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India

Guidelines on Remdisivir, tocilizumab usage Revised in ICMR’s New Covid-19 Treatments

The fresh guidelines made no recommendations for Favipiravir, Ivermectine and Doxycycline.

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Covid-19 patients lying in hospital receiving Oxygen. Picture used for representational purposes only. (PTI Image)

New Delhi: The Ministry of Health and Family Welfare revise the guidelines for the treatment and management of adult Covid-19 patients on Monday. The revised guidelines issued by AIIMS, ICMR-COVID-19 National Task Force and Joint Monitoring Group (DGHS) said that it found no evidence of injectable steroids benefitting Covid-19 patients who did not require oxygen supplementation or in continuation after discharge.

The fresh guidelines made no recommendations for Favipiravir, Ivermectine and Doxycycline. It added that if the cough persists for more than two-three weeks, the patient should get tested for tuberculosis and other conditions.

Anti-inflammatory or immunomodulatory therapy, such as steroids, can have the risk of secondary infection like invasive mucormycosis, when used too early, at higher dose or for longer than required, the guidelines said.

  • The guidelines recommended injection methylprednisolone 0.5 to one mg/kg in two divided doses, or an equivalent dose of dexamethasone, can be given usually for a duration of five to 10 days in moderate cases.
  • Inhalational budesonide (given via metered dose inhaler/dry powder inhaler) at a dose of 800 mcg BD for five days can be given in mild cases if symptoms (fever and/or cough) are persistent beyond five days of disease onset.
Remdesivir

The revised guidelines continue to recommend emergency use authorization (EUA) or off-label use of Remdesivir in patients with “moderate to severe” disease and those with no renal or hepatic dysfunction within 10 days of the onset of any symptom.

Dosage: Remdisiver 200 mg IV on day 1 f/b 100 mg IV OD for the next 4 days. Monitor for RFT and LFT (Remdesivir not recommended if eGFR<30ml/min/m2; AST/ALT >5times UNL) (not an absolute contraindication)

It warned against use of the drug for patients who are not on oxygen support or in home settings.

Tocilizumab

The guidelines stated that Tocilizumab may be considered for patients with significantly raised inflammatory markers, and not improving despite use of steroids with there being no active bacterial, fungal or tubercular infection

Dosage: Single dose of Tocilizumab recommended: 4 to 6 mg/kg (400 mg in 60kg adult) in 100 ml NS over 1 hour.

Covid-19 Patient Categorisation
  • According to the guidance note, upper respiratory tract symptoms without shortness of breath or hypoxia has been categorised as mild disease and have been advised home isolation and care.” Those suffering from mild Covid should seek medical attention if they have difficulty in breathing, high grade fever, or severe cough lasting for more than five days.
  • Those having breathlessness with SpO2 fluctuating between 90-93 per cent, can get admitted to a ward, and they will be considered moderate cases. Such patients should be given oxygen support and awake proning should be encouraged in all patients requiring supplemental oxygen therapy, in sequential position changes every two hours, the guidelines stated.
  • Respiratory rate over 30 per minute, breathlessness or SpO2 lower than 90 per cent on room air should be considered as severe disease and such patients have to admitted to an ICU as they will need respiratory support, the guidelines stated.

Such patients should be put on respiratory support. Non-invasive ventilation (NIV) — helmet or face mask interface depending on availability — may be considered in those with increasing oxygen requirements if work of breathing is low.

Those aged above 60 years, or those having cardiovascular disease, hypertension and coronary artery disease diabetes mellitus and other immunocompromised states, such as HIV, active tuberculosis, chronic lung, kidney or liver disease, cerebrovascular disease or obesity are at high risk for severe disease and mortality, the guidelines stated.

(With inputs from PTI)