Outpatient Treatment of Confirmed COVID-19 (Version 2)

Publication Date: September 18, 2023
Last Updated: September 19, 2023

Practice Points

Consider molnupiravir to treat symptomatic patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at a high risk for progressing to severe disease.
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Consider nirmatrelvir–ritonavir combination therapy to treat symptomatic patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at a high risk for progressing to severe disease.
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Practice Point 3: Consider remdesivir to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 7 days of the onset of symptoms and at high risk for progressing to severe disease.
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Practice Point 4: Do not use azithromycin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
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Practice Point 5: Do not use chloroquine or hydroxychloroquine to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
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Practice Point 6: Do not use ivermectin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
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Practice Point 7: Do not use nitazoxanide to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
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Practice Point 8: Do not use lopinavir–ritonavir combination therapy to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
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Practice Point 9: Do not use casirivimab–imdevimab combination therapy to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting unless it is considered effective against a SARS-CoV-2 variant or subvariant locally in circulation.
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Practice Point 10: Do not use regdanvimab to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting unless it is considered effective against a SARS-CoV-2 variant or subvariant locally in circulation.
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Practice Point 11: Do not use sotrovimab to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
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Practice Point 12: Do not use convalescent plasma to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
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Practice Point 13: Do not use ciclesonide to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
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Practice Point 14: Do not use fluvoxamine to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
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Recommendation Grading

Overview

Title

Outpatient Treatment of Confirmed COVID-19

Authoring Organization

American College of Physicians

Publication Month/Year

September 18, 2023

Last Updated Month/Year

April 1, 2024

Supplemental Implementation Tools

Document Type

Consensus

Country of Publication

US

Document Objectives

The SMPC developed version 1 of these living, rapid practice points to summarize the best available evidence about the use of pharmacologic and biologic treatments of COVID-19 in the outpatient setting. These practice points do not address the use of COVID-19 treatments in the inpatient setting or adjunctive treatments of COVID-19 in the outpatient setting. Table 1 and Figures 1 and 2 summarize the current evidence.

Inclusion Criteria

Male, Female, Adolescent, Older adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Treatment, Management

Diseases/Conditions (MeSH)

D000086382 - COVID-19, D000086402 - SARS-CoV-2

Keywords

outpatient, Coronavirus, covid-19, COVID, SARS-CoV-2

Source Citation

Sommer I, Ledinger D, Thaler K, Dobrescu A, Persad E, Fangmeyer M, Klerings I, Gartlehner G. Outpatient Treatment of Confirmed COVID-19: A Living, Rapid Evidence Review for the American College of Physicians (Version 2). Ann Intern Med. 2023 Sep 19. doi: 10.7326/M23-1626. Epub ahead of print. PMID: 37722115.

Qaseem A, Yost J, Miller MC, Andrews R, Jokela JA, Forciea MA, Abraham GM, Humphrey LL; Scientific Medical Policy Committee of the American College of Physicians. Outpatient Treatment of Confirmed COVID-19: Living, Rapid Practice Points From the American College of Physicians (Version 1). Ann Intern Med. 2022 Nov 29. doi: 10.7326/M22-2249. Epub ahead of print. PMID: 36442061.

Supplemental Methodology Resources

Data Supplement