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

PHILADELPHIA, November 29, 2022 – 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), was published today 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, or lopinavir-ritonavir combination therapy.

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 characteristics (e.g. risk factors, comorbid conditions, disease severity), and patient preferences.

“Management of COVID-19 in the outpatient setting continues to evolve as new data emerges on SARS-CoV-2 variants and the availability of newer treatments,” said Ryan D. Mire, MD, MACP, President, ACP. “These Living Practice Points will be a valuable clinical resource for physicians and the rest of the health care community in treating patients in the outpatient setting, as most COVID-19 cases are now managed as outpatients.”

These Practice Points are based on a systematic review conducted by the ACP Center for Evidence Reviews at Cochrane Austria/University for Continuing Education Krems (Danube University Krems).

ACP’s Practice Points are developed by ACP’s Scientific Medical Policy Committee and provide advice to improve the health of individuals and populations and promote high value care based on the best available evidence derived from assessment of scientific work (e.g. clinical guidelines, systematic reviews, individual studies). ACP Practice Points aim to address the value of screening and diagnostic tests and therapeutic interventions for various diseases, and consider known determinants of health, including but not limited to genetic variability, environment, and lifestyle. ACP’s Scientific Medical Policy Committee will maintain these practice points as living by monitoring and assessing the impact of new evidence and updating them as needed.


About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 160,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter, Facebook and Instagram.

ACP Media Contact: Andrew Hachadorian, (215) 351-2514,