Universität zu Köln

Kaduszkiewicz, Hanna, Kochen, Michael M., Kluge, Stefan, Malin, Jakob J. ORCID: 0000-0002-2989-0436, Weibel, Stephanie and Skoetz, Nicole (2022). Recommendations for the Outpatient Drug Treatment of Patients With COVID-19. Dtsch. Arztebl. Int., 119 (19). COLOGNE: DEUTSCHER AERZTE-VERLAG GMBH. ISSN 1866-0452

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Abstract

Background: One 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.Methods: This 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.Results: Unvaccinated 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 Practi-tioners 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.Conclusion: Drug 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. Cite this as: Kaduszkiewicz H, Kochen MM, Kluge S, Malin JJ, Weibel S, Skoetz N, on behalf of the guideline group:Clinical practice guideline: Recommendations for the outpatient drug treatment of patients with COVID-19.Dtsch Arztebl Int 2022; 119: 342-9. DOI: 10.3238/arztebl.m2022.0203

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kaduszkiewicz, Hanna UNSPECIFIED UNSPECIFIED UNSPECIFIED Kochen, Michael M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kluge, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Malin, Jakob J. UNSPECIFIED orcid.org/0000-0002-2989-0436 UNSPECIFIED Weibel, Stephanie UNSPECIFIED UNSPECIFIED UNSPECIFIED Skoetz, Nicole UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-684387
DOI:	10.3238/arztebl.m2022.0203
Journal or Publication Title:	Dtsch. Arztebl. Int.
Volume:	119
Number:	19
Date:	2022
Publisher:	DEUTSCHER AERZTE-VERLAG GMBH
Place of Publication:	COLOGNE
ISSN:	1866-0452
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language OPEN-LABEL Multiple languages Medicine, General & Internal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/68438