From the Guidelines
Outpatient treatment is suitable for adult patients with mild to moderate COVID-19 symptoms, particularly those at high risk for progressing to severe disease, and should include consideration of antiviral medications like molnupiravir or nirmatrelvir–ritonavir combination therapy within 5 days of symptom onset. Most patients with mild to moderate COVID-19 can be managed effectively at home with supportive care including rest, adequate hydration, and over-the-counter medications for symptom relief such as acetaminophen or ibuprofen for fever and pain. According to the American College of Physicians guidelines updated in 2024 1, specific practice points for outpatient treatment of COVID-19 include:
- Considering 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.
- Considering 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. Key points to note from the guidelines 1 are the recommendations against the use of ivermectin and sotrovimab for treating patients with confirmed mild to moderate COVID-19 in the outpatient setting. Patients should self-isolate for at least 5 days from symptom onset and wear a mask for an additional 5 days when around others, and they should seek immediate medical attention if they develop severe symptoms such as difficulty breathing, persistent chest pain, confusion, or bluish lips or face. Outpatient management helps preserve hospital resources while providing appropriate care, as most COVID-19 infections resolve without requiring hospitalization.
From the Research
Outpatient Treatment for Adult Patients with Mild to Moderate Covid-19 Symptoms
Outpatient treatment for adult patients with mild to moderate Covid-19 symptoms is a viable option, according to recent studies 2, 3. The key is to identify patients who are at high risk for progressing to severe disease and provide them with appropriate treatment.
Treatment Options
Several treatment options are available for outpatient treatment of Covid-19, including:
- Molnupiravir: Considered for patients with confirmed mild to moderate Covid-19 who are within 5 to 7 days of the onset of symptoms and at high risk for progressing to severe disease 2.
- Nirmatrelvir-ritonavir combination therapy: Considered for patients with confirmed mild to moderate Covid-19 who are within 5 days of the onset of symptoms and at high risk for progressing to severe disease 2.
- Remdesivir: Considered for patients with confirmed mild to moderate Covid-19 who are within 7 days of the onset of symptoms and at high risk for progressing to severe disease 2, 3.
- Sotrovimab: May be used for unvaccinated COVID-19 outpatients with at least one risk factor for a severe disease course, although its efficacy against certain variants is uncertain 3.
Patients Who Should Not Receive Outpatient Treatment
Certain patients should not receive outpatient treatment for Covid-19, including those who:
- Are not at high risk for progressing to severe disease
- Have severe symptoms or require hospitalization
- Have certain underlying medical conditions that may worsen with Covid-19
Important Considerations
When considering outpatient treatment for Covid-19, it is essential to:
- Monitor patients closely for signs of disease progression
- Provide patients with clear instructions on when to seek medical attention
- Ensure that patients have access to necessary medical care and support
Medications to Avoid
Certain medications should be avoided in the outpatient treatment of Covid-19, including:
- Azithromycin 2, 3
- Ivermectin 2, 3
- Systemic steroids 3
- Vitamin D 3
- Chloroquine or hydroxychloroquine 2
- Lopinavir-ritonavir combination therapy 2
- Casirivimab-imdevimab combination therapy, unless effective against a locally circulating SARS-CoV-2 variant or subvariant 2
- Regdanvimab, unless effective against a locally circulating SARS-CoV-2 variant or subvariant 2
- Sotrovimab, unless effective against a locally circulating SARS-CoV-2 variant or subvariant 2
- Convalescent plasma 2
- Ciclesonide 2
- Fluvoxamine 2, 3