• Amir Qaseem, Jennifer Yost, Matthew C Miller, Rebecca Andrews, Janet A Jokela, Mary Ann Forciea, George M Abraham, Linda L Humphrey, Scientific Medical Policy Committee of the American College of Physicians, Rachael A Lee, Mark P Tschanz, Itziar Etxeandia-Ikobaltzeta, Curtis Harrod, Tatyana Shamliyan, and Karla Umana.
• American College of Physicians, Philadelphia, Pennsylvania (A.Q.).
• Ann. Intern. Med. 2023 Jan 1; 176 (1): 115124115-124.

DescriptionStrategies 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.MethodsThe 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 1Consider 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 2Consider 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 3Consider 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 4Do not use azithromycin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.Practice Point 5Do not use chloroquine or hydroxychloroquine to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.Practice Point 6Do not use ivermectin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.Practice Point 7Do not use nitazoxanide to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.Practice Point 8Do not use lopinavir-ritonavir combination therapy to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.Practice Point 9Do 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 10Do 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 11Do 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 12Do not use convalescent plasma to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.Practice Point 13Do not use ciclesonide to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.Practice Point 14Do not use fluvoxamine to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.

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