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. 2023 Jan;176(1):115-124.
doi: 10.7326/M22-2249. Epub 2022 Nov 29.

Outpatient Treatment of Confirmed COVID-19: Living, Rapid Practice Points From the American College of Physicians (Version 1)

Amir Qaseem  1 , Jennifer Yost  2 , Matthew C Miller  3 , Rebecca Andrews  4 , Janet A Jokela  5 , Mary Ann Forciea  3 , George M Abraham  6 , Linda L Humphrey  7 ; Scientific Medical Policy Committee of the American College of Physicians; Rachael A Lee, Mark P Tschanz, Itziar Etxeandia-Ikobaltzeta, Curtis Harrod, Tatyana Shamliyan, Karla Umana
Collaborators, Affiliations

Outpatient Treatment of Confirmed COVID-19: Living, Rapid Practice Points From the American College of Physicians (Version 1)

Amir Qaseem et al. Ann Intern Med. 2023 Jan.

Erratum in

Update in

Abstract

Description: Strategies to manage COVID-19 in the outpatient setting continue to evolve as new data emerge on SARS-CoV-2 variants and the availability of newer treatments. The Scientific Medical Policy Committee (SMPC) of the American College of Physicians (ACP) developed these living, rapid practice points to summarize the best available evidence on the treatment of adults with confirmed COVID-19 in an outpatient setting. These practice points do not evaluate COVID-19 treatments in the inpatient setting or adjunctive COVID-19 treatments in the outpatient setting.

Methods: The SMPC developed these living, rapid practice points on the basis of a living, rapid review done by the ACP Center for Evidence Reviews at Cochrane Austria at the University for Continuing Education Krems (Danube University Krems). The SMPC will maintain these practice points as living by monitoring and assessing the impact of new evidence.

Practice point 1: Consider molnupiravir to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 to 7 days of the onset of symptoms and at high risk for progressing to severe disease.

Practice point 2: Consider nirmatrelvir-ritonavir combination therapy to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at high risk for progressing to severe disease.

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.

Practice point 4: Do not use azithromycin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.

Practice point 5: Do not use chloroquine or hydroxychloroquine to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.

Practice point 6: Do not use ivermectin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.

Practice point 7: Do not use nitazoxanide to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.

Practice point 8: Do not use lopinavir-ritonavir combination therapy to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.

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.

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.

Practice point 11: Do not use sotrovimab 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.

Practice point 12: Do not use convalescent plasma to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.

Practice point 13: Do not use ciclesonide to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.

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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Conflict of interest statement

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-2249. All financial and intellectual disclosures of interest were declared, and potential conflicts were discussed and managed. Drs. Akl, Dunn, Kansagara, Marcucci, and Obley were recused from authorship and voting due to moderate-level conflicts of interest (recently authored relevant publications). A record of disclosures of interest and management of conflicts is kept for each SMPC meeting and conference call and can be viewed at www.acponline.org/about-acp/who-we-are/leadership/boards-committees-councils/scientific-medical-policy-committee/disclosure-of-interests-and-conflict-of-interest-management-summary-for-scientific-medical-policy.

Figures

Figure 1.
Figure 1.. Evidence summary for treatment of confirmed COVID-19 in outpatient settings.
* Total baseline sample sizes are reported. Analytic sample sizes might vary by outcome. CoE = certainty of evidence; RCT = randomized controlled trial.
Figure 2.
Figure 2.. Evidence description.
Evidence search and assessment conducted by ACP Center for Evidence Reviews at Cochrane Austria at the University for Continuing Education Krems (Danube University Krems) (31). An updated search for evidence through 4 April 2022 aimed to identify placebo RCTs evaluating selected primary treatment of persons with COVID-19 in the outpatient setting. RCT = randomized controlled trial. * See reference 30.
See this image and copyright information in PMC

Comment in

  • Outpatient Treatment of Confirmed COVID-19.
    Sullivan DJ, Franchini M, Senefeld JW, Joyner MJ, Casadevall A, Focosi D. Sullivan DJ, et al. Ann Intern Med. 2023 May;176(5):eL230099. doi: 10.7326/L23-0099. Epub 2023 Apr 18. Ann Intern Med. 2023. PMID: 37068278 No abstract available.

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