• Hanna Kaduszkiewicz, Michael M Kochen, Stefan Kluge, Jakob J Malin, Stephanie Weibel, Nicole Skoetz, and guideline group.
• Institute of General Medicine, Christian Albrechts University of Kiel; Emeritus, University Medical Center Göttingen; Institute of General Medicine, Faculty of Medicine, University Medical Center Freiburg; Department of Intensive Care Medicine, Hamburg-Eppendorf University Hospital; Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne; Medical Clinic and Polyclinic for Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, University Hospital of Würzburg; Department I of Internal Medicine, Evidence-Based Oncology, Faculty of Medicine and University Hospital of Cologne, University of Cologne; *See eBox for members of the guideline group and the consensus conference (collaborators).
• Dtsch Arztebl Int. 2022 May 13; 119 (19): 342349342-349.

BackgroundOne of the purposes of outpatient treatment for COVID-19 patients is to prevent severe disease courses and hospitalization. There is a need for evidence-based recommendations to be applied in primary care and specialized outpatient settings.MethodsThis guideline was developed on the basis of publications that were retrieved by a systematic search for randomized controlled trials in the Cochrane COVID-19 trial registry. The quality of evidence was assessed with GRADE, and structured consensus generation was carried out with MAGICapp.ResultsUnvaccinated COVID-19 outpatients with at least one risk factor for a severe disease course may be treated in the early phase of the disease with sotrovimab, remdesivir, or nirmatrelvir/ritonavir. Molnupiravir may also be used for such patients if no other clinically appropriate treatment options are available. Immunosuppressed persons with COVID-19 who are at high risk, and whose response to vaccination is expected to be reduced, ought to be treated with sotrovimab. It should be noted, however, that the clinical efficacy of sotrovimab against infections with the omicron subtype BA.2 is uncertain at the currently used dose, as the drug has displayed reduced activity against this subtype in vitro. COVID-19 patients at risk of a severe course may be offered budesonide inhalation, according to an off-label recommendation of the German College of General Practitioners and Family Physicians (other medical societies do not recommend either for or against this treatment). Thrombo - embolism prophylaxis with low-molecular-weight heparin may be given to elderly patients or those with a pre-existing illness. No recommendation is made concerning fluvoxamine or colchicine. Acetylsalicylic acid, azithromycin, ivermectin, systemic steroids, and vitamin D should not be used for the outpatient treatment of COVID-19.ConclusionDrug treatment is now available for outpatients with COVID-19 in the early phase. Nearly all of the relevant trials have been conducted in unvaccinated subjects; this needs to be kept in mind in patient selection.

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