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):342-349. doi: 10.3238/arztebl.m2022.0203.
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.
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.
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 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.
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.
COVID-19 患者门诊治疗的目的之一是预防重症和住院。因此，需要在初级保健和专科门诊环境中应用基于证据的推荐意见。
本指南是基于系统检索 Cochrane COVID-19 试验注册中心的随机对照试验后得到的文献制定的。使用 GRADE 评估证据质量，并使用 MAGICapp 进行结构化共识生成。
未接种疫苗且至少存在一个重症疾病风险因素的 COVID-19 门诊患者，在疾病早期可使用索特罗维单抗、瑞德西韦或奈玛特韦/利托那韦进行治疗。如果没有其他临床适用的治疗方法，也可以使用莫努匹韦。高风险的 COVID-19 免疫抑制人群，以及预期其对疫苗的反应会降低的人群，应当使用索特罗维单抗治疗。需要注意的是，目前使用的剂量下，索特罗维单抗对奥密克戎亚谱系 BA.2 感染的临床疗效尚不确定，因为该药在体外对该亚谱系的活性降低。根据德国全科医生和家庭医生学会的一项标签外推荐意见，有发生重症风险的 COVID-19 患者可接受布地奈德吸入治疗（其他医学协会既不推荐也不反对这种治疗）。对于老年患者或有既往疾病的患者，可给予低分子肝素进行血栓栓塞预防。对于氟伏沙明或秋水仙碱，本指南不做推荐。不建议使用乙酰水杨酸、阿奇霉素、伊维菌素、全身皮质类固醇和维生素 D 进行 COVID-19 的门诊治疗。
目前对于 COVID-19 早期门诊患者可进行药物治疗。几乎所有相关试验均在未接种疫苗的人群中进行，这在患者选择时需要注意。
