prevent access to oral antivirals and additional mitigation strategies should be considered.

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