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. 2023 Oct;176(10):1396-1404.
doi: 10.7326/M23-1636. Epub 2023 Sep 19.

Outpatient Treatment of Confirmed COVID-19: Living, Rapid Practice Points From the American College of Physicians (Version 2)

Amir Qaseem  1 , Jennifer Yost  2 , George M Abraham  3 , Rebecca Andrews  4 , Janet A Jokela  5 , Matthew C Miller  6 , Linda L Humphrey  7 ; Population Health and Medical Science Committee of the American College of Physicians; Andrew Dunn, Ray Haeme, Rachael Lee, Sameer D Saini, Cdr 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 2)

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

Abstract

Description: Evidence for the use of outpatient treatments in adults with confirmed COVID-19 continues to evolve with new data. This is version 2 of the American College of Physicians (ACP) living, rapid practice points focusing on 22 outpatient treatments for COVID-19, specifically addressing the dominant SARS-CoV-2 Omicron variant.

Methods: The Population Health and Medical Science Committee (formerly the Scientific Medical Policy Committee) developed this version of the 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). This topic will be maintained as living and rapid by continually monitoring and assessing the impact of new evidence.

Practice point 1: 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.

Practice point 2: 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.

Practice point 3: Do not use ivermectin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.

Practice point 4: Do not use sotrovimab 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=M23-1636. All financial and intellectual disclosures of interest were declared, and potential conflicts were discussed and managed. Drs. Akl, Kansagara, Mackey, Obley, and Wilt 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 PHMSC meeting and conference call and can be viewed at www.acponline.org/about-acp/who-we-are/leadership/boards-committees-councils/population-health-and-medical-science-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.
CoE = certainty of evidence; RCT = randomized controlled trial.
Figure 2.
Figure 2.. Evidence description*.
ACP = American College of Physicians; RCT = randomized controlled trial. * Evidence search and assessment done by the ACP Center for Evidence Reviews at Cochrane Austria at the University for Continuing Education Krems (Danube University Krems) (14). A search for evidence from 26 November 2021 to 2 March 2023 aimed to identify RCTs and cohort studies evaluating select primary treatment of persons with COVID-19 in the outpatient setting. † See reference .
See this image and copyright information in PMC

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References

    1. World Health Organization. Statement on the fifteenth meeting of the IHR (2005) Emergency Committee on the COVID-19 pandemic. Accessed at www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-t... on 29 July 2023.
    1. Centers for Disease Control and Prevention. End of the federal COVID-19 public health emergency (PHE) declaration. Accessed at www.cdc.gov/coronavirus/2019-ncov/your-health/end-of-phe.html on 29 July 2023.
    1. Center for Disease Control and Prevention. Variants of the virus. Accessed at www.cdc.gov/coronavirus/2019-ncov/variants/index.html on 29 July 2023.
    1. World Health Organization. Tracking SARS-CoV-2 variants. Accessed at www.who.int/activities/tracking-SARS-CoV-2-variants on 29 July 2023.
    1. Qaseem A, Yost J, Miller MC, et al; 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. 2023;176:115-124. [PMID: ] doi:10.7326/M22-2249 - DOI - PMC - PubMed

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