- According to the government’s revised guidelines, doctors should avoid prescribing steroids.
- Ivermectin, favipiravir, and Doxycycline were not recommended in the most recent guidelines.
- The guidelines also exclude antivirals such as molnupiravir and monoclonal antibodies.
Doctors should avoid prescribing steroids to COVID-19 patients, according to the government’s new clinical guidelines for coronavirus treatment, released only days after the task force’s chief expressed concern over the drug’s usage during the second wave.
According to the revised guidelines, medications such as steroids might raise the risk of a secondary infection such as invasive mucormycosis or ‘black fungus’ when administered too early, at a higher dose, or for a longer period of time than needed.
The guidelines stated that if a cough persists for more than two to three weeks, patients should be checked for TB and other illnesses. They also specified the doses for the medications if necessary for three types of infections – “mild, moderate, and severe.”
Dr V K Paul, NITI Aayog Member (Health) and Chief of the Covid Task Force, highlighted worries about the “overuse and misuse” of medications like steroids at a news conference last week.
Upper respiratory tract symptoms without shortness of breath or hypoxia have been classified as a moderate illness, and home isolation and care have been suggested.
Mild Covid patients should get medical assistance if they have trouble breathing, a high temperature, or a severe cough that lasts more than five days.
Those who have shortness of breath and fluctuating oxygen saturation of 90-93 percent can be hospitalized as moderate cases. Such patients should be provided oxygen support.
Respiratory rate higher than 30 per minute, breathlessness, or oxygen saturation less than 90% on room air should be considered a serious illness, according to the statement, and such patients should be sent to an ICU since they would require respiratory support.
Such patients should be placed on ventilators. If the work of breathing is low, non-invasive ventilation (NIV) – helmet or face mask interface depending on availability – may be considered in people with increasing oxygen needs.
The new guidelines continue to advise patients with “moderate to severe” illness and no renal or hepatic dysfunction to seek emergency use authorization (EUA) or off-label use of remdesivir within 10 days of the onset of any symptom.
It cautioned against using the medicine on patients who are not on oxygen support or who are in an in-home setting.
EUA or off-label use of the tocilizumab medicine may also be explored in the case of severe disease, ideally within 24 to 48 hours after the onset of severe disease or ICU admission, according to the guidelines.
Tocilizumab may be considered for patients with considerably increased inflammatory markers who are not improving despite the administration of steroids and have no active bacterial, fungal, or tubercular infection, experts said.
The guidelines state that those over the age of 60, as well as those with cardiovascular disease, hypertension and coronary artery disease, diabetes mellitus, and other immunocompromised states such as HIV, chronic lung, kidney, active tuberculosis, or liver disease, obesity, or cerebrovascular disease, are at high risk for severe disease and mortality.