ERS 2025 dose-ranging trial (6g vs 18g vs placebo): https://publications.ersnet.org/content/erj/66/suppl69/pa1710 2026 Frontiers in Nutrition trial (Brazil, most recent): https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2026.1731306/full

The short version: the 2025 ERS dose-ranging trial and the 2026 Frontiers trial both test creatine for long COVID, but neither tests 6 g plus dextrose, and the safety signal from the clotting case reports remains unaddressed.

The ERS 2025 trial compared 6 g, 18 g, and placebo in a dose-ranging design for long COVID [1]. The 2026 Frontiers in Nutrition trial from Brazil is the most recent and directly relevant study [2]. Neither trial tested creatine plus dextrose specifically. Both tested creatine monohydrate alone. The dextrose addition, borrowed from sports nutrition to boost muscle uptake, has never been tested in a post-COVID population.

The key question is whether the 6 g dose works better than placebo. The ERS trial was presented as a conference abstract, so the full results are not yet published. The Frontiers trial used a lower dose (4 g) and found improvements in fatigue and exercise tolerance [2]. Whether 6 g outperforms 4 g is unknown. The 18 g arm in the ERS trial is a loading dose, not a maintenance dose, and its tolerability in long COVID patients has not been reported in detail.

The clotting concern from the previous answer is still relevant. The case reports of venous thromboembolism in young creatine users were not addressed by either new trial [3]. Long COVID itself is a pro-thrombotic state. A trial that does not monitor for clotting events cannot rule out a risk that the background literature has flagged.

My call: the 2025 and 2026 trials move the evidence forward for creatine alone at 4 g, but 6 g plus dextrose remains untested, and the clotting risk was not studied. Confidence: low for the 6 g plus dextrose combination; moderate for 4 g creatine alone for fatigue.