ACP Issues Practice Points on Treating COVID-19 Patients in Outpatient Settings

In a new Rapid and Living Practice Points, the American College of Physicians (ACP) summarizes the best available evidence about the use of pharmacologic and biologic treatments of COVID-19 in the outpatient setting. Outpatient Treatment of Confirmed Mild or Moderate COVID-19: Living and Rapid Practice Points from the American College of Physicians (Version 1), is published in Annals of Internal Medicine.

The ACP’s Practice Points focus on patients who can be managed in outpatient settings. Treatments evaluated include antibiotics, antiparasitic agents, antivirals, convalescent plasma, corticosteroids, fluvoxamine and monoclonal antibodies. In the Practice Points, ACP suggests that clinicians consider using the following antiviral treatments in patients with confirmed mild to moderate COVID-19 who are at a high risk for progressing to severe disease:

  • Molnupiravir within 5 to 7 days of the onset of symptoms
  • Nirmatrelvir-ritonavir combination therapy within 5 days of onset of symptoms
  • Remdesivir within 7 days of the onset of symptoms

ACP suggests against the use of certain monoclonal antibodies (casirivimab-imdevimab combination therapy, regdanvimab, sotrovimab) unless it is considered effective against a SARS-CoV-2 variant or subvariant locally in circulation. Finally, ACP suggests against the use of the other reviewed treatments: azithromycin, chloroquine or hydroxychloroquine, convalescent plasma, ciclesonide, fluvoxamine, ivermectin, nitazoxanide, lopinavir-ritonavir combination therapy, or sotrovimab.

The Practice Points note that the informed decision to initiate treatment for COVID-19 in the outpatient setting should be personalized and based on clinical judgment and an informed decision-making approach with the patient on potential treatment benefits, harms, patient level-factors (e.g. risk factors, comorbid conditions, disease severity), and patient preferences.

Source: American College of Physicians (ACP)