Outpatient Treatment of Confirmed COVID-19 in Symptomatic Adults: A Clinical Update Based on American College of Physicians Practice Points (Version 3, published online in February 2026)
Keywords:
COVID-19, outpatient treatment, antiviral therapy, nirmatrelvir-ritonavir, molnupiravir, American College of PhysiciansAbstract
Background: Outpatient management of coronavirus disease 2019 (COVID-19) focuses on preventing progression to severe illness in high-risk individuals. The American College of Physicians (ACP) provides living, rapid practice points to guide antiviral use in symptomatic adults.
Objective: To summarize the 2026 ACP Practice Points (Version 3) for outpatient treatment of confirmed mild-to-moderate COVID-19.
Methods: This clinical update is based on ACP practice points and the accompanying living rapid review, incorporating evidence from randomized controlled trials and observational studies conducted during the SARS-CoV-2 Omicron variant period.
Results: ACP suggests considering nirmatrelvir–ritonavir and molnupiravir in symptomatic adults with mild-to-moderate COVID-19 who are within 5 days of symptom onset and at high risk for progression. Nirmatrelvir–ritonavir may improve recovery and reduce time to recovery, with cumulative evidence supporting reductions in hospitalization and mortality. Molnupiravir probably improves recovery and reduces persistent symptoms but likely does not reduce hospital admissions. ACP recommends against the use of ivermectin and sotrovimab.
Conclusion: Current ACP guidance supports selective use of oral antivirals in high-risk outpatients with early COVID-19. Clinical decision-making should be individualized, with attention to drug-drug interactions and patient-specific risk factors.
J Bangladesh Coll Phys Surg 2026; 44: 207-209
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