Recommendations for the primary care management of post COVID and post acute infectious syndrome: a comparative analysis of international guidelines

The medical care of people with post COVID syndrome (PCS) and other post-acute infectious syndromes (PAIS) remains a major challenge as dedicated care structures are scarce, diagnostic evaluation is often complex, and curative therapies are largely lacking. General practitioners play an essential role in initial assessment and the coordination of care and treatment. However, standardized and evidence-based recommendations specifically tailored to primary care are scarce. This study aimed to analyze and compare diagnostic and therapeutic recommendations for primary care of PCS from international guidelines. Six guidelines and recommendations were included, originating from Germany, Switzerland, the United Kingdom, the United States, the WHO, and a European scientific society. The analysis revealed considerable variation in scope, level of detail and practical applicability. Most guidelines recommend symptom-based or exclusionary diagnostic approaches. Non-pharmacological interventions such as rehabilitation, self-management and psychological support are commonly addressed. In contrast, pharmacological options are rarely specified due to limited evidence. While the importance of general practitioners is acknowledged across documents, specific support structures and implementation strategies vary. To date, structured care recommendations for patients with Long COVID and other PAIS in primary care remain limited.