Abstract
Background: Coronavirus Disease 2019 (COVID-19) has become a significant public health crisis and one of leading causes of death internationally. Although, most infected people develop smooth symptoms and are treated ambulatory, only few studies focus on outpatient care. Thus, there is crucial need of recommendations for therapeutic strategies in outpatient care. Aim of this study was to focus on relevant aspects regarding outpatient care in General Practice.
Methods: An open search for pertinent publications was conducted through PUBMED search using keywords like “medical treatment”, “therapeutic strategies”, “COVID-19”, “SARS-CoV-2”, “ambulatory“, “outpatient“, and with their corresponding MeSH terms, if any, connected by OR and AND. Snowball technique was used to gather further relevant papers from the reference lists of the initial search result articles. Most important results regarding COVID-19 ambulatory care are presented for daily use in General Practice.
Results: Antiviral drugs cannot yet be generally recommended for regular use in outpatient care as no significant benefit was seen so far. For immunomodulatory drugs convincing data is missing supporting its efficacy and safety for COVID-19 management. Dexamethasone, budesonide turbohaler, methylprednisolone and prednisone should be regarded for outpatient treatment. Use of low-molecular weight heparin is beneficial to reduce risk of thrombosis. Several adjuvant therapeutics as tramadol, statins, thiamine, and ascorbic acid can be considered as supportive. Different natural products show promising effects, but much more investigation is necessary to give final advise. Preventive effects of zinc and vitamin D are still under discussion, no strong recommendation can be given so far. Most important, supportive care including supplemental oxygen, monitoring, and telemedicine should be available.
Conclusion: Recommendations for daily ambulatory routine include a multi-pronged therapeutic approach in COVID-19 outpatient care. Most important strategies in therapy involve symptomatic supportive treatment along with anti-inflammatory therapies including corticosteroids. Prohibition of severe COVID-19 cases requires early identification and acceleration of vaccination process.
Keywords
SARS-CoV-2, COVID-19, Outpatient, Ambulatory, Treatment, Immunomodulation